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tubulointerstital disease
tubulointerstital disease
50
Medical
Graduate
03/04/2012

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Term
Acute renal failure
Definition
acute suppresin of renal funcitnodevleoping in 24 hours. Accompaniged by anuria/oliguria.
Term
most ocmmon cause of ARF
Definition
ATN.
Term
mechanisms of tubulointerstiaitl injury
Definition
glomeruular, immunoglogical , atleratiosn in tubular metabolism, atlerations in I ntrarenal dynamics, diabetest, crystalline, deposition, nephron obsturciton .
Term
glomerular injury mechanism of injury
Definition
loss of permselectivity. Results in increased levels of proteins in glomerular space leadign to lysosomal degradation of urinary proteins which leads to complment activation and all sorts of immno injury (ROS and cyotkine release)
Term
Immuno processes mechanisms of injury
Definition
altered antigenicity of kidney leadign to renal tubule acting as atngien presenting cell.
Term
alteriantions in tubular metabolism mechanism of injur
Definition
in disease states sruviign nephrons have icnreased o2 consumptino, increased ammoniagenesis, increased production of ROS.
Term
intarenal dyamic change mechaniism of injury
Definition
increased wall tension, increased urinary flow rate.
Term
Diabetes mechanism of injury
Definition
protein glycation, indcuing GBm release of inflammatory emdiators (cytokiens gamma itnerferon and tnf a), production of colalgen types I and IV, and icnrease fbironectin nad laminin.
Term
cryastllinedpeosition associated with
Definition
high po4 diet (deposition of calciu amdn phosphorus), leading to calcifications I ntubualr lumen isnterstitiu mand epithelial cels.
Term
effect of oxalate
Definition
tubular enlargement
Term
effect of urate
Definition
epithelial cell injury and lysoszyme relase.
Term
intratubular casts are the restult of
Definition
nephron obstruction, commin in CKD.
Term
nephron obstruction mechanism of injury
Definition
obsturction rpoducing chceomtactic lipid,- infiklmmatory ifniltrate with cyotkeins and ROS. , Tamm horsfall protein activates neutrophils and complement.
Term
clues to tubulointerstital disease
Definition
mild/moderate proteinuria, no hematuria, sterile pyruia (eosonphils). Amino aciduria (form prox tubule), renal hyperkalemia, and metaolci acidosis.
Term
fanconi syndrome most commonly seen in
Definition
pediatrics
Term
fanconi syndrome in adults associated with
Definition
multiple myeloma
Term
fanconi syndrome pathological features
Definition
proximal tubular dysfunciton with urinary excretion of glucose aminoacids phosphates, bicarbonate and various other protiens.
Term
fanconi clinical signs
Definition
glucosuria in presence of normal plasma glucose, aminoaciduria, non-gap metabolic acidosis, voluem depletion, hypokalemia, osteomalacia, malnutrition **failure to thrive**
Term
type II RTA
Definition
proximal tubule acidosis related to bicarbonate loss canbe casued by fanconi syndrome
Term
AD polycystic kidney disease genetic basis
Definition
chromosome 16 pkd 1 mostly, some with pkd2 gene.
Term
AD polycystic kidney disease epi
Definition
adults.
Term
APKD renal manifestatiosn
Definition
bilateral renal cysts, nephromegaly, hematuria and hemmorhage (cysts rupturing), preserved EPO produciton depsirte ESRD due to CRF.
Term
APKD extrarenal manifestatiosn
Definition
hypertension with high renin elvels, anuerysms, diverticulosis,, mitral valve prolapse.
Term
APKD cysts also presetn extrarenally in
Definition
liver and pancreas
Term
APKD treatment
Definition
control HTN, protein restricitoandn cyst draingage doesn’t really work.
Term
characetrsitic casts of ATN
Definition
muddy brown casts/ renal tubular cell cast.
Term
ATN vs. prereanal azotemiaa
Definition
Bun/CR noraml in Atn, greater htan 20:1 in prerenal. Rate of Cr rise higher in ATN, urine sodium higher in ATN, FE-NA hgiehr in ATN, FE urea higher in ATN. U osmolarity is lower in ATN. Ucr/ Pcr is lwoer in ATN.
Term
Ischemic atn common cause
Definition
prereanal azotemia due to hypovelmia
Term
common sites of tubular dmage in ischemic ATN
Definition
sragiht segment of proxima tubule, and Thick ascending limb. - theBM is disrupted athtese sites tienrfering if apropraite tubular regenration.
Term
ATN prognosis
Definition
usually recovers after afew weeks.
Term
drug which causes nephrotoxic ATN
Definition
Aminoglycosisdes msot common cause (gentamicin).
Term
Atn clinical findinsg
Definition
iligruia. Hyperkalemia and metabolic acidosis.
Term
Most common cause of tubulonersitital nephritis
Definition
Acute pylonephrittis.
Term
Acute drug idncuted tubuloitnerstial neprhittis
Definition
usually Methicillin, Nsaids, sulfonamides
Term
acute drug induced tubulointerstial nephritits clinifal findings
Definition
fever, oliguria and rash.
Term
acute drug induced itnerstial nerphittis miscoscopy
Definition
eosonophilia and eosoniophiluria.
Term
allergic interstital nephritis infectiona lcause
Definition
not very common, but possible due to reactie change to systemic infeciton or direct invasiovnia pyelonephritis mechanism. (look for b-hemolytic strep as cause0.
Term
chronic intersitial nephrtitis usually caused by
Definition
chronic use of acetaminpohen and aspirin for 3 or mor years (aaspirin inhbiits prostaglandin elaving AtIi unopposed).
Term
analsegic nepropathy msot commonl ycauses
Definition
renal papillary necrosis.
Term
renal papilalry encorsis characterstic finding radiology
Definition
ring defect where the papailale used to reside on iVP (due to sloughing off).
Term
APN more common in
Definition
women >men
Term
Most common cause of APN
Definition
e. coli.
Term
pathogenesis of Acute pyelonephrittis, msot ocmmonly.
Definition
vesicoureteral reflux.
Term
msot common mechanism for upper/lwoer Utis in females
Definition
ascendign ifneciton.
Term
hematogouenosu spread to kidneys most commonly cuased by
Definition
staph aureus.
Term
how to distinguish lower UTI from pyelonephritis
Definition
fever, flank pain, wbc casts.
Term
dRug induced itnerstial neprhitits why doe sparticular drug cause it
Definition
methicillin due to b-lactam ring
Term
Rifampin kdiney effects
Definition
AIN- with fever, GI symtpoms, abnomral liver tests THROMBOCYTOPENIA
Term
APKD cysts also presetn extrarenally in
Definition
the liver and pancreas
Term
APKD extra renal manifestations
Definition
hypertension with high renin elvels, anuerysms, diverticulosis,hematuria and hemmorhage (cysts rupturing), mitral valve prolapse.
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