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Lecture 4

Interstitial Renal Disease

Definition of Acute Interstitial (Hypersensitivity) Nephritis Acute renal failure with interstitial inflammatory cells (activated T-lymphocytes and/or eosinophils) and interstitial edema
Main Causes of AIN? Idiopathic, Drugs, Infection, Toxins, Immunologic Disease
What are some Drugs that can cause AIN NSAIDS, Methicillin, Some Antibiotics, and diuretics (furosemide and thiazide)
What is the mechanism of AIN Allergic hypersensitivity
How long does it take AIN to develop several weeks
Definition of Chronic Interstitial Nephritis (CIN) Chronic renal failure with mixed chronic inflammatory cell infiltrate in interstitium, tubular atrophy and fibrosis
What is the mechanism for CIN Physical or Chemical with precipitation of substances in the medulla or ischemic due to drug induced vascular changes
What are the main causes of CIN Drugs (NSAIDS, Analgesics, Lithium), Urinary Tract Obstruction, Kidney stones/infection, Polycystic Kidney Disease
What is the gross pathology of CIN asymmetrically scarred small shrunken kidneys, sometimes with papillary necrosis with NSAIDS/acetaminophen
What is the most common bacteria responsible for Ascending infection in pyelonephritis E. coli
Define Pyelonephritis Infection involving the parenchyma, calyces and pelvis
Define Chronic Pyelonephritis Multiple episodes of infection secondary to vicoureteral reflux with chronic renal damage or secondary to obstruction
What is the gross pathology of chronic pyelonephritis small kidneys with coarse scars, dilated papillae, parenchymal atrophy
Define ATN (acute tubular necrosis) Acute renal failure secondary to tubular damage
What are the four main causes of ATN Ischemic, Post-transplantation, Toxic, and Obstructive
What are the three phases of ATN Oliguric, Diuretic, Regenerative
What makes someone predisposed to papillary necrosis long term analgesic use, dibetic with pyelonephritis, and sickle cell anemia
What is the etiology of calcium oxalate or phosphate kidney stones idiopathic
what is the etiology of struvite/magnesium ammonium phosphate kidney stones Infection
What are the three "urias" that can result in urolithiasis Hypercalciuria, Hyperuricosuria, and cystinuria
What are the kidneys like in patients with ADPKD (Autosomal Dominant Polycystic Kidney Disease) very large cystic kidneys with round cysts of variable size and no dysplasia (all parts of nephron invoved and bilateral)
Where else do you see cysts in pts with ADPKD liver, spleen, pancreas (no effect on function)
What are two other associated problems in patients with ADPKD (Cardiovascular) Mitral valve prolapse (25%) and Cerebral Aneurysms (10-20%)
How do the kidneys look in patients with ARPKD (autosomal recessive polycystic kidney disease? Large smooth kidneys with narrow cysts perpendicular to the pasule and involving the collecting ducts
What percent of patients on dialysis develop cysts after 5 years 75%
What disease results in translucent cysts on the surface of the cortex up to 10cm and is present in 50% of people >50 Benign simple cystic disease
What is the most common cause of an abdominal mass in newborns Multicysitc renal dysplasia
What are causes for Early Non-Function following Renal Transplantation "Plumbing" problem, ATN, Acute Cellular rejection
When does Acute Cellular Rejection typically occur usually within the first 3 months
How do you detect Acute Cellular Rejection increasing creatinine
What findings support the diagnosis of Acute Antibody Mediated Rejection Fluorescent antibodies to C4d and Donor Specific Antibodies
What is the most frequent cause of graft loss Chronic Allograft Nephropathy
What Renal Diseases can be recurrent after transplant Type II Membranoproliferative GN, Diabetic glomerulosclerosis, IgA nephropathy, Focal Segmental Glomerulosclerosis
Created by: UVAPATH3