Chronic interstitial nephritis Flashcards Preview

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Flashcards in Chronic interstitial nephritis Deck (4)
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1
Q

What is chronic interstitial nephritis

A

A Histologically defined condition of the kidney

Tubular atrophy, fibrosis, loss
Chronic lymphocytic infiltration
Interstitial fibrosis

Slow, progressive disease course, which will eventually cause glomerular and vascular damage to the kidney.
15-30% go to ESRD

2
Q

Causes of chronic interstitial nephritis

A

Drugs:

  • most often analgesics, NSAIDs
  • lithium, cyclosporin,

Autoimmune diseases:

  • SLE
  • Sjogren’s syn.

Toxins:
heavy metals, mercury
aristolochic acid, an herb, balkan nephropathy

Chronic urinary tract obstruction,
Chronic vesicoureteral reflux,
Hydronephrosis

Acute Pyelonephritis

Hematologic diseases, Myeloma and Light Chain Nephropathy.

Irradiation

Chronic transplant rejection

Chronic hypercalcemia, hyperuricemia, hypokalemia

3
Q

Symptoms and presentation of Chronic interstitial nephritis

A

Asymptomatic, slow decline of kidney function over many years.

Possible presentations:

1) Patient often presents for the first time with end-stage kidney disease. MAD HHHHUNGER
2) Polyuria and DI
3) Renal diabetes insipidus, and inability to concentrate urine, from medullary fibrosis and impaired permeability of the collecting ducts. ADH resistance.
4) Fanconi syndrome
5) Renal tubular acidosis

Hypertension commonly comorbid, but not always

Urine:
Sterile pyuria, Leukocyte casts with no infection or pus.
Hematuria

mild tubular proteinuria, below nephrotic range. from low and medium mw proteins, immunoglobulins, beta-2 microglobulin, a1 microglobulin.

negative albumin dipstick is common.

4
Q

Fanconi syndrome

A

Generalized impairment of proximal tubule function.
impaired glucose, amino acid, small protein, phosphate, and urate reabsorption.

  • Non-diabetic glucosuria and polyuria, polydipsia
  • Phosphaturia, phosphate wasting and hypophosphatemia
  • Tubular proteinuria, no albuminuria but elevatred PCR ratio.
  • Hypouricemia

Treatment:
Replace phosphate to prevent bone demineralization.