60 Questions
Which part of the kidney is affected in most forms of tubular injury?
Interstitium
Tubulointerstitial nephritis refers to inflammatory diseases of the kidneys affecting which two parts?
Interstitium and tubules
What is the term used for non-bacterial origin causes of interstitial nephritis?
Immune nephritis
Which of the following is NOT a cause of acute and chronic tubulointerstitial nephritis?
Bacterial infection
What is the typical manifestation of acute pyelonephritis?
Suppurative inflammation of the kidneys and pelvis
Which bacteria is commonly associated with acute pyelonephritis?
E. Coli
Which route of infection can lead to acute pyelonephritis?
Ascending infection
Which location are the scars usually found in chronic pyelonephritis?
Upper poles of the kidney
What is the most characteristic cell type seen in chronic pyelonephritis?
Plasma cells
Which type of hypersensitivity reaction is associated with drug-induced interstitial nephritis?
Type IV (T-cell mediated)
Which part of the kidney is mainly injured in ischemic acute tubular injury?
Tubules
What is the most common cause of intrarenal acute kidney injury?
Ischemic acute tubular injury
What is the clinical presentation of acute tubular injury?
Oliguria with high serum creatinine
What is the most common cell type seen in drug-induced allergic interstitial nephritis?
Lymphocytes
Which factor is NOT a predisposing factor for acute pyelonephritis?
Male gender and age
Which condition can lead to the development of papillary necrosis in acute pyelonephritis?
Sickle cell anemia
Which symptom is commonly associated with acute pyelonephritis?
Pain at the costovertebral angle
What is the important cause of chronic renal failure in chronic pyelonephritis?
Scarring of renal parenchyma
Which form of chronic pyelonephritis is characterized by the superimposition of a UTI on congenital vesicoureteral reflux?
Reflux nephropathy
What is a characteristic feature of chronic pyelonephritis on gross examination?
Scarring involving the pelvis
What is the most common type of inflammatory infiltrate seen in chronic pyelonephritis?
Plasma cells
Which of the following is a characteristic of ischemic acute tubular injury (ATI)?
Epithelial regeneration is not observed
Which part of the renal tubule is most commonly affected in ischemic ATI?
Straight portions of the proximal tubule and the ascending thick limbs
Which of the following is a morphological feature of ischemic ATI?
Detachment of tubular cells from their underlying basement membranes
Which type of acute tubular injury (ATI) is characterized by necrosis of individual tubular epithelial cells with sparing of the tubular basement membranes?
Toxic ATI
Which of the following is a clinical feature of ATI?
Electrolyte abnormalities and acidosis
Which of the following is responsible for the formation of granular casts in ATI?
Intratubular obstruction due to denuded epithelium and cellular debris
Which type of acute tubular necrosis is characterized by widespread necrosis of proximal tubular epithelial cells with minimal interstitial inflammation?
Toxic ATI
Which of the following is a recommended resource for further information on ATI?
Robbin Basic Pathology (10th edition)
Which of the following is NOT a major intrinsic renal disease that causes acute renal failure?
Generalized acute tubular injury
Which of the following is a common cause of tubulointerstitial nephritis (TIN)?
Bacterial infection
What is the typical manifestation of acute pyelonephritis?
Suppurative inflammation of the kidney and pelvis
Which bacteria is commonly associated with acute pyelonephritis?
E. Coli
What is a characteristic feature of chronic pyelonephritis on gross examination?
Scarring of the kidney
Which part of the kidney is mainly injured in ischemic acute tubular injury?
Renal tubules
Which type of hypersensitivity reaction is associated with drug-induced interstitial nephritis?
Type IV hypersensitivity
Which condition can lead to the development of papillary necrosis in acute pyelonephritis?
Diabetes mellitus
Which part of the kidney is mainly affected in chronic pyelonephritis?
Interstitium
Which type of hypersensitivity reaction is associated with drug-induced interstitial nephritis?
Type IV hypersensitivity reaction
What is the most common cause of intrarenal acute kidney injury?
Ischemic acute tubular injury
What is the characteristic feature of chronic pyelonephritis on gross examination?
Blunted calyces
Which type of acute tubular injury (ATI) is characterized by necrosis of individual tubular epithelial cells with sparing of the tubular basement membranes?
Toxic acute tubular injury
What is the typical manifestation of acute pyelonephritis?
Inflammatory infiltrate
Which symptom is commonly associated with acute pyelonephritis?
Oliguria
Which part of the urinary tract is most commonly affected in acute pyelonephritis?
Kidneys
What are the predisposing factors for acute pyelonephritis?
Urinary obstruction, instrumentation of the urinary tract, vesicoureteral reflux
What are the gross features of acute pyelonephritis?
Enlarged kidneys with discrete abscesses on the renal surface
What are the histological features of acute pyelonephritis?
Patchy interstitial purulent inflammation, tubular destruction, neutrophilic casts
What are the clinical features of acute pyelonephritis?
Pain at the costovertebral angle, systemic evidence of infection, localizing urinary tract signs
What is the most common cause of chronic renal failure in chronic pyelonephritis?
Recurrent urinary tract infections
What are the morphological features of chronic pyelonephritis?
Scarring involving the pelvis or calyces, papillary blunting, marked calyceal deformities
Which of the following is a characteristic feature of ischemic acute tubular necrosis (ATN)?
Widespread necrosis of proximal tubular epithelial cells with minimal interstitial inflammation
Which of the following is responsible for the formation of granular casts in acute tubular injury (ATI)?
Sloughing of cells, which is responsible for the formation of granular casts
Which part of the renal tubule is most commonly affected in ischemic acute tubular injury (ATI)?
Straight portions of the proximal tubule and the ascending thick limbs
What is the clinical presentation of acute tubular injury (ATI)?
Rapidly rising serum creatinine, usually with decreased urine output (oliguria)
Which type of acute tubular injury (ATI) is characterized by overt necrosis in the proximal tubule and sparing of the tubular basement membranes?
Toxic ATI
Which of the following is NOT a cause of acute and chronic tubulointerstitial nephritis?
Renal artery stenosis
Which of the following is a recommended resource for further information on acute tubular injury (ATI)?
Robbin Basic Pathology (10th edition)
What is the most common type of inflammatory infiltrate seen in chronic pyelonephritis?
Lymphocytes
Which of the following is a morphological feature of ischemic acute tubular injury (ATI)?
Attenuation of proximal tubular brush borders
Study Notes
Diseases Affecting the Kidney Tubules and Interstitium: Tubulointerstitial Nephritis and Acute Pyelonephritis
- Tubulointerstitial nephritis (TIN) refers to inflammatory diseases affecting the interstitium and tubules of the kidneys.
- TIN can be caused by bacterial infections, drugs, metabolic disorders, physical injury, viral infections, and immune reactions.
- Acute pyelonephritis is a suppurative inflammation of the kidney and pelvis, usually caused by bacteria such as E. Coli, Klebsiella, Proteus, Enterobacter, and Pseudomonas.
- Acute pyelonephritis is typically associated with urinary tract infections (UTIs) and can be caused by ascending infection from the lower urinary tract or hematogenous infection through the bloodstream.
- Predisposing factors for acute pyelonephritis include urinary obstruction, instrumentation of the urinary tract, vesicoureteral reflux, pregnancy, and certain medical conditions such as diabetes and immunosuppression.
- Acute pyelonephritis is characterized by pain at the costovertebral angle, systemic signs of infection, localizing urinary tract signs, and pus in the urine (pyuria).
- Chronic pyelonephritis is characterized by interstitial inflammation and scarring of the renal parenchyma, often resulting from recurrent UTIs and obstruction.
- Chronic pyelonephritis can lead to chronic renal failure and may be caused by obstructive lesions or reflux nephropathy.
- Drug-induced interstitial nephritis is an important cause of renal injury, typically occurring as an adverse reaction to certain drugs such as penicillins, diuretics, and nonsteroidal anti-inflammatory agents.
- Analgesic nephropathy, caused by drugs like phenacetin and aspirin, can lead to interstitial nephritis associated with papillary necrosis.
- Acute tubular injury (ATI) is a clinicopathologic entity characterized by damaged tubular epithelial cells, acute decline in renal function, and presence of granular casts and tubular cells in the urine.
- ATI can be caused by severe glomerular diseases, acute tubular injury caused by renal vascular diseases, and acute drug-induced allergic interstitial nephritis. The two main forms of ATI are toxic (due to poisons, solvents, and drugs) and ischemic (due to reduced blood flow).
Quiz: Chronic Pyelonephritis - Morphology and Symptoms Test your knowledge on chronic pyelonephritis, a condition characterized by kidney scarring and blunted calyces. This quiz will cover the morphology of the disease, as well as symptoms and associated conditions. Challenge yourself and enhance your understanding of chronic pyelonephritis.
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