Ipapburke Gu Test 1- Tubulointerstitial Dz

Front 1

Acute tubulointerstitial Nephritis is most commonly associated with what?

Back 1

toxins and ischemia

Front 2

What part of the kidney anatomy is normally spared by acute tubulointerstitial nephritis?

Back 2

glomeruli

Front 3

What are the marked interstitial inflammatory responses characterized by in ATN?

Back 3

interstitial edema and varying degrees of tubular cell damage

Front 4

ATN generally induces ______________ in renal function.

Back 4

rapid deterioration

Front 5

Overall prognosis of ATN

Back 5

favorable

Front 6

What is chronic tubulointerstitial disease associated with?

Back 6

insult from an acute factor OR progressive insult without any obvious acute cause

Front 7

Interstitial fibrosis and tubular atrophy--- acute or chronic tubulointerstitial disease?

Back 7

chronic disease

Front 8

Essentials of diagnosis for chronic tubulointerstitial disease (5)

Back 8

small kidney size, decreased urinary concentrating ability, hyperchloremic metabolic acidosis, hyperkalemia, reduced GFR

Front 9

Is the GFR in chronic tubulointerstitial disease increased or decreased?

Back 9

reduced

Front 10

Is the kidney size in chronic tubulointerstitial disease increased or decreased?

Back 10

small kidneys

Front 11

Is the urinary concentrating ability increased or decreased in chronic tubulointerstitial disease?

Back 11

decreased

Front 12

Four main causes of chronic tubulointerstitial disease.

Back 12

obstructive uropathy, vesicoureteral reflux, analgesics, heavy metals

Front 13

MC cause of chronic tubulointerstitial disease

Back 13

obstructive uropathy

Front 14

Major causes of obstructive uropathy

Back 14

distention of the renal pelvis and calices with urine, as a result of obstruction

Front 15

Why is obstructive uropathy one of the most important urologic disorders?

Back 15

damaging effects on renal function

Front 16

Three consequences of obstruction.

Back 16

stasis, infection, and renal failure

Front 17

This condition can lead to hydronephrosis.

Back 17

obstruction

Front 18

What is hydronephrosis?

Back 18

distention of the renal pelvis and calices with urine, as a result of obstruction distal to the kidney, w/ accompanying atrophy of renal parenchyma

Front 19

Urine usually flows out of the kidneys at ________ pressure.

Back 19

extremely low

Front 20

What causes increasing pressure on internal structures of the kidney when there is obstruction?

Back 20

when flow is obstructed, urine backs up behind the point of blockage, eventually reaching the renal pelvis, distending the kidney and increasing pressure

Front 21

What may happen if both kidneys are obstructed?

Back 21

kidney failure

Front 22

second most common cause of chronic tubulointerstitial disease

Back 22

vesicoureteral reflux

Front 23

Vesicoureteral reflux- mostly adulthood or childhood?

Back 23

childhood

Front 24

What is the cause of vesicoureteral reflux?

Back 24

caused by urine passing retrograde from bladder to kidneys when voiding (secondary due incompetent vesicoureteral sphincter)

Front 25

What grades of vesicoureteral reflux tend to resolve by age 5?

Back 25

I and II

Front 26

What drugs are of concern in analgesic nephropathy?

Back 26

NSAIDS and combo agents

Front 27

Why do NSAIDS mediate a number of adverse renal side effects?

Back 27

they inhibit renal prostaglandin synthesis

Front 28

Diagnostic of Choice for vesicoureteral reflux

Back 28

VCUG

Front 29

What patients get analgesic nephropathy?

Back 29

patients who ingest large quantities of analgesics

Front 30

When will symptoms from analgesic nephropathy usually present (time frame)?

Back 30

weeks or months

Front 31

What is seen on pathologic exam of the kidneys with analgesic neuropathy?

Back 31

tubulointerstitial inflammation and papillary necrosis

Front 32

Presenting symptoms of analgesic neuropathy

Back 32

sterile pyuria, hematuria, mild proteinuria, polyuria (tubular damage), anemia (GI bleeding), and hyperkalemia

Front 33

Why is sloughed papillae found in the urine of analgesic neuropathy patients?

Back 33

as a result of papillary necrosis

Front 34

When you do an IVP on an analgesic neuropathy patient what should you look for and what does it mean?

Back 34

look for ring shadows----papillary necrosis

Front 35

What can help to prevent analgesic nephropathy?

Back 35

good hydration

Front 36

Analgesic nephropathy can lead to what two conditions ---bad

Back 36

cancer and renal failure

Front 37

Heavy Metals that can lead to chronic tubulointerstitial disease

Back 37

lead, but also cadmium, mercury, and bismuth

Front 38

How does lead cause chronic tubulointerstitial disease?

Back 38

it is filtered by the glomerulus and transported across the PCT, where it collects and causes damage- long term therapy not from acute illness due to exposure

Front 39

What is found in many OTC natural remedies that may lead to chronic tubulointerstitial kidney disease?

Back 39

lead

Front 40

Lab findings in chronic tubulointerstitial kidney disease?

Back 40

microscopic hematurias, pyuria, altered specific gravity, and broad waxy casts; glycosuria, phosphaturia, proteinuria, hyperkalemia

Front 41

What is isothenuria?

Back 41

spec gravity of 1.010

Front 42

Salt wasting causes what condition?

Back 42

hyperkalemia

Front 43

3 causes of hyperchloremic metabolic acidosis

Back 43

renal tubular bicarb wasting, reduced ammonia production, inability to acidify the distal tubules

Front 44

What test is for diagnosis of analgesic neuropathy?

Back 44

IVP

Front 45

Treatment for chronic tubulointerstitial kidney disease?

Back 45

identify cause/remove from exposure or treat

Front 46

If hydronephrosis is present, what must be done ASAP?

Back 46

relief of obstruction b/c chronic obstruction will lead to further progression

Front 47

Once there is onset of parenchyma, what can prevent ESRF?

Back 47

nothing

Front 48

Tx of analgesic neuropathy

Back 48

discontinues all analgesics; tx with steroids possibly or aspirin

Front 49

Tx of vesicoureteral reflux

Back 49

long term antibiotic and cover for E. coli

Front 50

Tx of lead nephropathy

Back 50

chlelation therapy with EDTA