Tubulo interstitial diseases

tubulo-interstitial diseases

• acute tubular necrosis (ATN)
• damage to tubular epithelial cells
• causes
• pre-renal hypotension/hypoperfusion = oxygen deprivation = necrosis
• renal - toxins, nephritis, radio-contrast dyes, drugs (antibiotics), Hb, Mb
• post-renal - urinary obstruction (stones, enlarged prostate, pregnancy)
• light microscopy
• cell regeneration with mitotic figures
• clinical course
• highly variable
• acute tubulo-interstitial nephritis
• acute inflammation of tubules and interstitium
• causes
• drugs
• infection
• pathogenesis
• abnormal immune reaction
• acute hypersensitivity immune reaction
• IgE mediated
• acute pyelonephritis
• most common kidney disease
• cause
• bacterial (promoted by factors that reduce urine flow)
• urine findings
• neutrophils
• white cell casts
• complications
• papillary necrosis
• peri-nephric abscess
• sepsis - septic shock
• obstructive uropathy
• myeloma cast nephropathy
• Bence-Jones proteins = monoclonal immunoglobulin light chains - in patients with multiple myeloma;  cause M spike on protein electrophoresis