Clinical V Renal

Question 1

what are histological alterations of the filtration mechanism associated with glomerular injury?

Answer 1

hypercellularity
thickening of the BM
hyalinosis and sclerosis

Question 2

what are causes of glomerular kidney disorder?

Answer 2

immunological

toxic or infectious agents

Question 3

what are example of glomerular kidney disorders?

Answer 3

glomerulonephritis

IgA nephropathy

Question 4

what are some causes of tubular kidney disorders?

Answer 4

toxic
ischemia
mechanical

Question 5

what are some causes of interstitial kidney disorders?

Answer 5

infectious

medication

Question 6

what are examples of vascular kidney disorders?

Answer 6

hypertension

vasculitis

Question 7

what is acute proliferative (post streptococcal Post infectious) glomerular nephritis

Answer 7

inflammation reaction = injury of the capillary wall
there is an escape of RBCs

leads to nephrotic syndrome

Question 8

what are the symptoms associated with nephrotic syndrome?

Answer 8

hematuria
oliguria
HTN
proteinuria
edema

Question 9

where might you find Ag-Ab complexes - electron dense deposits?

Answer 9

subendothelial - circulating, granular
subepithelial - in situ, granular
membranous - in situ, linear
mesangial

Question 10

what occurs with hypercellularity in post streptococcal GN?

Answer 10

endothelial and mesangial cells
infiltration of neutrophils
crescent formation

Question 11

what can you see with immunoflourescence in post streptococcal GN?

Answer 11

GRANULAR deposits of IgG, IgM and complement along BM

Question 12

what can you see using electron micrograph in post streptococcal GN?

Answer 12

subendothelial intramembraneous and subepithelial hump against the GBM

Question 13

what is Mesangial proliferative GM (IgA nephropathy)? What population is it commonly found in? What type of injury?

Answer 13

upper respiratory tract infection
young children and adults
diffuse and global injury

Question 14

what are histological symptoms of Mesangial proliferative GM (IgA nephropathy)

Answer 14

increased mesangial maxtrix and cellularity
EM = electron dense deposits in the mesangium
IF = deposits of IgA (HALLMARK)*

associated with nephrotic syndrome

Question 15

what is nephrotic syndrome?

Answer 15

increase in permeability of the capillary wall to plasma proteins

Question 16

what are characteritstics of the PCT?

Answer 16

resorption
excretion
Mv

Question 17

what is the function of the loop of Henle in relation to the tubules?

Answer 17

create a hypertonic environment surrounding the tubules

Question 18

what are characteristics of the DCT?

Answer 18

macula densa

well developed basal foldings

Question 19

what can cause tubular and interstitial injury?

Answer 19

drugs
iodine containing contrast agents
metals
infections
hypovolemic shock

Question 20

what protein is affected in the adolescent congenital polycystic disease of the kidney?

Answer 20

fibroystin

Question 21

what type of disease is the kind that affects kids congenital polycystic disease of the kidney?

Answer 21

autosomal recessive PKD

Question 22

what protein is defective in adult congenital polycystic disease of the kidney?

Answer 22

polycystin

Question 23

what type of disease is adult congenital polycystic disease of the kidney?

Answer 23

autosomal dominant PKD

Question 24

what is the most common cause of acute tubular necrosis?

Answer 24

acute ischemia

Question 25

what can you see with light microscopy of acute tubular necrosis(tubular injury)?

Answer 25

PCT - dilated tubules and flat epithelium | loss of brush borders and infoldings

Question 26

what are common causes of acute pyelonephritis?

Answer 26

acute suppurative bacterial infection BPH pregnancy

Question 27

what will you find in light microscopy of acute pyelonephritis?

Answer 27

neutrophil infiltration of the renal interstitum and tubules

Question 28

chronic inflammation and obstruction of the drainging system (calyces, ureters) associated with acute pyelonephritis may result in what?

Answer 28

hydronephrosis /hydroureters

Question 29

what does chronic pyelonephritis result in?

Answer 29

vesicourethral reflux corticomedullary scaring papillary necrosis

Question 30

what is hydronephrosis/ hydroureters? What can it lead to?

Answer 30

obstruction of the collecting system draining the kidney | maintained pressure in the system can lead to permanent kidney damage

Question 31

what is one of the principle causes of renal failure?

Answer 31

untreated HTN

Question 32

what does increased tension in the vessels lead to?

Answer 32

thickening of the walls and reduction in the calibre of the vessel

Question 33

what can you see using light microscopy of htn?

Answer 33

thickened and eosinophilic vessel walls

Question 34

what are the risks associated with DM in kidneys?

Answer 34

infections | atherosclerosis

Question 35

what are the histological changes seen in the kidney with DM?

Answer 35

icrease mesangial matrix (KIMMELSTEIL-WILSON NODULES) | increase thickness of the basement membrane with EM

Question 36

what is the frequency of renal cell carcinoma

Answer 36

80-85% adults

Question 37

who is at risk for renal cell carcinoma?

Answer 37

males , 60-70 yo, smokers, obesity, htn

Question 38

where is the common location of renal cell carcinoma?

Answer 38

cortex - renal tubular epithelium

Question 39

how often is hematuria present with renal cell carcinoma?

Answer 39

50% of cases

Question 40

what are the symptoms of renal cell carcinoma?

Answer 40

``` flank pain ab mass prolonged fever polycythemia paraneoplastic symptoms metastases - lung, bone etc. ```

Question 41

where is the origin of renal cell carcinoma?

Answer 41

renal tubular epithelial cells (adenocarcinoma)

Question 42

what are the subtypes of renal cell carcinoma?

Answer 42

clear cell papillary (chromophil) chromophobe

Question 43

what is the growth patterns of renal cell carcinoma?

Answer 43

trabeculae or cordlike or tubular

Question 44

what kind of cells are present with renal cell carcinoma?

Answer 44

rounded or polygonal with clear or granular cytoplasm

Question 45

what types of cells are found in papillary carcinoma?

Answer 45

cuboidal or low columnar cells

Question 46

what types of cells are found in chromophobe carcinoma?

Answer 46

pale eosinophilic cells with perinuclear halo

Question 47

what is the major cause of renal artery stenosis?

Answer 47

atheromatous plaques - atherosclerosis

Question 48

what is a less common >1% cause of renal artery stenosis??

Answer 48

htn

Question 49

what will untreated renal artery stenosis result in?

Answer 49

renal atrophy

Question 50

is renal artery stenosis curable?

Answer 50

yes

Question 51

what is the htn effect due to with renal artery stenosis?

Answer 51

increased production of renin and subsequent circulation of angiotensin II