PATH exam Flashcards
Name a systemic disease in which you may see MPGN-type renal disease.
It can occur in association with SLE, hepatitis B or C antigenemia, and alpha1-antitrypsin deficiency.
What are predisposing factors for developing necrotizing papillitis?
Compromised blood supply (eg, diabetes mellitus, sickle cell anemia), acute pyelonephritis with obstruction, nephritis associated with analgesic abuse.
What is the survival rate for Wilms tumor?
The survival rate for Wilms tumor is 90% with treatment combining chemotherapy, radiation, and surgery.
What is the Whipple triad?
1) Symptoms of hypoglycemia are present, especially confusion, stupor, or loss of consciousness. 2) Hypoglycemia is present, typically glucose less than 50 mg/dL. 3) Attacks are precipitated by fasting or exercise and are promptly relieved by administration of glucose.
Are WBC casts seen only in acute pyelonephritis?
The presence of WBC (neutrophils) in casts indicates that acute tubular inflammation of the kidney is present. Thus, they may also be seen in acute tubulointerstitial nephritis and acute tubular necrosis.
What would the IF show in this segmentally sclerotic focus (focus segmental glomerulosclerosis)?
IF will be positive in the sclerotic focus, which will stain with antibodies to IgM and C3.
Why do medullary carcinomas not arise within the thyroid isthmus or thyroglossal duct remnants?
C cells migrate separately from follicular cells embryologically. C cells migrate from the neural crest to the lateral thyroid lobes; follicular cells migrate from the midline tongue base down the anterior neck.
Compare and contrast clinical features of goiter with those of thyroid neoplasms.
Goiters generally have multiple nodules. Peak occurrence is during menstruating years of women, and patients are usually euthyroid. Thyroid neoplasms generally are solitary masses. They occur in patients over a wider age range than do goiters; patients are also usually euthyroid (although the nodule itself may be cold). Fixation to adjacent structures and hoarseness due to invasion of the recurrent laryngeal nerve are findings of advanced carcinoma.
Is FSGS the result of immune complex injury?
No. The basic lesion in primary FSGS is disruption of visceral epithelial cells by unknown mechanisms. The sclerosis and entrapment of plasma protein, including IgM and C3, are nonspecific. They result from hyperpermeability at sites of epithelial cell damage.
What does the abrupt enlargement of the thyroid nodule indicate?
Abrupt enlargement of a thyroid nodule usually indicates hemorrhage into a pre-existing goiter nodule, though hemorrhage into a neoplasm can also occur spontaneously. Most thyroid neoplasms are slow-growing, but the uncommon anaplastic carcinoma grows visibly in the course of weeks.
What do you expect to see on electron microscopy (EM) of IgA nephropathy?
The EM will show mesangial deposits.
What is the pathogenesis of necrotizing papillitis?
This complication requires the presence of three factors: (1) acute pyelonephritis (2) obstruction to urine flow, as with a stone or neurogenic bladder in diabetes (3) compromised blood supply, as with diabetes or sickle cell anemia. It results from a combination of ischemia and infection. Ischemia in diabetes results from microangiopathy, and diabetics are also more prone to infections.
What are the opposites of diffuse and global with respect to renal pathology?
Diffuse is the opposite of focal. Global is the opposite of segmental.
In what area are the deposits located, in membranous glomerulopathy?
The deposits are located in the outer aspect of the glomerular basement membrane (GBM) under the visceral epithelium of the Bowman capsule. Thus, they are subepithelial.
Compare and contrast primary and secondary parathyroid hyperplasia.
Histologically similar, but clinically quite different. Primary - autonomous high PTH causes hypercalcemia; treated surgically (excise 3 1/2 glands). Secondary - hypocalcemia (most often due to renal failure) stimulates parathyroid hyperplasia; treated by calcium supplementation (or renal transplantation).
What are other causes of asymptomatic hematuria?
Alport syndrome and thin glomerular basement membrane (GBM) disease are also associated with asymptomatic hematuria.
How do you confirm that this patient has IgA GN?
You confirm the diagnosis by IF staining with anti-IgA.
What is the pathogenesis of acute pyelonephritis?
Acute pyelonephritis is caused most commonly by enteric gram-negative rods that reach the kidney by ascending infection. This type of infection is favored by instrumentation (eg catheters) and by obstruction in the lower urinary tract (eg, prostate enlargement). Incompetence of the vesicoureteral valve is also important, because reflux of urine from the bladder allows the infection to move upward to the kidney.
What is the classic triad of presenting symptoms of renal cell carcinoma?
The classic triad of presenting symptoms is: (1) Costovertebral angle pain (2) Palpable mass (3) Hematuria. However, these are seen together in only 10% of patients. Most reliable is hematuria, seen in 90%.
Are the spikes part of the deposits?
No. The spikes are part of the GBM that lies between the deposits.
What is the biochemical stimulant to hyperplasia in goiter?
Goiters usually form when some derangement that hampers thyroid hormone output causes compensatory elevation of the TSH level. The TSH causes hyperplasia and hypertrophy of thyroid epithelium.
What other lab test can narrow the diagnosis in crescentic GN (aside from IF)?
Antineutrophil cytoplasmic antibody (ANCA). ANCA is negative in type I and type II crescentic GN, and it is positive in type III.
What characteristics are seen in late stages of FSGS?
dense glomerular sclerosis and more interstitial fibrosis, tubular atrophy, and chronic inflammation
What are the complications of stones?
Stones in the ureter may cause intense pain (renal colic); they may cause hematuria, and, most importantly, they predispose to urinary tract infection.
