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44 Cards in this Set
- Front
- Back
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What are the two major groups of tubular/interstital injury?
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ischemic/ toxic tubular
inflammatory reactions |
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What is the morphology of acute kidney injury?
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destruction of tubular epithelial cells
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What is the clinical presentation of acute kidney injury?
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acute suppression of renal function
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What is the most common cause of acute renal failure?
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acute kidney injury
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What is acute kidney injury?
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abrupt reduction in kidney function,
increased serum creatinine and oligouria |
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What are the causes of acute kidney injury?
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ischemia
direct toxic injury acute tubulointerstitial nephritis urinary obstruction |
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Is acute kidney injury reversible?
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yes it often is, but not always
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What is the morphology of ischemic or toxic acute kidney injury**
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focal necrosis at many sites, with skips
tubular lumens have casts (tamm-horsfall) |
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What are the casts in acute kidney injury?
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Tamm-Horsfall protein
a urinary glycoprotein secreted by cells of ascending thick limb and distal tubules |
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What are the clincal features of acute kidney injury?
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decreases urine output
salt/water overload* rising BUN Hyperkalemia* metabolic Acidosis* |
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What happens in the recovery phase of acute kidney injury?
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urine volume goes up to liters per day
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What is the prognosis of acute kidney injury?
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not bad if other organs arent damaged
bad with burns/sepsis |
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What are the clinical manifestations of tubulointersitial nephririts?
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polyuria, nocturia
salt wasting metabolic acidosis* |
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What are the most common agents that cause Pyelonephritis?
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E coli** most likely
Proteus Klebsiella |
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What are the causes of Pyelonephritis in transplanted kidneys?
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polyomarvirus
CMV adenovirus |
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What is the most common route of Pyelonephritis infection?
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ascending infection
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What are the steps leading to Pyelonephritis?
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colonize distal urethra
bladder multiply in bladder vesicoureteral reflux |
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What is the morphology of acute Pyelonephritis?
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patchy interstitial suppurative inflammation
nerutophils** (and thus white cell casts) tubular necrosis** |
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What are the three complications of acute Pyelonephritis?
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papillary necrosis (diabetics- bilateral)
pyonephrosis (kidney full of inflammatory cells) perineprhic abscess |
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What is the clinical presentation of acute Pyelonephritis?
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predisposing conditions**
sudden onset pain @ CVA Fever, malaise dyuria, frequency, urgency White cell casts** |
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What causes Pyelonephritis in kidney allografts? Tx?
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polyoma virus
reduce immune suppression, but risk losing kidney |
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What are the two forms of chronic Pyelonephritis?
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chronic obstructive, from recurrent infections
reflux nephropathy- childhood |
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What is the gross morphology of chronic Pyelonephritis
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irregularl scarred
coarse, discrete corticomedullar scar** |
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What is the microscopic morphology of chronic Pyelonephritis?
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atrophy, fibrosis, chronic inflammation of tubules
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How does chronic Pyelonephritis present?
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insidious or recurrent with back pain
pyuria, bacteruria and proteinuria**- can get focal segmental glomeruloscelrosis |
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What two drugs cause acute drug induced interstitial nephritis?
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synthetic penicillins, sulfonamides
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what is the clinical presentation of acute drug induced interstitial nephritis?
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onset two weeks after exposure
fever,eosinophilia, rash renal abnormalities- hematuria, proteinuria |
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What is the KEY word for acute drug induced interstitial nephritis?
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Eosinophils in blood or urine**
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What is the morphology of acute drug induced interstitial nephritis?
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Intersitial edema
infiltration by lymphocytes and macrophages EOSINOPHILS* |
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What is the morphology of analgesic abuse nephropathy?
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chronic tubulointerstitial nephritis with renal papillary necrosis**
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What is the metabolite that cause analgesic abuse nephropathy?
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Phenacetin
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How does aspirin help phenacetin cause analgesic abuse nephropathy?
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aspirin potentiates the effect by inhibitng vasodilatory effects
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What is the gross morphology of analgesic abuse nephropathy
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papillae show various stages of necrosis and sloughing*
PAPILLAE is key here* |
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What are the clinical signs of analgesic abuse nephropathy?
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gross hematuria
renal colic headache, GI sxs, HTN |
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What are the complications of analgesic abuse nephropathy?
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transitional papillary carcinoma
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What are the four conditions that can cause Papillary necrosis other than analgesic abuse nephropathy**
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Diabeties mellitus
analgesic abuse nephropathy Sickle cell disease Obstruction |
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What is acute Urate Nephropathy?
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this is obstruction that leads to renal faiure
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Who is likely to get acute Urate Nephropahty?
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leukemia and lymphoma due to chemo**
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Who gets chronic urate nephropathy?
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people with gout
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What causes chronic urate neprhopathy?
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monosodium urate crystals (gout)
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What is the morphology of chronic urate neprhopathy?
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tophus surrounded by giant cells
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What causes acute phosphate nephropathy?
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extensive accumulations of calcium phosphate crystals in tubules
due to high doses or oral phosphate solutions |
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What type of casts indicate multiple myeloma?
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Bence Jones casts
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What do Bence Jones casts look like?
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these look pink to blue amorphous masses, filling and distending tubular lumens
these are surrounded by multinucleated giant cells |
