Kidney Pathology

Question 1

Does renal dialysis and transplantation increase survival from renal disease in all groups?

Answer 1

No, only in certain groups

In older populations, conservative management has similar survival rates

Question 2

What are the differential diagnoses for generalised oedema?

Answer 2

Kidney failure
Heart failure
Liver failure
Respiratory failure with cor pulmonale

Question 3

What is the significance of glucosuria in kidney disease?

Answer 3

Not unusual to get a little glucosuria in kidney disease

Question 4

What are the hallmarks of nephrotic syndrome?

Answer 4

Proteinuria
Low albumin
Peripheral oedema

Question 5

What can renal biopsies be used to diagnose?

Answer 5

Glomerular diseases
Tubular diseases
Interstitial diseases
Vascular diseases

Question 6

Why should you have someone on hand to check that you have glomeruli in your biopsy sample?

Answer 6

They can be missed

Question 7

What part of the kidney is required for biopsy?

Answer 7

Cortex

Question 8

What does a silver stain show?

Answer 8

Collagen

Question 9

What is the pathological hallmark of minimal change disease?

Answer 9

Effacement of basement membrane of glomerulus, seen only on electron microscope

Question 10

What is the significance of a recent sore throat prior to presentation with a kidney issue?

Answer 10

Possible post-streptococcal glomerulonephritis

Question 11

What is active urine sediment?

Answer 11

On urine dipstick

• 3+ protein
• 3+ erythrocytes

Question 12

What should be done if there is active urine sediment?

Answer 12

In context of acute renal impairment, urgent action required

Question 13

What are the two patterns of immunofluorescence seen in the glomerulus, and what do they mean?

Answer 13

Granular > IgA nephropathy

Linear > Goodpasture’s syndrome

Question 14

What does the presence of crescents in the glomeruli imply?

Answer 14

Much more serious degree of nephropathy

Question 15

What are the possible causes of acute renal failure?

Answer 15

Glomerular lesions
- Rapidly progressive/crescentic glomerulonephritis
Tubular lesions = acute tubular necrosis
- Ischaemic
- Toxic
Acute tubulo-interstitial nephritis
Vascular lesions
- Emboli
- Thrombotic microangiopathy

Question 16

What is cANCA staining more specific for?

Answer 16

Granulomatosis with polyangiitis

Question 17

What is pANCA staining more specific for?

Answer 17

Microscopic polyangiitis

Question 18

A 20-year-old male presents with haematuria. Renal biopsy shows mesangial hypercellularity and an increase in mesangial matrix with electron dense deposits in the mesangium. Which of the following is likely to predominate in these mesangial deposits on immunofluorescence or immunohistochemical staining of glomeruli?

Answer 18

IgA

Question 19

A 46-year-old male with leukocytoclastic vasculitis diagnosed on skin biopsy, cough with haemoptysis, pauci-immune crescentic glomerulonephritis and positive serology for pANCA is most likely to have…

Answer 19

Microscopic polyangiitis

Question 20

When are renal biopsies performed in the context of diabetes?

Answer 20

Proteinuria excessive, usually at least 1 g/day

Question 21

What finding on renal biopsy is pathognomonic of diabetic nephropathy?

Answer 21

Kimmelsteil-Wilson nodules

Question 22

Are spontaneous mutations causing autosomal dominant polycystic kidney disease common?

Answer 22

Not common, but not as uncommon as you’d expect

Question 23

Is kidney failure avoidable in adult polycystic kidney disease?

Answer 23

No, it’s inevitable

Question 24

Presence of which modifiable risk factor accelerates the progression to kidney failure in adult polycystic kidney disease?

Answer 24

HTN

Question 25

What is it called when you have normal sized kidneys with cysts?

Answer 25

Multicystic kidney disease

Question 26

What is the microscopic appearance of glomerulonephritis?

Answer 26

Neutrophil infiltration

Glomeruli and tubules relatively intact

Question 27

What is the worry with complex renal cysts seen on ultrasound?

Answer 27

Almost always malignant, especially when they light up with contrast on CT

Question 28

A 52-year-old man is diagnosed with systemic hypertension. Investigations reveal significantly elevated serum creatinine and the presence of a large polycystic kidneys. Compared to the general population, this man is more likely to have or develop what?

Answer 28

Intracranial berry aneurysm

Question 29

Why aren’t berry aneurysms often not screened for in the context of adult polycystic kidney disease?

Answer 29

What will you do about it, if it’s found?

Question 30

When may you screen for berry aneurysms in the context of adult polycystic kidney disease?

Answer 30

FHx of ruptured aneurysm

Question 31

A 72-year-old man presented with a several week history of shortness of breath and fever. He was found to also have hypertension and polycythaemia. Chest x-ray revealed features suggestive of pulmonary metastases. If a biopsy of one of the lung lesions revealed a tumour composed of cells with clear cytoplasm containing glycogen, between which were many thin-walled blood vessels, the primary site is most likely to be in which of the following organs?

Answer 31

Kidney