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CVPR > CVPR First Aid: Renal pathology > Flashcards

CVPR First Aid: Renal pathology Flashcards

1
Q

Are there urine casts in acute cystitis with pyuria

A

No casts

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2
Q

RBC casts indicate

A

Glomerulonephritis

Hypertensive emergency

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3
Q

WBC casts are indicative of?

3 listed

A
  • Tubulointerstitial inflammation
  • Acute pyelonephritis
  • Transplant rejection
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4
Q

Fatty casts are indicative of?

A

Nephrotic syndrome

Associated with “maltese cross” sign

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5
Q

Granular (“muddy brown”) casts are associated with?

A

Acute tubular necrosis

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6
Q

Acute tubular necrosis AKA

A

ATN

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7
Q

Waxy casts are indicative of?

A

End-stage renal disease/chronic renal failure

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8
Q

Hyaline casts are indicative of?

A

Nonspecific

Can be a normal finding

Often seen in concentrated urine samples

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9
Q

Pictures of casts

A

578

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10
Q

Nomenclature of glomerular disorders

A

Focal

Diffuse

Proliferative

Membranous

Primary glomerular disease

Secondary glomerular disease

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11
Q

Characteristics of focal glomerular disease

A

< 50% of glomeruli are involved

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12
Q

Characteristics of diffuse glomerular disease

A

>50% of glomeruli are involved

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13
Q

Characteristics of proliferative glomerular disease

A

Hypercellular glomeruli

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14
Q

Characteristics of membranous glomerular disease

A

Thickening of glomerular basement membrane (GBM)

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15
Q

Characteristics of primary glomerular disease

A

1° disease of the kidney specifically impacting the glomeruli

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16
Q

Characteristics of secondary glomerular disease

A

Systemic disease or disease of another organ system that also impacts the glomeruli

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17
Q

Examples of focal segmental glomerulosclerosis

A

Focal segmental glomerulosclerosis

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18
Q

Examples of diffuse glomerular disorders

A

Diffuse proliferative glomerulonephritis

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19
Q

Examples of proliferative glomerular disorders

A

Membranoproliferative glomerulosclerosis

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20
Q

Examples of membranous glomerular disorders

A

Membranous nephropathy

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21
Q

Examples of primary glomerular disease

A

Minimal change disease

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22
Q

Examples of secondary glomerular disease

A

SLE

Diabetic nephropathy

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23
Q

Describe nephritic syndrome

A

Due to GBM disruption

HTN

↑ BUN

↑ creatinine

Oliguria

Hematuria

RBC casts in urine

Proteinuria often in the subnephrotic range (<3.5g/day) but in severe cases can be in the nephrotic range

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24
Q

Examples of nephritic syndrome

5 listed

A

Acute poststreptococcal glomerulonephritis

Rapidly progressive glomerulonephritis

IgA nephropathy (Berger disease)

Alport syndrome

Membranoproliferative glomerulonephritis

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25
Q

Examples of nephritic-nephrotic syndrome

A

Diffuse proliferative glomerulonephritis

Membranoproliferative glomerulonephritis

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26
Q

Examples of nephrotic syndrome

A

Focal segmental glomerulosclerosis (1° or 2°)

Minimal change disease (1°or 2°)

Membranous nephropathy (1° or 2°)

Amyloidosis (2°)

Diabetic glomerulonephropathy (2°)

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27
Q

Describe nephrotic syndrome

A

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))

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28
Q

Describe nephritic-nephrotic syndrome

A

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

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29
Q

Describe the features of nephrotic syndrome

A

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)

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30
Q

Describe the features of severe nephritic syndrome

A

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

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31
Q

Nephrotic syndrome associated complications

A

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)

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32
Q

What is the most common type of nephrotic syndrome in children?

A

Minimal change disease

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33
Q

Minimal change disease AKA

A

Lipoid nephrosis

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34
Q

Most common causes of minimal change disease

A

Often 1° idiopathic and may be triggered by recent infection, immunization, immune stimulus

Rarely 2° to lymphoma (eg, cytokine-mediated damage)

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35
Q

Treatment of minimal change disease

A

1° disease has excellent response to corticosteroids

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36
Q

Minimal change disease features under Light microscopy

A

normal glomeruli (lipid may be seen in PCT cells)

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37
Q

Minimal change disease features under immunofluorescence

A

(-)

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38
Q

Minimal change disease features under Electron microscope

A

Effacement of podocyte foot processes

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39
Q

Focal segmental glomerulosclerosis prevalence

A

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

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40
Q

Causes of Focal segmental glomerulosclerosis

A

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

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41
Q

Treatment of focal segmental glomerulosclerosis

A

1° disease has inconsistent responses to steroids

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42
Q

What is IF?

A

immunofluorescence

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43
Q

Complications of Focal segmental glomerulosclerosis

A

Can progress to CKD

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44
Q

Focal segmental glomerulosclerosis under light microscopy

A

Segmental sclerosis and hyalinosis

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45
Q

Focal segmental glomerulosclerosis under immunofluoresence

A

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

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46
Q

Focal segmental glomerulosclerosis under EM

A

Effacement of podocyte foot processes similar to minimal change disease

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47
Q

What is the most common cause of nephrotic syndrome in African-Americans and Hispanics?

A

Focal segmental glomerulosclerosis

48
Q

Membranous nephropathy AKA

A

Membranous glomerulonephritis

49
Q

Membranous glomerulonephritis AKA

A

Membranous nephropathy

50
Q

Causes of Membranous nephropathy

A

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

51
Q

Treatment of Membranous nephropathy

A

1° disease has poor response to steroids

52
Q

Complications of membranous nephropathy

A

Can progress to CKD

53
Q

Membranous nephropathy under light microscopy

A

Diffuse capillary and GBM thickening

54
Q

Membranous nephropathy under IF

A

Granular due to IC deposition

55
Q

Membranous nephropathy under EM

A

“spike and dome” appearance of subepithelial deposits

56
Q

Amyloidosis

A

Kidney is the most commonly involved organ (systemic amyloidoisis)

57
Q

Amyloidosis associations

A

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

58
Q

Amyloidosis under LM

A

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

59
Q

What is ESRD?

A

End-stage renal disease

60
Q

What is the most common cause of ESRD in the US?

A

Diabetic glomerulonephropathy

61
Q

Diabetic glomerulonephropathy

A

Most common cause of ESRD in the U.S

62
Q

Causes of Diabetic glomerulonephropathy

A

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

63
Q

Features of Diabetic glomerulonephropathy under LM

4 listed

A

Mesangial expansion

GBM thickening

Eosinophilic nodular glomerulosclerosis

Kimmelstiel-Wilson lesions picture 580

64
Q

Nephritic syndrome

A

Nephritic syndrome = inflammatory process

When glomeruli are involved, leads to hematuria and RBC casts in urine

65
Q

Nephritic syndrome is associated with?

A

Azotemia

Oliguria

HTN (due to salt retention)

Proteinuria

Hypercellular/inflamed glomeruli on biopsy

66
Q

Acute poststreptococcal glomerulonephritis most commonly occurs in?

A

Most frequently seen in children

67
Q

Causes of Acute poststreptococcal glomerulonephritis

A

2-4 weeks after group A streptococcal infection of pharynx or skinn

Type III hypersensitivity reaction

68
Q

Prognosis of Acute poststreptococcal glomerulonephritis

A
  • Resolves spontaneously in most children
  • May progress to renal insufficiency in adults
69
Q

Presentation of acute post-streptococcal glomerulonephritis

5 listed

A

Presents with

  • peripheral and periorbital edema
  • cola-colored urine,
  • HTN,
  • (+) strep titers/serologies
  • ↓ complement levels (C3) due to consumption
70
Q

LM features of Acute poststreptococcal glomerulonephritis

A

Glomeruli enlarged and hypercellular

71
Q

Features of Acute poststreptococcal glomerulonephritis under IF

A

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

72
Q

Pesentation of Acute post-streptococcal glomerulonephritis

A

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

73
Q

Features of Acute post-streptococcal glomerulonephritis under EM

A

Subepithelial immune complex IC humps

74
Q

Causes of Rapidly progressive (crescentic) glomerulonephritis

A

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

75
Q

Features of Acute post-streptococcal glomerulonephritis under LM

A

Glomeruli enlarged and hypercellular

76
Q

Features of Acute poststreptococcal glomerulonephritis under IF

A

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

77
Q

Features of Acute poststreptococcal glomerulonephritis under EM

A

Subepithelial immune complex IC humps

78
Q

How to distinguish causes of Rapidly progressive (crescentic) glomerulonephritis

A

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

79
Q

Linear IF due to antibodies to GBM and alveolar basement membrane in RPG

A

Goodpasture syndrome- hematuria and hemoptysis; type II hypersensitivity reaction

80
Q

Pauci-immune IF in RPG

A

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

81
Q

Granular IF-PSGN or DPGN in RPG

A

Microscopic polyangiitis- MPO-ANCA/p-ANCA

82
Q

Treatment of Goodpasture syndrome

A

plasmapheresis

83
Q

Features of rapidly progressive (crescentic) glomerulonephritis under LM

A

Crescent moon shape

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

84
Q

Course of rapidly progressing glomerulonephritis

A

Poor prognosis

Rapidly deteriorating renal function (days to weeks)

85
Q

Crescentic AKA

A

Rapidly progressing glomerulonephritis

86
Q

Diffuse proliferative glomerulonephritis

A

Often due to SLE (think “wire lupus”)

DPGN and MPGN often present as nephrotic syndrome and nephritic syndrome concurrently

87
Q

Features of diffuse proliferative glomerulonephritis under LM

A

“wire looping” of capillaries

88
Q

Features of diffuse proliferative glomerulonephritis under IF

A

Granular

89
Q

Features of diffuse proliferative glomerulonephritis under EM

A

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

90
Q

IgA nephropathy AKA

A

Berger disease

91
Q

Describe the presentation of IgA nephropathy

A

Episodic hematuria that occurs concurrently with respiratory or GI tract infections (IgA is secreted by mucosal linings)

Renal pathology of IgA vasculitis (HSP)

92
Q

Features of IgA nephropathy under LM

A

Mesangial proliferation

93
Q

Features of IgA nephropathy under IF

A

IgA-based IC deposits in mesangium

94
Q

Features of IgA nephropathy under EM

A

Mesangial IC deposition

95
Q

Causes of Alport syndrome

A

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

96
Q

Alport syndrome symptoms

A

Eye problems (eg, retinopathy, lens dislocation)

Glomerulonephritis

Sensorineural deafness

“can’t see, can’t pee, cant hear a bee”

97
Q

Features of Alport syndrome under LM

A

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

98
Q

Features of Alport syndrome under EM

A

“Basketweave”

99
Q

Membranoproliferative glomerulonephritis

A

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

100
Q

Types of kidney stones

A

Calcium

Ammonium magnesium phosphate

Uric acid

Cystine

101
Q

Complications of Kidney stones

A

Can lead to severe complications such as hydronephrosis, pyelonephritis

102
Q

Presentation of obstructed kidney stone

A

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

103
Q

Kidney stone treatment and prevention

A

Encouraging fluid intake

104
Q

What is the most commmon kidney stone presentation

A

Calcium oxalate stone in patient with hypercalciuria and normocalcemia

105
Q

Focal segmental glomerulosclerosis nephritic or neprotic?

A

nephrotic

106
Q

Minimal change disease nephritic or nephrotic

A

nephrotic

107
Q

Membranous nephropathy nephritic or nephrotic

A

nephrotic

108
Q

Amyloidosis nephritic or nephrotic?

A

nephrotic

109
Q

Diabetic glomerulonephropathy nephritic or nephrotic

A

nephrotic

110
Q

Acute post-streptococcal glomerulonephritis nephritic or nephrotic

A

nephritic

111
Q

Rapidly progressive glomerulonephritis nephritic or nephrotic

A

nephritic

112
Q

IgA nephropathy (Berger disease) nephritic or nephrotic

A

nephritic

113
Q

Alport syndrome nephritic or nephrotic

A

nephritic

114
Q

Membranoproliferative glomerulonephritis nephritic or nephrotic

A

nephritic

115
Q

Most common types of nephritic-nephrotic syndromes

A

Can occur wuth any form of nephritic syndrome but is most commonly seen with

Diffuse proliferative glomerulonephritis

Membranoproliferative glomerulonephritis

116
Q

Describe the pathophysiology of Alport syndrome

A

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

CVPR (93 decks)

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