Term
| What are the components of the renal system that are typically involved in tubulointerstitial diseases? |
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Definition
1) tubules
2) interstitium
3) pelvocalyceal system |
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Term
| What are the two major categories of tubulointertstitial disease? |
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Definition
1) acute tubular necrosis (ischemia and toxins)
2) tubulointerstitial nephritis (inflammation) |
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Term
| What are the major categories of causes of acute kidney injury? |
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Definition
1) perfusion-related
2) intrinsic
3) obstructive |
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Term
| What are the two major patterns of ATN? |
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Definition
1) ischemic ATN
2) toxic ATN |
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Term
| Describe the pathogenesis of ATN (both ischemic and toxic) |
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Definition
- ischemic: vasoconstriction (dec. GFR) w/ epithelial dmg
- Toxic: direct epithelial damage
- dmgd cells undergo necrosis and detachment
- casts: raise intratubular pressure (dec GFR)
- dmgd tubules leak fluid
- edematous interstitium
- inflammatory cells |
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Term
| Describe the necrosis seen in ATN w/ ischemic damage, toxic damage. What regions of the tubule are first to be affected? |
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Definition
1) ischemic dmg: patchy necrosis
2) toxic dmg: long segments
3) proximal tubule and loop of Henle |
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Term
| Describe the morphology of the affected tubules with ATN |
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Definition
- dilated
- patchy loss vs. epithelial cell flattening
- granular casts
- interstitial edema
- regenerative changes
- specific toxin fingerprint (ethylene glycol w/ Ca oxalate) |
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Term
| What are the components to granular casts? |
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Definition
- necrotic cells
- plasma proteins
- Tamm-Horsfall protein |
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Term
| What are the three phases of ATN? What does each involve? |
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Definition
1) initiaion: precipitating event
2) Maintenance: kidney failure - oliguria, elevated BUN, metabolic acidosis, hyperkalemia
3) Recovery: inc. UVol, return of normal fxn |
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Term
| What types of characteristics are found with tubulointerstitial nephritis? |
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Definition
| 1) injury to the tubules and inflammatory infiltrates in the interstitium |
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Term
| What are the major etiologies of tubulointerstitial nephritis? |
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Definition
1) infections
2) toxins
3) metabolic diseases
4) neoplasms (of course...cancer)
5) physical factors
6) immunologic feactions
7) vascular disease
8) hereditatry |
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Term
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Definition
- inflammation of the pelvis, calyces, tubules, and interstitium
- may be acute or chronic |
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Term
| Describe Acute Pyelonephritis |
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Definition
1) E.coli (most common), Proteus, Klebsiella, enterobacter, strep fecalis
2) ascending infection w/ sequential steps
3) typically predisposing factors present
4) yellow nodules w/ ring of red hyperemia
5) triad of Sx: CVA tenderness, fever, urinary sx
6) fibrous scarring w/ horseshoe depression |
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Term
| Describe the sequential steps for the pathogenesis of acute pyelonephritis |
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Definition
1) colonization of urethra
2) extension to the bladder
3) multiplication of bacteria in the bladder
4) vesicoureteric reflux
5) intrarenal reflux
6) bacterial reach renal parenchyma, inflammation response |
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Term
| What are major predisposing factors associated with acute pyelonephritis? |
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Definition
1) instrumentation
2) urinary obstruction and reflux
3) pregnancy
4) patient's gender (F:M::10:1)
5) diabetes
6) immunodeficiency/immunosuppression
7) pre-existing lesions such as scars or congenital abnormalities of the tract |
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Term
| Describe the associated pathology of acute pyelonephritis |
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Definition
1) multiple subcapsular abscesses
2) yellow nodules w/ ring or red hyperemia
2) neutrophilic infiltrate
3) polyoma virus |
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Term
| What are clinical features associated with acute pyelonephritis? |
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Definition
1) Hx of cystitis
2) predisposing factor present
3) Triad of Sx: CVA tenderness; fever; urinary Sx (dysuria, pyuria, leukocyte casts) |
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Term
| What ist he significance of leukocyte casts in urine? |
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Definition
| 1) indicates that the inflammatory process is in the kidney, not the bladder |
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Term
| What are the major complications of acute pyelonephritis? |
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Definition
1) perinephric abscess
2) pyonephrosis
3) papillary necrosis |
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Term
| Define: chronic pyelonephritis |
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Definition
| - chronic tubulointerstitial inflammation with renal scarring AND deformation of the pelvocalyceal system |
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Term
| Describe teh pathogenesis of chronic pyelonephritis |
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Definition
- recurrent and persistent bacterial infections
- predisposing factors of obstruction and vesicoureteric reflux (more common) |
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Term
| What are the major causes of obstructive uropathy in adults? Children? |
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Definition
1) adults: prostatic hyperplasia; urinary calculi; malignancy; pregnancy
2) posterior urethral valves in boys; ureterocele; meatal strictures; ureteropelvic jxn stenosis/atresia |
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Term
| Describe the pathology associated with obstructive type chronic pyelonephritis |
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Definition
- calyces are dilated and distorted
- atrophic tubules
- eosinophilic casts ("thyroidization")
- spared glomeruli
- coarse corticomedullary scar over a dilated calyx (focal and irregular)
- yellow nodules (proteus infections) |
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Term
| What are clinical features of chronic pyelonephritis? |
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Definition
1) insidious onset
- associated HTN in children
- polyuria
- nocturia
- pyuria and bacteriuria if persisting bacterial infection |
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Term
| What is the pathogenesis of allergic interstitial nephritis (AIN)? |
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Definition
1) various drugs: NSAIDS, antibiotics (sulfonamides)
2) Type IV hypersensitivity; Type I hypersensitivity |
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Term
| Describe the pathology associated with allergic interstitial nephritis (AIN) |
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Definition
- interstitial infiltrate (lymphocytes, macrophages, eosinophils***)
- granulomas
- tubules inflammatory infiltrates |
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Term
| What is allergic interstitial nephritis? |
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Definition
| 1) hypersensitivity reaction to certain drugs and toxic agents involving kidney interstitium |
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Term
| What are clinical features associated with allergic interstitial nephritis (AIN) |
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Definition
1) history of exposure
2) physical sx: fever; rash
3) peripheral blood eosinophilia
4) urine analysis: blood, low proteinuria, leukocytes, eosinophils
5) reversible if drug is withdrawn |
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Term
| What is analgesic nephropathy? |
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Definition
| 1) chronic tubulointrstitial nephritis and/or papillary necrosis secondary to analgesic drug usage |
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Term
| Describe the pathogenesis associated with analgesic nephropathy |
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Definition
1) phenacetin directly or in combination medications
2) acetaminophen (phenacetin metabolite) injures cells by covalent bonding and oxidation esp in papillae |
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Term
| Describe the pathology seen with analgesic nephropathy |
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Definition
1) papillary necrosis
2) structureless and often calcified mass |
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Term
| Descirbe the clinical features associated with analgesic nephropathy |
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Definition
- uncommon in USA
- urine concentration deficit
- metabolic acidosis
- chronic renal failure
- hematuria
- renal colic
- transiional cell carcinoma of the renal pelvis |
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Term
| Describe urate nephropathy (acute and chronic) |
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Definition
1) acute: rapid metabolism of DNA to uric acid; urate crystals lead to obstruction and AKI
2) chronic: chronic gout; foreign body giant cell rxn; interstitial fibrosis |
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Term
| Describe hypercalcemia and tubulointerstitial disease |
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Definition
1) caused by hperparathyroidism, metastatic tumors in bode, myeloma, increased calcium intake or absorption
2) calcium deposits (nephrocalcinosis)
- atubular atrophy; interstitial fibrosis |
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Term
| How is the kidney affected by multiple myeloma |
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Definition
- proteinuria: Bence-Jones proteins, casts, foreign body giant cells
- light-chain nephropathy: kappa deposition
- amyloidosis: lambda deposition
- hypercalcemia
- hyperuricemia |
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Term
| Describe renal tuberculosis |
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Definition
- part of systemic dissemination
- kidney is most frequently involved organ after lung
- interstitial necrotizing granulomas in miliary distribution |
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Term
| Describe renal sarcoidosis |
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Definition
1) multpile non-necrotizing granulomas
2) inflammation
3) diagnosis of exclusion after TB and other granulomatous conditions |
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Term
| What are the major sources of kidney complications in kidney transplantation |
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Definition
1) rejection
2) drug toxicity
3) infections
4) post-transpland lymphoproliferative d/o
5) glomerulonephritis |
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Term
| Describe acute cellular rejection of kidney vs. acute antibody mediated rejection |
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Definition
1) acute cellular: T-cell response; usually suppressed by medication; days to weeks
2) acute antibody: antibodies against donor antigens (endothelial cells); shortly after t-plant; inflammatory cells in subendothelium; intimal arteritis B. |
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Term
| What two drugs are associated with complications of kidney transplant? |
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Definition
1) cyclosporine and FK506
2) nephrotoxic
3) suppression of transplant reection |
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Term
| What are the most common causes of recurrent kidney disease associated with transplanted kidneys? |
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Definition
1) FSGS
2) IgA Nephropathy
3) SLE |
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