20 Tubulointerstitial Disease
- cat scan
- multiple myeloma: bence jones protein
- Rusty downspout draining muddy water: acute tubular necrosis (ATN)
- muddy cast on urinalysis
- epithelial cells squeeze through nephron and form casts
- phase 1: clinically silent
- maintenance: acute RF, a few days later
- metabolic acidosis: can't excrete acids
- phase 3: fast urine output, drop K with urine
- know hyperkalemia in phase 2 and hypo in phase 3
AIN
Acute
- Kidney bag with little blue candies: interstitial nephritis
- Blue star clusters in kidney nebula: drug-induced interstitial nephritis
- Baseball-filled kidney containers: NSAIDs can cause acute interstitial nephritis
- Kidney filled with blue tickets: loop diuretics can cause interstitial nephritis (blue cells on histology )
- Kidney sharps: IV acyclovir can cause interstitial nephritis or crystalline nephropathy
- don't need to know individual bacteria
- WBC casts: inflammation of nephron
- no bladder symptoms (frequency, urgency, burning urination) association with pyelonephritis (ascending infection from bladder to kidney)
- eosinophilia: allergic reaction
Chronic
NSAIDS
- Constricted proximal end of hose: NSAIDs cause afferent arteriole vasoconstriction, decreasing GFR
- Bursting from high pressure: NSAIDs can increase blood pressure due to COX inhibition in the kidney, decreasing sodium excretion
- Baseball-filled kidney containers: NSAIDs can cause acute interstitial nephritis
- Sloughing off cleat spikes: NSAIDs can cause renal papillary necrosis (sloughing of renal papillae)
- Elevated “lift-ium” balloons: NSAIDs can increase serum lithium concentrations
- Depleted mineral mine: NSAIDs can cause hypoaldosteronism (decreased mineralocorticoids)
- Big K: NSAID induced hypoaldosteronism can cause hyperkalemia. Type 4 RTA
Papillary Necrosis
- Gray-white or yellow necrosis of the distal two-thirds of the renal pyramids is seen macroscopically and corresponds microscopically to coagulation necrosis with preserved tubule outlines; cortical surface scars can develop subsequently as inflammatory foci are replaced by fibrous depressions.
- Symptoms are due to sloughed papillae (sometimes visible in urine as tissue flecks) and include dark or bloody urine and colicky flank pain (due to ureteral obstruction).
- phenacetin: analgesic no longer used
- Baseball-filled kidney containers: NSAIDs can cause acute interstitial nephritis
Cortical Necrosis
- i in cortical stands for ICU and DIC: critically ill
- caused by massive tissue destruction
- kidney diseases as either glomerular diseases (biopsy) or tubulointerstitial diseases (clinical diagnosis)
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