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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