AIN versus NSAID nephropathy versus papillary necrosis - USMLE Forums
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  #1  
Old 08-19-2011
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Kidney AIN versus NSAID nephropathy versus papillary necrosis

hey guys;

how can u differentiate between the following conditions clinically as well as on urine analysis

1) Acute interstitial nephritis
2) NSAID induced nephropathy
3) Renal papillary necrosis.
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Old 08-19-2011
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Default hi

hi
i hate it when u post a question and no one replies
i don't know the ans but i will check it up.
in the mean time i need to devise a way to keep the light, electron and immunofluorescent patterns of the numerous renal pathologies straight! i have read them over and over yet keep mixing them up.
have u figured a way yet?
has anyone figured a way yet???
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Old 08-19-2011
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Default hope this helps

RPN: coagulative necrosis of medullary papillae

A useful mnemonic device for the conditions associated with renal papillary necrosis is POSTCARDS, which stands for the following:
  • Pyelonephritis
  • Obstruction of the urinary tract
  • Sickle cell hemoglobinopathies, including sickle cell trait
  • Tuberculosis
  • Cirrhosis of the liver, chronic alcoholism
  • Analgesic abuse
  • Renal transplant rejection, radiation
  • Diabetes mellitus
  • Systemic vasculitis
The most common presenting symptoms in symptomatic patients include fever and chills, flank and/or abdominal pain, and hematuria. Acute renal failure with oliguria or anuria is rare. Acute ureteral obstruction from sloughed papillae manifests as flank pain and colic due to hydronephrosis or pyonephrosis; hematuria is invariably present.

The most common urinalysis findings include proteinuria, pyuria, bacteriuria, and low urine-specific gravity, by the passage of sloughed papillae in the urine. More than 50% of patients develop leukocytosis and azotemia.

CT findings include (1) small kidneys, (2) ring shadows in the medullae, (3) contrast-filled clefts in the renal parenchyma, and (4) renal pelvic filling defects.
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Old 08-19-2011
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Quote:
Originally Posted by nativedoc2 View Post
hi
i hate it when u post a question and no one replies
i don't know the ans but i will check it up.
in the mean time i need to devise a way to keep the light, electron and immunofluorescent patterns of the numerous renal pathologies straight! i have read them over and over yet keep mixing them up.
have u figured a way yet?
has anyone figured a way yet???
I'm telling you, big books RULE!!

Anyways, it is very nicely explained in like the first 2 pages on the Robbins Basic pathology book (the medium sized one). A simple look at the image in the kidney chapter says more that 1,000 words.

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Old 08-19-2011
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Default AIN/hypersensitivity nephritis

Both humoral and cell-mediated immune reactions are implicated in the pathophysiology of acute interstitial nephritis
Patients who have acute interstitial nephritis due to nonsteroidal anti-inflammatory drugs (NSAIDs) typically present with features of minimal change disease, including fusion of foot processes.

Patients invariably present with an abrupt onset of renal dysfunction. Patients with other symptoms are much less uniform in their presentation. Possible presentations include the following:
  • Recent etiological exposure (eg, drugs, infection) can cause acute interstitial nephritis at any time following exposure.
  • Fever is present in 60-100% of patients.
  • Patients with tubulointerstitial nephritis-uveitis (TINU) usually present with a 2- to 3-week history of uveitis. Uveitis may precede nephritis, occur subsequent to nephritis, or occur simultaneous with nephritis.
  • Patients with NSAID-associated acute interstitial nephritis have a history of NSAID use, and symptoms of nephrotic syndrome may be present (eg, lower extremity edema, lethargy).

Frequently, nothing unusual is discovered on physical examination. The two most common findings are rash and fever.
  • The rash is frequently described as maculopapular, although, in allopurinol-related acute interstitial nephritis, it is sometimes exfoliative.
  • Fever is present in 60-100% of cases.

  • Urine is often examined for eosinophils, but this method lacks adequate sensitivity and specificity. One study found a positive predictive value of 38%. Regular urine microscopy must be supplanted with specific stains for eosinophils (Hansel stain).
  • Eosinophilia may be present, but this is also an unreliable diagnostic finding.
  • Urinalysis often reveals sterile pyuria with microscopic hematuria. Proteinuria is often present, but the quantity varies greatly, ranging from nephrotic levels in patients with NSAID-associated acute interstitial nephritis (AIN) to less than 1 g/d in others.
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Old 08-19-2011
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Default thanks

thanks i will check it up!

Quote:
Originally Posted by tootsie View Post
I'm telling you, big books RULE!!

Anyways, it is very nicely explained in like the first 2 pages on the Robbins Basic pathology book (the medium sized one). A simple look at the image in the kidney chapter says more that 1,000 words.

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  #7  
Old 08-19-2011
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Default

ok..that was good.

so to put it in short,

Renal papillary necrosis:
presentation: flank pain,fever,acute renal failure ,or obstruction symptoms
diagnosis: protienuria,pyuria,bactiuria,and sloughed papillae
classical ct findings

nsaid induce nephropathy:
presents: rash fever
diagnosis eiosinophil raised,hematuria and sterile pyuria

Acute interstial nephritis: muddy brown granular casts , anything more????
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