CVPR First Aid: Renal pathology Flashcards

Question

Examples of nephritic-nephrotic syndrome

Answer 1

Diffuse proliferative glomerulonephritis Membranoproliferative glomerulonephritis

Answer 2

Focal segmental glomerulosclerosis (1° or 2°) Minimal change disease (1°or 2°) Membranous nephropathy (1° or 2°) Amyloidosis (2°) Diabetic glomerulonephropathy (2°)

Answer 3

Podocyte disruption → charge barrier impaired Massive proteinuria (\>3.5g/day) Hypoalbuminemia Hyperlipidemia Edema May be 1°(direct podocyte damage) or 2° (podocyte damage from systemic process [eg, diabetes))

Answer 4

Severe nephritic syndrome with profound GBM damage that damages the glomerular filtration charge barrier → nephrotic-range proteinuria (\>3.5 g/day) and concomitant features of nephrotic syndrome Can occur wuth any form of nephritic syndrome but is most commonly seen with Diffuse proliferative glomerulonephritis Membranoproliferative glomerulonephritis

Answer 5

Nephrotic syndrome - massive proteinuria (\> 3.5 g/day) with hypoalbuminemia, resulting edema, hyperlipidemia Frothy urine with fatty casts Disruption of glomerilar filtration charge barrier may be 1° or (eg,direct sclerosis of podocytes) or 2°(systemic process [eg diabetes] secondarily damages podocytes)

Answer 6

May present with nephrotic syndrome features (nephritic-nephrotic syndrome) if damage to GBM is severe enough to damage the charge barrier

Answer 7

Associated with hypercoaguable state due to antithrombin III (AT III) loss in urine and ↑ risk of infection (loss of immunoglobulins in urine and soft tissssue compromise by edema)

Answer 8

Minimal change disease

Answer 9

Lipoid nephrosis

Answer 10

Often 1° idiopathic and may be triggered by recent infection, immunization, immune stimulus Rarely 2° to lymphoma (eg, cytokine-mediated damage)

Answer 11

1° disease has excellent response to corticosteroids

Answer 12

normal glomeruli (lipid may be seen in PCT cells)

Answer 13

Effacement of podocyte foot processes

Answer 14

Most common cause of nephrotic syndrome in African-Americans and Hispanics

Answer 15

Can be 1° idiopathic or 2° to other conditions (eg, HIV, Sickle Cell disease, heroin abuse, massive obesity, interferon treatment or congenital malformations)

Answer 16

1° disease has inconsistent responses to steroids

Answer 17

immunofluorescence

Answer 18

Can progress to CKD

Answer 19

Segmental sclerosis and hyalinosis

Answer 20

Often (-) but may be positive for non-specific focal deposits of IgM, C3 and C1

Answer 21

Effacement of podocyte foot processes similar to minimal change disease

Answer 22

Focal segmental glomerulosclerosis

Answer 23

Membranous glomerulonephritis

Answer 24

Membranous nephropathy

Answer 25

Can be 1° (eg, antibodies to phospholipase A2 receptor) or 2° to drugs (eg, NSAIDs, penicillamine, gold) Infections (eg, HBV, HCV and syphilis), SLE or solid tumors

Answer 26

1° disease has poor response to steroids

Answer 27

Can progress to CKD

Answer 28

Diffuse capillary and GBM thickening

Answer 29

Granular due to IC deposition

Answer 30

"spike and dome" appearance of subepithelial deposits

Answer 31

Kidney is the most commonly involved organ (systemic amyloidoisis)

Answer 32

Associated with chronic conditions that predispose amyloid deposition (eg, AL amyloid, AA amyloid)

Answer 33

Congo red stain shows apple-green bifringence under polarized light due to amyloid deposition in the mesangium

Answer 34

End-stage renal disease

Answer 35

Diabetic glomerulonephropathy

Answer 36

Most common cause of ESRD in the U.S

Answer 37

Hyperglycemia → nonenzymatic glycation of tissue proteins → mesangial expansion; GBM thickening and ↑ permeability Hyperfiltation (glomerular HTN and ↑GFR) → glomerular hypertrophy and glomerular scarring (glomerulosclerosis) leading to further progression of nephropathy

Answer 38

Mesangial expansion GBM thickening Eosinophilic nodular glomerulosclerosis Kimmelstiel-Wilson lesions picture 580

Answer 39

Nephritic syndrome = inflammatory process When glomeruli are involved, leads to hematuria and RBC casts in urine

Answer 40

Azotemia Oliguria HTN (due to salt retention) Proteinuria Hypercellular/inflamed glomeruli on biopsy

Answer 41

Most frequently seen in children

Answer 42

2-4 weeks after group A streptococcal infection of pharynx or skinn Type III hypersensitivity reaction

Answer 43

* Resolves spontaneously in most children * May progress to renal insufficiency in adults

Answer 44

Presents with * peripheral and periorbital edema * cola-colored urine, * HTN, * (+) strep titers/serologies * ↓ complement levels (C3) due to consumption

Answer 45

Glomeruli enlarged and hypercellular

Answer 46

(Starry sky) granular appearance ("lumpy-bumpy") due to IgG, IgM and C3 deposition along GBM and mesangium

Answer 47

Presents with peripheral and periorbital edema, cola-colored urine, HTN, (+) strep titers/serologies, ↓ complement levels (C3) due to consumption

Answer 48

Subepithelial immune complex IC humps

Answer 49

Poor prognosis Rapidly deteriorating renal function (days to weeks) Several disease processes may result in this pattern which may be delineated via IF pattern Linear IF due to antibodies to GBM and alveolar basement membrane: Goodpasture syndrome- hematuria and hemoptysis; type II hypersensitivity reaction Negative IF/Pauci-immune (no Ig/C3 deposition): granulomatosis with polyangiitis (Wegner) - PR3-ANCA/c-ANCA Or Microscopic polyangiitis- MPO-ANCA/p-ANCA Granular IF-PSGN or DPGN

Answer 50

Glomeruli enlarged and hypercellular

Answer 51

(Starry sky) granular appearance ("lumpy-bumpy") due to IgG, IgM and C3 deposition along GBM and mesangium

Answer 52

Subepithelial immune complex IC humps

Answer 53

Several disease processes may result in this pattern which may be delineated via IF pattern Goodpasture syndrome - linear IF Granulomatosis with polyangiitis (Wegner) - pauci-immune Microscopic polyangiitis - granular

Answer 54

Goodpasture syndrome- hematuria and hemoptysis; type II hypersensitivity reaction

Answer 55

Granulomatosis with polyangiitis (Wegner) - PR3-ANCA/c-ANCA

Answer 56

Microscopic polyangiitis- MPO-ANCA/p-ANCA

Answer 57

plasmapheresis

Answer 58

Crescent moon shape Crescents consist of fibrin and plasma proteins (eg, C3b) with glomerular parietal cells, monocytes and macrophages

Answer 59

Poor prognosis Rapidly deteriorating renal function (days to weeks)

Answer 60

Rapidly progressing glomerulonephritis

Answer 61

Often due to SLE (think "wire lupus") DPGN and MPGN often present as nephrotic syndrome and nephritic syndrome concurrently

Answer 62

"wire looping" of capillaries

Answer 63

Subendothelial and sometimes intramembranous IgG-based ICs often with C3 deposition

Answer 64

Berger disease

Answer 65

Episodic hematuria that occurs concurrently with respiratory or GI tract infections (IgA is secreted by mucosal linings) Renal pathology of IgA vasculitis (HSP)

Answer 66

Mesangial proliferation

Answer 67

IgA-based IC deposits in mesangium

Answer 68

Mesangial IC deposition

Answer 69

Most commonly X-linked dominant mutation in Type IV collagen → thinning and splitting of glomerular basement membrane

Answer 70

Eye problems (eg, retinopathy, lens dislocation) Glomerulonephritis Sensorineural deafness "can't see, can't pee, cant hear a bee"

Answer 71

Mutation in Type IV collagen → thinning and splitting of glomerular basement membrane

Answer 72

"Basketweave"

Answer 73

MPGN is a nephritis syndrome that often co-presents with nephrotic syndrome Type I may be 2° to hepatitis B or C infection May also be idiopathic Subendothelial IC deposits with granular IF Type II is associated with C3 nephritic factory (IgG antibody that stabilizes C3 convertase → persistent complement activation → ↓ C3 levels Intramembranous deposits, also called dense deposit disease In both types mesangial outgrowth → GBM splitting → "tram-track" appearance on H&E and PAS stains

Answer 74

Calcium Ammonium magnesium phosphate Uric acid Cystine

Answer 75

Can lead to severe complications such as hydronephrosis, pyelonephritis

Answer 76

Obstructed stone presents with unilateral flank tenderness, colicky pain radiating to groin, hematuria

Answer 77

Encouraging fluid intake

Answer 78

Calcium oxalate stone in patient with hypercalciuria and normocalcemia

Answer 79

Can occur wuth any form of nephritic syndrome but is most commonly seen with Diffuse proliferative glomerulonephritis Membranoproliferative glomerulonephritis

Answer 80

Mutation in Type IV collagen → thinning and splitting of glomerular basement membrane

CVPR First Aid: Renal pathology Flashcards

(116 cards)