NP26 Nephrology

Parenchymal Kidney Diseases

Signs and Symptoms

AKI
if hypersensitivity reaction: may see fever, skin rash, arthralgia, serum sickness-like syndrome
(particularly rifampin)
if pyelonephritis: flank pain and costovertebral angle (CVA) tenderness
other signs and symptoms based on underlying etiology
HTN and edema are uncommon
Investigations
mild, non-nephrotic range proteinuria and microscopic hematuria
urine
sterile pyuria, WBC casts, mild proteinuria, hematuria
eosinophils if AIN
blood work
increased Cr and urea
eosinophilia if drug reaction
normal AG metabolic acidosis (RTA)
hypophosphatemia, hyperkalemia, hyponatremia
gallium scan often shows intense signal due to inflammatory infiltrate
renal biopsy definitive
Treatment
treat underlying cause (e.g. stop offending medications, antibiotics if pyelonephritis)
corticosteroids (may be indicated in allergic or immune disease)
Prognosis
recovery within 2 wk if underlying insult can be eliminated
the longer the patient is in renal failure, the less likely full renal recovery becomes
2. CHRONIC TUBULOINTERSTITIAL NEPHRITIS
Definition
characterized by slowly progressive renal failure, moderate proteinuria, and signs of abnormal
tubule function
Etiology
persistence or progression of acute TIN
urinary tract obstruction: most important cause of chronic TIN (tumors, stones, bladder outlet
obstruction, vesicoureteral reflux)
chronic pyelonephritis due to vesicoureteral reflux or UTI with obstruction
nephrotoxins
exogenous
analgesics: NSAIDs (common), acetaminophen
cisplatin, lithium, cyclosporine, tacrolimus
heavy metals (lead, cadmium, copper, lithium, mercury, arsenic)
radiation
Chinese herbs
endogenous
hypercalcemia, hypokalemia, oxalate, uric acid nephropathy
vascular disease: ischemic nephrosclerosis, atheroembolic disease
malignancies: multiple myeloma, lymphoma
granulomatous: TB, sarcoidosis, granulomatosis with polyangiitis
immune: SLE, Sjgrens, cryoglobulinemia, Goodpastures, amyloidosis, renal graft rejection,
vasculitis
hereditary: cystic diseases of the kidney, sickle cell disease
others: radiation, Balkan (endemic) nephropathy
Pathophysiology
fibrosis of interstitium with atrophy of tubules, mononuclear cell inflammation
Signs and Symptoms
tubular dysfunction (e.g. acidosis, electrolyte disturbances)
progressive renal failure with azotemia and uremia
dependent on underlying etiology
Treatment
stop offending agent or treat underlying disease
supportive measures: correct metabolic disorders (Ca2+, PO43-) and anemia

Essential Med Notes 2015