Renal - Tubulointerstitial Diseases

Front 1

Acute renal failure is divided into three causes, what are they?

Back 1

1. Pre-renal -- processes which result in inadequate perfusion of the kidney; hemorrhage, reduced CO, decreased PVR, local renal vasoconstriction
2. Post-renal -- obstruction (bilateral) of urine flow; urethral stricture, prostatic hypertrophy with obstruction, renal stone (rare)
3. Renal -- process affecting any of the renal compartments

Hint 1

pg 63

Front 2

Acute tubular necrosis

-structure injured
-causes (2)

Back 2

--injury and/or destruction to the renal tubular epithelium (75% of acute renal failure)

1. Ischemic injury (pre-renal) -- shock or hypotension from sepsis; burns; surgery; hemorrhage

2. Tubulo-toxic injury (renal) -- aminoglycoside antibiotics; mercury; contrast dyes
2.

Hint 2

pg 63

Front 3

Does acute tubular necrosis always lead to necrosis and death of the tubular cells?

Back 3

No, this is not often the case. Cells may become injured and lose most functions resulting in this clinical syndrome without actually becoming necrotic. ATN is often reversible which is why biopsy is so important.

Hint 3

pg 63

Front 4

Acute tubular necrosis can lead to a decrease in GFR, how so? (3)

Back 4

1. vasoconstriction
2. obstruction of tubules by necrotic cells (casts) causing increased intratubular pressure and decreased filtration
3. backleak of filtered urine through the damaged tubules back into the kidney vasculature and interstitium

Hint 4

pg 64

Front 5

Acute Pyelonephritis

-conditions that lead to AP from a UTI

Back 5

1. Obstruction of the urine flow at any level increases the chane of AP -- urethral stricture; functional bladder obstruction w/ imcomplete emptying (neurogenic bladder of DM); prostatic hypertrophy
2. vesico-ureteral reflux
3. catheterization
4. pregnancy
5. age and sex
6. immune dysfunction

Hint 5

pg 64

Front 6

Vesico-ureteral reflux

-predisposing conditions (3)

Back 6

1. absence of the intra-vesicular ureter (ureter enters bladder perpenicular to bladder wall instead of vertically)
2. Congenital para-ureteral diverticulum which interferes with normal function
3. Inflammation of the bladder wall

Hint 6

pg 65

Front 7

Acute pyelonephritis

-complications (3)

Back 7

1. pyonephrosis -- kidney completely destroyed
2. perinephric abscess
3. necrotizing papillitis -- necrosis of the renal papillae, in which they often slough into the renal pelvis where they may cause further obstruction

Hint 7

pg 65

Front 8

Necrotizing papillitis

-conditions that must be present (3)

Back 8

1. infection -- as in AP
2. obstruction to urinary outflow
3. compromised blood flow, as might be seen in DM or sickle cell anemia

Hint 8

pg 65

Front 9

Chronic pyelonephritis

-diagnosis

Back 9

--diagnosis is made grossly
--kidneys are scarred and asymmetric
--pelvis and calyces are markedkly thickened and scarred
--broad cortical scars

Hint 9

pg 66

Front 10

Acute tubulo-interstitial nephritis (ATIN)

-defintion

Back 10

--represents inflammation of the interstitium of the kidney which also affects the tubules
--occurs after exposure to certain drugs or toxins, or may occure during system infections with certain organisms or may be associated with certain systemic illnesses like SLE
--likely immunological

Hint 10

pg 66

Front 11

Acute tubulo-interstitial nephritis (ATIN)

-most common cause

Back 11

--drug reaction:

-beta-lactam antibiotics
-sulfonamide (Bactrim)
-NSAIDs
-diuretics

Hint 11

pg 66

Front 12

Acute tubulo-interstitial nephritis (ATIN)

-associated systemic infections (4)

Back 12

1. Group A strep
2. Diptheria
3. toxoplasmosis
4. Legionnaire's disease

Hint 12

pg 66

Front 13

Acute tubulo-interstitial nephritis (ATIN)

-clinical features

Back 13

*features of hypersensitivity:

-fever
-hematuria
-eosinophilia/eosinouria
-pyuria
-skin rash
-mild proteinuria

Hint 13

pg 66