Imported: Renal_Quiz2_Ryan: Tubulointerstitial Diseases

Front 1

do features of glomerular disease occur late or early in the disease?

Back 1

late

Front 2

Proteinuria- usually less than 1 g/day
Anemia-due to low level of Erythropoetin
Acidosis-RTA’s are common
Hypertension-common
Urinalysis-WBC’s and WBC casts seen
Electrolyte Abnormalities-Na and K

features of?

Back 2

Tubulointerstitial Disease

Front 3

Proteinuria->3 Gm/da
Anemia-uncommon until late
Acidosis-uncommon until late
Hypertension-may occur at any time
Urinalysis-may see Oval Fat Bodies
Electrolytes-May see low Na

features of?

Back 3

Glomerular Disease

Front 4

big culprit of Acute interstitial nephritis in kids? adults?

Back 4

kids: antibiotics

adults: NSAIDs

Front 5

what infections can be responsible for Acute interstitial nephritis

Back 5

CMV, Legionella, Leptospiosis, Streptococcus

Front 6

sarcoidosis can be a cause of what?

Back 6

Acute interstitial nephritis

Front 7

Hansel's Stain =

Back 7

Acute interstitial nephritis

Front 8

Hansel's Stain =

Back 8

Acute interstitial nephritis

**Detects Eosinophils**

Front 9

clinical features of the following are associated with what?
Rash
Fever
Azotemia
Malaise
Arthalgias
Usually seen 7-10 days after starting a new medication

Back 9

Acute interstitial nephritis

Front 10

Eosinophilia, elevated sed rate, low compliments, WBCs with casts and RBCs may be seen in what?

Back 10

Acute interstitial nephritis

Front 11

Pt gets on a beta-lactam and later has rash fever and azotemia..what do they have

Back 11

Acute interstitial nephritis

Front 12

What is the classic triad of AIN? is this seen with use of antiboitics or NSAIDs or both?

Back 12

of fever, rash, and eosinophils

antibiotic

Front 13

treatment for AIN

Back 13

STOP THE DRUG!!!!!!!!
This usually brings about an improvement in renal function.
In severe cases, a trial of Steroids may be of benefit, but no large trials have confirmed this

Front 14

A chronic condition involving fibrosis of the interstitium and tubular destruction.
The final common pathway of most chronic renal diseases

Back 14

Chronic Interstitial Nephritis (CIN)

Front 15

if pt has a history of frequent pain who presents with proteinuria & elevated creatinine what should you think

Back 15

Chronic Interstitial Nephritis

Front 16

in Chronic Interstitial Nephritis for kids, what do you have to look for

Back 16

lead toxicity

Front 17

if a pt has glucosuria with normal serum glucose, what should you think

Back 17

Chronic Interstitial Nephritis

Front 18

what is the common cause of Chronic Interstitial Nephritis

Back 18

Chronic Obstructive Uropathy-Ureteral Reflux

aka kidney stones block up the urethra and urine gets refluxed back up

Front 19

Chronic Pyelonephritis
Chronic Renal Lithiasis
Medications-NSIADs, Lithium
Post Acute Tubular Necrosis
Autoimmune-Sjogren’s Syndrome
Radiation

all possible causes of what?

Back 19

Chronic Interstitial Nephritis

Front 20

what is the hallmark of Chronic Interstitial Nephritis?

Back 20

STERILE PYURIA

white blood cells in urine but no infection

Front 21

most important treatment for Chronic Interstitial Nephritis

Back 21

Blood pressure controll

Front 22

DOC for Chronic Interstitial Nephritis

Back 22

ACE-I or ARBs

control BP at level of kidney

Front 23

most common cause of RENAL acute renal failure

Back 23

Acute Tubular Necrosis

Front 24

what happens in Acute Tubular Necrosis...what is it due to?

Back 24

Necrosis of the tubules due to micro-thrombi.

This is frequently due to prolonged hypotension and augmentation of the immune system from sepsis.

Front 25

number one cause of Acute Tubular Necrosis

Back 25

Sepsis

Front 26

urine sediment showing multiple muddy brown granular casts =

Back 26

Acute Tubular Necrosis

Front 27

treatment for Acute Tubular Necrosis?

Back 27

Treat underlying condition (sepsis, volume depletion, hypotension)

remember from the quiz though that this apparently can get better on its own...

Front 28

does Dopamine work for Acute Tubular Necrosis?

Back 28

nope

Front 29

Metabolic acidosis usually caused by a defect in renal tubular function

Back 29

Renal tubular acidosis

Front 30

what are the different types of Renal tubular acidosis?

Back 30

One proximal type (type 2) & two distal types (1 & 4)

Front 31

what is the anion gap like in RTA?

Back 31

normal

Front 32

what do the number type of RTA indicate?

Back 32

Number indicates the serum K+ level

1 is low, 2 normal, 4 is high

Front 33

in type 2 RTA what is the mechanism similar to?

Back 33

Causes by a mechanism similar to acetazolamide

Decreases bicarbonate resorption in the proximal tubule

Front 34

what is a cause of type 2 RTA for kids?

Back 34

Fanconi Syndrome

Front 35

what is Fanconi Syndrome and what is it associated with

Back 35

Rare disorder of tubule function
Results in excess amounts of glucose, bicarbonate, phosphates (phosphorus salts), uric acid, potassium, sodium, and certain amino acids being excreted in the urine.

seen in type 2 RTA

Front 36

mechanism of type 4 RTA?

Back 36

Affects the Na/K-H exchange in the distal tubule

Front 37

Hyperkalemic, hyperchloremic acidosis is associated with what RTA?

Back 37

type 4

Front 38

what causes type 4 RTA (mostly in kids)

Back 38

Obstructive uropathy
Interstitial renal disease
Multicystic dysplastic kidneys

Front 39

Patients become acidotic & hypokalemic in what?

Back 39

Type 1 RTA

Front 40

in this Tubulointerstitial Disease, children present with failure to thrive, and can cause kidney stones

Back 40

type 1 RTA

Front 41

A type of blood cancer in which plasma cells grow uncontrollably, usually inside the bone marrow =

Back 41

Multiple Myeloma

Front 42

the following are causes of renal failure due to what?

Cast nephropathy
Light chain deposition disease
Primary amyloidosis
Hypercalcemia
Renal tubular dysfunction
Volume depletion

Back 42

Multiple Myeloma

Front 43

what are the 2 main pathologic mechanisms in myeloma of the kidney

Back 43

Intracellular cast formation
Direct tubular toxicity by light chains

Front 44

Most common pathological diagnosis on renal biopsy in multiple myeloma?

Back 44

Cast nephropathy

Occurs due to light chains binding with Tamm-Horsfall mucoprotein, which is secreted by tubular cells in ascending loop of Henle forming casts

Front 45

Light chain deposition disease is usually due to what?

Back 45

kappa immunoglobulin fragments which deposit in kidneys

seen in multiple myeloma

Front 46

Amyloidosis is usually due to what?

Back 46

lambda light chains

seen in multiple myeloma

Front 47

Congo red positive, b-pleated=

Back 47

AL amyloidiosis

Front 48

why does hypercalcemia occur in multiple myeloma

Back 48

Hypercalcemia occurs in multiple myeloma due to bone resorption from lytic lesions

occurs in 15% of patients with multiple myeloma

Front 49

Renal Tubular Dysfunction – Acquired Fanconi syndrome occurs due to what

Back 49

Most commonly occurs with kappa light chains

Front 50

what are light chains resistant to?

Back 50

protease degradation and have tendency to accumulate in tubule epithelial cells and form crystals

Front 51

Tubular damage due to light chain toxic effects or indirectly from ?

Back 51

the release of intracellular lysosomal enzymes

Front 52

Tubular damage due to light chain toxic effects or indirectly from ?

Back 52

the release of intracellular lysosomal enzymes

**Acquired Fanconi Syndrome**

Front 53

Normocytic Normochromic Anemia =

Back 53

a finding in multiple myeloma

Front 54

Urinalysis in multiple myeloma may show NO Protein, unless _____ _____ test is done, which will be positive.

Back 54

sulfasalicylic acid

Front 55

tx for Multiple myeloma?

Back 55

hydration with IV fluid

Front 56

Chronic Back Pain
Males >50 y.o.
African-Americans are more commonly affected
Hepatosplenomegaly
Cardiomyopathy due to Amyloid deposition

all buzzwords for?

Back 56

multiple myeloma

Front 57

47 year old man presents with nephrotic-range proteinuria. He has been taking an NSAID for the past 3 months for his arthritis. You suspect Acute Interstitial Nephritis. Why doesn't this patient present with the triad of fever, eosinophilia and rash?

Back 57

NSAIDs are blunting inflammatory response.

There is still an allergic rxn occurring, but the NSAIDs are masking some of the dead give-aways

Front 58

What protein acts as the glue that holds casts together in multiple myeloma? What type of cells surround the cast in the lumen?

***

Back 58

-Tamm-Horsfall proteins hold casts together

-Multinucleated Giant Cells surround the cast in the lumen

Front 59

T/F

Decreased volume/ Dehydration worsens the damage caused by casts in multiple myeloma

Back 59

True

Front 60

Upon examining an X-ray you notice multiple bone lesions. What might you expect?

Back 60

Multiple Myeloma