1 / 40

TUBULOINTERSTITIAL DISEASES Terminology

TUBULOINTERSTITIAL DISEASES Terminology. Tubulointerstitial nephritis: Primary - Inflammation limited to tubules & with uninvolved or minimally involved glomeruli/vessels . Acute - Sudden onset & rapid decline in renal function associated with interstitial edema

Download Presentation

TUBULOINTERSTITIAL DISEASES Terminology

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. TUBULOINTERSTITIAL DISEASESTerminology • Tubulointerstitial nephritis: • Primary - Inflammation limited to tubules & with uninvolved or minimally involved glomeruli/vessels. • Acute- Sudden onset & rapid decline in renal function associated with interstitial edema • Chronic- Protracted onset and slow decline in renal function associated with interstitial fibrosis • Secondary - Tubulointerstitial inflammation associated with primary glomerular/vascular diseases • Infectious – Tubulointerstitial inflammation associated with presence of live microorganism • Idiopathic – Tubulointerstitial nephritis where etiological agents or causes are not known • Reactive – Tubulointerstitial inflammation from the effects of systemic inflammation. Kidney is sterile.

  2. TUBULOINTERSTITIAL DISEASETerminology ( cont.) • Urinary tract infection • colonization of excretory system by live microorganism • Pyelonephritis:tubulointerstitial nephritis with pelvis and calyceal involvement • Acute -usually suppurative inflammation involving pelvi-calyceal system and parenchyma • Chronic -involvement of pelvi-calyceal system and parenchyma with prominent scarring

  3. Tubulointerstitial nephritisCauses • Infections: (1) Reactive (2) Infectious • Drug reaction • Obstruction: (1) with infection: pyelonephritis / pyonephrosis (2) without infection : hydronephrosis • Non-obstructive : vesicoureteral reflux • Immune mediated : (1) with anti TBM antibodies, can be 10 or 20 (2) with IC deposition which can be 10 or 20

  4. Tubulointerstitial nephritisPathogenetic mechanisms • Antibody mediated • Anti-TBM-antibody disease • Immune-complex disease • T-cell mediated • Associated with infections • Reactive • Infectious

  5. Tubuluinterstitial nephritis • Primary anti-TBM-antibody nephritis • IgG antibodies directed against tubular basement membrane • Linear staining on immunofluorescence microscopy • Edema and mononuclear cells in interstitium • Glomeruli and blood vessels are unremarkable • Secondary anti-TBM-antibody disease • 20 to 10 glomerulonephritidies, allograft nephropathy

  6. Tubulointerstitial nephritis with immune complexes • Primary immune complex disease • granular staining on IF microscopy on tubular basement membrane • Primary – Rare • Secondary – Usually associated with primary glomerulonephritidies involving TBM and interstitium • e.g SLE, MPGN, Membranous GN etc.

  7. Cell-mediated mechanism • Delayed-type hypersensitivity reaction • Activated CD4+ T and monocyte / macrophage cells releases cytokines which modulates inflammatory reactions and fibrogenesis • Cytotoxic T-cell injury in which CD4+ T and CD8+ T play important role

  8. Pathology of primary IN • bilaterally symmetrical enlargement of kidney • edema • inflammatory cells in interstitium • tubular change including tubulitis, breaks in TBM, necrosis of tubular epithelial cells etc.

  9. Pathology of renal failure acute chronic

  10. Acute renal failure (ARF) • Rapid deterioration of renal function in a relatively short period of time • Sudden inability to maintain normal fluid and electrolyte homeostasis • Marked decrease in renal output • May be of glomerular, tubular, interstitial or vascular origin

  11. Causes of ARF • acute tubular necrosis • infarction & cortical necrosis • organic diseases of renal vessels • severe forms of glomerulonephritis • severe infection • acute tubulointerstitial nephritis • outflow obstruction (post-renal) • impairment of blood flow (pre-renal)

  12. Acute tubular necrosis (ATN) • commonest cause of acute renal failure • develops due to : • direct poisoning of tubules (nephrotoxic lesions) • renal ischemia (tubulorrhexic lesions)

  13. Acute tubular necrosisEtiology & Pathogenesis • Ischemic in origin (Tubulorrhexic lesion) Prolonged ischemia due to: Shock: postoperative, intra-operative, post-traumatic, septic, hypotensive Hemorrhage:postpartum hemorrhage, abruptio placentae Other: severe burns, transfusion accidents, dehydration, heat stroke, crushing injuries, non-traumatic rhabdomyolysis, paroxysmal hemoglobinuria etc.

  14. Acute tubular necrosisEtiology and Pathogenesis • Direct effects of toxins (Nephrotoxic lesion) Therapeutic agents : • Antibiotics : Aminoglycosides, NSAIDs, chemotherapeutic agents, etc. • Heavy metals: mercury, lead, gold etc. • Radiocontrast agents • Multiple bee stings, scorpion bites etc.

  15. Gross pathology • bilaterally enlarged & swollen kidney due to edema • Cut surface bulges and has a flabby consistency • widened & pale cortex • dark & congested medulla

  16. Light microscopy • dilated lumen with flattened epithelial cells • Greatest change in proximal tubules, varies in two forms • loss of brush borders- proximal tubules • evidence of regeneration of epithelial cells • hyaline, granular and pigmented casts • interstitial edema & inflammation • Intra-vascular collection of nucleated red blood cells

  17. ATN- Prognosis • depends upon underlying cause, over all mortality rate  50% • post-traumatic (62%), post-operative (56%), medical (46 %), obstetric (17 %) • Higher in older debilitated pts. & in pts.with multiple organ disease • good for uncomplicated and younger patients

  18. Chronic renal failure • Occurs in all cases of end-stage renal disease of whatever etiology • GFR falls below 20% of normal • End result of all chronic renal disease which can be glomerular, tubulointerstitial or vascular in origin • Characterized by prolonged signs and symptoms of uremia • Is a major cause of death in renal disease

  19. Chronic renal failure • Systemic (visceral) manifestations • Enlarged heart & pericarditis • Uremic pneumonitis & pleuritis • Uremic colitis • Uremic encephalopathy • Hypoplastic anemia

  20. TUBULO-INTERSTITIAL DISEASE • Urinary tract infection • colonization of excretory system by live microorganism • Most caused by gram negative enteric organism • Most common form of renal involvement is: • Pyelonephritis: bacterial infection of the kidney that affects parenchyma, calyces and pelvis • Acute -usually suppurative inflammation involving • pelvi-calyceal system and parenchyma • Chronic -involvement pelvi-calyceal system and parenchyma with prominent scarring

  21. Pyelonephritis • Acute: usually suppurative, often associated (1) with / without obstruction (2) ascending infection through vesicoureteral reflux (3) from hematogenous dissemination. • Chronic: inflammation with prominent scarring; may be (1) obstructive with recurrent infection (2) non-obstructive with vesicoureteral reflux → reflux nephropathy

  22. Acute PyelonephritisPredisposing factors • Urinary obstruction: congenital or acquired • Instrumentation of urinary tract • Vesicoureteral reflux • Pregnancy: 4-6% develops bacteriuria • Gender and age • Preexisting renal lesions • Diabetes mellitus, immunosuppression & immunodeficiency

  23. Acute pyelonephritis • route of invasion : • via blood stream • ascending route • obstructive • non-obstructive role of vesicoureteral reflux and infected urine

  24. Chronic pyelonephritis • It is a chronic tubulointerstitial inflammation involving renal parenchyma, pelvis and calyces associated with scarring • non-obstructive • reflux nephropathy • obstructive

More Related