RE Tubulointerstitial Ds
Terms
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- general characteristics of renal failure
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high creatinine (rapid increase)
oligouria
azotemia (elevated BUN) - renal failure b/c vascular compartment
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Prerenal ARF
-low b flow - causes of prerenal ARF
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decreased blood flow
hypotension
volume depletion
hemorrhage
sepsis - renal failure b/c kidney
- Intrarenal ARF
- causes of intrarenal ARF
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Drug Induced Tubular necrosis (most common)
tubular or interstitial dz - renal failure b/c obstruction
- Postrenal ARF
- Tubulointerstitial diseases
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Acute Tubular Necrosis (ATN cast)
-ischemic
-nephrotoxic
Drug Induced Interstitial Necrosis (eos, creat, WBC cast)
Acute Pyelonephritis (polis, casts, pus)
Chronic Pyelonephritis (cortex thin, thyroid)
Cast Nephropathy (lambda, kappa, frag'd casts, giant cells) -
Pt w/burn, hemorrhage, or shock
Gross: pale cortex, swollen
brown, grannular casts in urine
LM: flat brush border, gunk in tubule -
Acute Tubular Necrosis
Ischemic -
Pt on Abs (sulfa drug), post contrast, heavy metal, carbon, poisons
LM: flat brush border, gunk in tubule, diffuse, cytoplasmic atypia -
Acute Tubular Necrosis
Nephrotoxic -
Pt on Abs, NSAIDs, Diuretics, Ace inhibs
HIGH creatinine
UA: WBC cast, eos, lymphos
LM: eos, lymphos, cellular, glom & vessels ok - Drug Induced Interstitial Nephritis
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Pt post UTI, reflux, bacterial sepsis
B sx's, flank pain, CVA tender
UA: leuko casts, polis
Gross: pockets of pus
LM: inflamm, polis, WBC casts in tubules - acute pyelonephritis
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Gross: polar scar
Histo: atrophy, scarring, contracted papillary tip, thin, pitted cortex, dilation
Thyroid like appearance -
chronic pyelonephritis
untreated acute or obstruction/reflux - Cast Nephrophathy
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Pt w/ myelomeloma, lymphoma
LM: fragmented casts, multinucleated giant cells
IMFL: kappa/lambda positive - tamm horsfall protein
- protein componant of casts
- acute tubular necrosis (key words)
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brown grannular casts
flattened brush border
necrosis
nephrotoxic or ischemic - Drug Induced Interstitial Nephritis (keywords)
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eosiniphils
WBC casts
ELEVATED creatinine - Acute Pyelonephritis (keywords)
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WBC casts
pockets of pus
Polis - Chronic Pyelonephritis (keywords)
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atrophy, scarring
cortical thinning (polar scar)
contracted papillary tip
thyroid-like