17 - Renal Pathology III Flashcards Preview

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Flashcards in 17 - Renal Pathology III Deck (53)
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1

What diseases cause asymptomatic isolated hematuria?

- IgA nephropathy(Berger Disease)
- Alport syndrome
- Thin GBM disease

2

Describe IgA nephropathy

- Most common type of primary glomerulonephritis worldwide
- Affects children and young adults
- Quite common in young adults, but NOT in African-Americans
- Causes recurrent hematuria

3

What will you see in a urinalysis of IgA nephropathy?

Mild hematuria
Mild proteinuria

4

What will you see in an LM, IF and EM of IgA nephropathy?

NEED TO KNOW ****

- LM: Mesangial proliferation
- IF: Mesangial IgA
- EM: Mesangial deposits

***

5

Describe mesengial proliferation

Mesangial hypercellularity of more than 3 cells per mesangial region

6

Describe alport syndrome

- Alport syndrome is a defect of the glomerular basement membrane due to mutation in the gene encoding for the alpha-5 chain of collagen type IV

7

What are the clinical manifestations of alport syndrome?

- Sensorineural deafness
- X-linked dominant inheritance
- Affects males, females are carriers
- Presents with microscopic hematuria
- Progresses to renal failure
- Proteinuria is a sign of progression

8

What are the key lesions of alport syndrome?

*******

- GBM thickening, splitting and lamination
- "Basket-weave" pattern

***KNOW BASKET WEAVE***

AB --> Alport = Basket

9

Describe thin GBM disease

- Benign familial (hereditary) hematuria
- About HALF of the GBM is as uniformly thin as it should be

10

What will you see on the LM, IF and EM or thin GBM disease?

LM = normal
IF = negative
EM = thin GBM

11

What are the secondary causes of glomerulonephropathies?

- SLE (lupus)
- Diabetes
- Amyloidosis

12

Describe lupus nephritis (SLE)

- Kidney is a major target of disease
- Granular immune complexes deposit in the glomerulus

13

What are the types of immune complexes that deposit in lupus nephritis?

*********

Granular immune complex deposition of IgG, IgA, IgM, C3, C4

This is the ONLY glomerular disease with ALL immunoglobin deposition *****

14

What does diabetes cause in the kindey?

Nodular glomerulosclerosis

AKA diabetic nephropathy

15

How does diabetic nephropathy present?

Can present as proteinuria, nephrotic syndrome or chronic renal failure

16

Describe amyloidosis with kindney involvement

Amyloid gets "trapped" in:
- glomeruli
- blood vessels
- tubules

17

What does amyloid deposition cause?

***

- Usually the glomerular basement membrane becomes too "leaky" to proteins and the patient gets "nephrotic syndrome"
- Kidneys appear as a big pale "waxy" kidney

NEPHROTIC ***

18

What will amyloidosis appear like under polarized light?

NEED TO KNOW *****

"Apple green birefringence"

Know this word by word ***

This apple green birefrigence appearance will be visible when stained with CONGO RED and seen under polarized light *****

19

Describe acute tubular necrosis (ANT)?

- Destruction of renal TUBULAR epithelium
- Loss of renal function
- 50% of ACUTE renal failure

This is NOT in the glomerulus, in the TUBULAR epithelium ***

20

What are the two types of acute tubular necrosis?

- Ischemia
- Nephrotoxic

Either due to lack of blood flow or toxins

21

What types of nephrotoxic substances cause acute tubular necrosis (ANT)?

- Drugs (aminoglycosides, amphotericin B, gentamycin)
- Heavy metals (mercury)
- Organic solvents (carbon tetrachloride from dry cleaners)
- Radiocontrast dyes (contrast)
- Myoglobin (rhabdomyolysis in heat stroke)

22

What are the pathologic changes seen in acute tubular necrosis (ANT)?

- Dilated tubules with flattened epithelium
- Necrotic debris in tubules

23

Describe acute interstitial nephritis

A drug induced hypersensitivity reaction

24

What can cause acute interstitial nephritis?

- Synthetic penicillins
- Rifampin
- Ibuprofen
- Thiazide diuretics

25

What happens 2 weeks after taking the drug?

***

- Fever
- Eosinophilia***
- Rash
- Acute renal failure (oligouria + increased Cr)

***

26

What are the different types of pyelonephritis?

- Ascending = MOST COMMON*** (reflux or obstruction)
- Hematogenous is also possible (from blood)

Ascending means urethra --> bladder --> ureters --> kidney --> pelvis

27

What is the most common pathogen of pyelonephritis?

E coli ***

This is only for when it comes from ascending, not blood

28

What will you see in an acute case pylonephritis?

Neutrophils

29

What will you see in chronic pyelonephritis?

Lymphocytes and scars (fibrosis)

30

What is the most common pathogen of pyelonephritis from the blood?

Staph

Hematogenous is also called "descending"

Can cause the formation of an abscess on the kidney (more commonly in hematogenous than ascending)