{"id":5843,"date":"2017-06-08T16:20:03","date_gmt":"2017-06-08T08:20:03","guid":{"rendered":"http:\/\/https:\/\/medicine.nus.edu.sg\/pathweb\/?page_id=5843"},"modified":"2020-10-28T10:11:39","modified_gmt":"2020-10-28T02:11:39","slug":"tubulointerstitial-and-vascular-diseases","status":"publish","type":"page","link":"https:\/\/medicine.nus.edu.sg\/pathweb\/pathology-demystified\/urogenital-pathology\/tubulointerstitial-and-vascular-diseases\/","title":{"rendered":"Tubulointerstitial and Vascular Diseases"},"content":{"rendered":"\n\t\t\tI. Tubulointerstitial Diseases (Click to expand)<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t

I. How do tubulointerstitial diseases present clinically?<\/strong><\/p>\n

1. Polyuria, nocturia<\/p>\n

2. Signs and symptoms of infection (pyelonephritis) – fever, flank pain and tenderness, urinary frequency, bacteraemia, pyuria<\/p>\n

3. Severe renal colic (spasmodic pain) and haematuria – this occurs in nephrolithiasis (stones in the kidney)<\/p>\n

4. Acute renal failure (seen in Acute Interstitial.Tubulointerstitial Nephritis and Acute Tubular Necrosis – below)<\/p>\n

Oligura \/Anuria (marked decrease or absence of urine production)<\/p>\n

Azotaemia (progressive rise in serum creatinine)<\/p>\n

II. What are some tubulointerstitial diseases according to the main aetiologic categories?<\/u><\/strong><\/p>\n

1. Inflammatory conditions<\/strong><\/p>\n

i. Acute interstitial.tubulointerstitial nephritis (AIN)<\/p>\n

Causes:<\/p>\n

Drugs (eg. NSAIDs, antibiotics)<\/p>\n

Autoimmune disease<\/p>\n

Non-kidney infections<\/p>\n

Clinical presentation: Acute renal failure<\/p>\n

2. Acute pyelonephritis<\/p>\n

Causes:<\/p>\n

Infectious agents – Bacterial, from ascending infections (vesico-ureteric reflux, calculi, tumous, exacerbated by Diabetes)<\/p>\n

Less commonly from haematogenous soread<\/p>\n

Clinical presentation: Fever, flank pain, urinary symptoms, acute renal failure<\/p>\n

3. Chronic pyelonephritis<\/p>\n

Definition: Chronic and progressive renal scarring with involvement of calyces and pelvis<\/p>\n

Causes:\u00a0Infections – Vesicoureteric reflux, calculi, obstruction<\/p>\n

Complicationx: Chronic renal failure<\/p>\n\t

This chart, taken from Robbins, describes the many possible causes of tubular diseases. The commonest causes fall into 3 categories: Toxic, ischaemic<\/strong> and infectious<\/strong>.<\/p>\n\t\t\t\t\"TI-diseases-1dj33xc\"\n\t\t\tII. Diseases Involving Renal Blood Vessels (Click to expand)<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t

Many kidney diseases have secondary effects of the renal vessels.<\/p>\n

In addition,\u00a0 many systemic conditions also cause changes in the renal vessels. You can find a good discussion of these in the Kidney chapter in Robbins and Cotrans Pathologic Basis of Disease.<\/p>\n

Here are a few important conditions that affect the renal vessels:<\/p>\n

1. Hypertension<\/strong><\/p>\n

Benign nephrosclerosis –\u00a0 This refers to the renal pathology associated with sclerosis of the renal arteries and arterioles, as very often seen in hypertension<\/p>\n