Flashcards
Tubulointerstitial Disease
Flashcards do conjunto (63)
- 1What is the most common cause of acute renal failure?Acute Tubular Injury/ Necrosis
- 2In Acute Tubular Injury/ Necrosis the tubules are sensative to injury due to what?High metabolic rate
- 3What is the prognosis of Acute Tubular Injury/ Necrosis?Good prognosis if not extensive systemic damage from the precipitating cause. Need to manage water balance, electrolytes. May need temporary dialysis
- 4What is Acute Tubular Injury/Necrosis?Acute diminution of renal function, usually with morphologic evidence of tubular injury
- 5What is Acute Tubular Injury/ Necrosis usually due to?Usually due to tubular damage from ischemia or toxins
- 6What are examples of Ischemia Causes of Acute Tubular Necrosis?Massive hemorrhage
Septic shock
Severe burns
Dehydration
Prolonged diarrhea
Congestive heart failure
Volume redistribution (e.g., pancreatitis, peritonitis) - 7What are examples of Nephrotoxin Causes of Acute Tubular Necrosis?Antibiotics (e.g., aminoglycosides, amphotericin B)
Radiographic contrast agents
Heavy metals (e.g., mercury, lead, cisplatin)
Organic solvents (e.g., ethylene glycol, carbon tetrachloride)
Poisons (e.g., paraquat)
Myoglobin (from rhabdomyolysis, e.g., with crush injury)
Hemoglobin (from hemolysis, e.g., with transfusion reaction) - 8—Pathogenesis of Acute Tubular Injury
/Necrosis - 9Describe the Biopsy of Ischemic ATI– Segmental injury of tubular epithelium
– Necrosis: Patchy segments of cells in proximal tubule and
Loop of Henle
• Necrotic cells within tubular lumen
• Tubules are lined by regenerating epithelium (healing)
– Tubulorrhexis: Basement membrane rupture
– Inflammatory infiltration of interstitium - 10Describe the Biopsy of Toxic ATI– Extensive cell injury and necrosis of epithelium of proximal
convoluted tubules and Loop of Henle - 11True or False In Toxic ATN there is a pale, swollen cortex.False
Pale, swollen Cortex in Ischemia
In contrast
Toxic ATN Swollen and Red cortex - 12True or False Ischemic Tubular Necrosis Necrosis is focal. May see only intraluminal debris and regenerative changes in tubulesTrue
Note: Toxic TN - Extensive necrosis
of proximal tubules - 13What are the clinical phases of Acute Tubular Injury?• Initiation phase (36 hr): dominated by
precipitating event (trauma etc)
• Maintenance phase(several days): oliguria , salt and water overload, hyperkalemia, uremia
• Recovery phase (days to months): polyuria, large amounts of water and electrolytes lost in urine, hypokalemia, BUN and creatinine levels improve
• Up to 50% do not go through oliguric stage and may only have increased urine volumes - 14With Urinary Tract Obstruction (Obstructive Uropathy) there is increased risk of what?• Increased risk of infection
• Increased risk of stone formation
• Can result in permanent renal atrophy
(Hydronephrosis) - 15What is Hydronephrosis?Hydronephrosis = dilatation of renal pelvis and calyces with renal atrophy from urinary obstruction
- 16What is the pathogenesis of Obstructive Uropathy and Hydronephrosis– Obstruction: uni- or bilateral, usually partial
– Pelvis and calyceal system are dilated due to back pressure
– Initially the trapped filtrate is reabsorbed by lymphatics and vascular route
– Continued obstruction ultimately reduces glomerular blood flow and GFR
– Prolonged back pressure leads to Hydronephrosis - 17—Hydronephrosis
- 18What does Reflux Nephropathy present as?Reflux nephropathy presents as recurrent
urinary tract infections - 19How is Reflux Nephropathy diagnosed?It is diagnosed by a voiding cystogram which shows retrograde flow of urine from bladder to ureter
- 20What is Pyelonephritis?Infection of Kidney (pyelo = renal pelvis,
nephro = renal parenchyma,
itis = inflammation) - 21What is Acute Pyelonephritis usually due to?Acute pyelonephritis usually due to bacterial infection
- 22What is Chronic Pyelonephritis usually due to?Chronic pyelonephritis usually due to bacterial infection associated with vesicoureteral reflux or obstruction
- 23What are the routes of infection in Pyelonephritis?• Ascending infection (most common)
• Hematogenous - 24Describe Ascending Infection in Pyelonephritis• Usually from colonization of distal urethra by intestinal bacteria
• Ascends to bladder, ureters and kidney - 25What are predisposing factors for Ascending Infection in Pyelonephritis?Predisposing factors: females (shorter
urethra), urine stasis in bladder
(obstruction),instrumentation (foley catheter), vesicoureteral reflux (1.5% of children), intrarenal reflux (renal papillae flat instead of pointed) - 26What are predisposing factors for Acute Pyelonephritis?Obstruction
Diabetes
Vesico-ureteral reflux - 27What is the Etiology of Ascending infections in Acute Pyelonephritis?Ascending infection (UTI): own fecal flora (gramnegative bacilli): E.coli, Proteus, Enterobacter, Klebsiella, and Serratia
- 28What is the Etiology of Descending (hematogenous infection) in Acute Pyelonephritis?– Descending (hematogenous infection): grampositive pyogenic bacteria e.g. Infective endocarditis (minority of cases)
– Others causes including fungi and viruses possible, especially with immunosuppression - 29What are the signs and symptoms of Acute Pyelonephritis?– Flank pain, spiking fever, chills, malaise, nausea and vomiting
– Dysuria, frequency, and urgency
– Costo-vertebral angle tenderness - 30Describe the UA for Acute Pyelonephritis.Urinalysis: pyuria (WBC clumps), WBC casts,
epithelial casts, bacteruria, and hematuria - 31What is the morphology of Acute Pyelonephritis?• Grossly: Enlarged and swollen kidneys with small abscesses
– Uni- or bilateral
• Histology: Acute inflammation
– Neutrophilic infiltration of the tubules and interstitium. Neutrophils inside tubular lumen leads to WBC casts on Urinalysis - 32—Acute Pyelonephritis
- 33What are complications of Acute Pyelonephritis?• Papillary necrosis
– Histology: coagulative necrosis
• Pyonephrosis
– Accumulation of pus in renal pelvis and calyces
• Perinephric abscess
– When abscess breaches the renal capsule
• Pyelonephritic scar (after healing) - 34What is the definition of Papillary Necrosis?Necrosis of one or more renal papillae
- 35What is Papillary Necrosis usually seen in?– Obstruction + pyelonephritis
– Diabetes + pyelonephritis
– Analgesic nephropathy - 36What is Chronic Pyelonephritis (PN)?Chronic tubulointerstitial inflammation with scarring of the renal parenchyma, calyces, and pelvis
- 37What is the Etiology and Classification of Chronic Pyelonephritis (PN)?1. Reflux Nephropathy
UTI + VUR leads to chronic reflux-associated PN
2. Chronic Obstructive Pyelonephritis
UTI + obstruction leads to chronic obstructive PN - 38What is the morphology of Chronic Pyelonephritis?• Gross: irregular scarring: broad depressed areas of cortical fibrosis overlying a dilated, blunted or deformed calyx. Papilla flattened
• Histology
– Interstitial fibrosis and mononuclear infiltration
– “Thyroidization”: dilated tubules with hyaline casts
– Glomeruli spared initially, may become sclerotic - 39What are the causes of Chronic Pyelonephritis?Vesiculoureteral Reflux
Obstruction in Urinary Tract - 40What is Xanthogranulomatous Pyelonephritis?• Unusual special form of chronic
pyelonephritis
• Often associated with obstruction and
proteus infection
• Can simulate renal cell carcinoma grossly
(yellow nodules) and histologically (many
clear cells due to foamy macrophages) - 41What is the clinical presentation of Chronic Pyelonephritis? Include UA and Radiology.• Gradual insidious onset, or can begin as acute PN
• Renal insufficiency / Hypertension (can be an initial sign)
• Slowly progressive renal failure
• Urinalysis
– Pyuria (WBCs)
– Polyuria and nocturia (decreased tubular function)
– Epithelial, granular, and occasional WBC casts – +/- Bacteriuria
• Radiology
– Asymmetrically scarred kidneys
– Blunting and deformity of calyceal system - 42What is Acute Drug Induced Interstitial Nephritis?• Hypersensitivity reaction
• Begins about 15 days after drug exposure
• Fever, eosinophilia (may be transient), rash (25%), and renal abnormalities (azotemia to acute renal failure)
• Most common with antibiotics, diuretics and NSAIDS
• Treatment: WITHDRAW DRUG - 43What is the treatment for Acute Drug Induced Interstitial Nephritis?Treatment: WITHDRAW DRUG
- 44What is Acute Drug Induced Interstitial Nephritis most common with?Most common with antibiotics, diuretics and NSAIDS
- 45What does Acute Drug Induced Interstitial Nephritis look like?• Begins about 15 days after drug exposure
• Fever, eosinophilia (may be transient), rash (25%), and renal abnormalities (azotemia to acute renal failure) - 46What is the morphology of Acute Interstitial Nephritis?• Interstitial inflammation by mononuclear cells (lymphocytes and macrophages)
• Eosinophils and neutrophils may be prominent (eosinophils classic and helpful)
• May have granulomas
• Infiltrate commonly may extend into tubules (tubulitis)
• Urinalysis may show eosinophils / eosinophil casts - 47What is Analgesic Nephropathy?• Chronic renal disease from excessive intake of analgesics with tubulointerstitial nephritis and papillary necrosis
• Usually from mixtures with phenacetin
• Can be induced experimentally with high doses of phenacetin + aspirin + water depletion
• Papillary necrosis occurs first with impeded urine outflow causing interstitial nephritis
• In some areas with high incidence of analgesic abuse (Australia, Europe), this is a major cause of renal failure - 48What is Urate Nephropathy?• Acute uric acid nephropathy
• Chronic uric acid nephropathy
• Nephrolithiasis (Uric acid stones –
discussed in urolithiasis lecture) - 49What is Acute Uric Acid Nephropathy?Precipitation of uric acid crystals in
tubules/collecting ducts leads to obstruction of nephrons with acute renal failure - 50What patients is Acute Uric Acid Nephropathy most common in?Most common in patients receiving
chemotherapy for lymphoma/leukemia
(hyperuricemia from increased cell break down) - 51What is the preventative measure for Acute Uric Acid Nephropathy?• Preventive measure: Increase fluids and raise PH of urine
- 52What is Chronic Urate Nephropathy?• Uric acid crystals in tubules/collecting
ducts/interstitium from chronic hyperuricemia (gout)
• Obstruction causes cortical atrophy and scarring
• Subtle slow disease
• Often in patients with gout + lead exposure (such as “moonshine” whiskey) - 53What are renal diseases Associated with Multiple Myeloma (Myeloma Kidney)?• Light Chain Nephropathy:
Light chains (Bence Jones
Proteins) combine with urinary
glycoprotein to form casts
obstructing tubules
• Amyloidosis (in glomeruli)
• Light Chain Deposition
Disease: Light chains
deposited in glomeruli causing
glomerulopathy or tubular
basement membranes causing
a tubulinterstitial nephritis
• Hypercalcemia/hyperuricemia
causing stones etc - 54—Analgesic Nephropathy
Papillary Necrosis and Calcification
- 55—Eosinophiluria and Eosinophil Casts
- 56—Xanthogranulomatous Pyelonephritis
- 57—Chronic Pyelonephritis
- 58—Renal Scars, Dilated Blunted Calyces in
Chronic Pyelonephritis
- 59—Papillary Necrosis
- 60—Reflux Nephropathy
- 61—Urinary Tract Obstruction
- 62—Acute Tubular Necrosis
Intratubular cast formation (black arrow)
Sloughing of cells is responsible for the formation of the so
called dirty granular casts (red arrow)
- 63—
Informações
- Descrição
- FINAL FlashCards sobre Tubulointerstitial Disease, criado por Victoria Wright em 06-04-2017.
- Criado por
- Victoria Wright · abr 2017
- Atualizado
- 6 abr 2018
- Visualizações
- 2
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