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SS- Renal > Path Pictures > Flashcards

Path Pictures Flashcards

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1
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hyaline sclerosis due to high BP

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2
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arterionephrosclerosis: end stage hypertensive nephropathy

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3
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fibrinoid necrosis of arterioles (far end of hyaline sclerosis) leading to necrosis of glomeruli

Malignant HTN

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4
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onion skin: proliferation of intimal cells in small arterie

Hyperplastic arteriosclerosis due to malignant HTN

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5
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flea-bitten kidney: damgae of small arteries and arterioles

Malignant HTN

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6
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proliferative glomerular disease

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7
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membranous glomerular disease

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8
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membrano-proliferative glomerular disease

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9
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crescentic disease

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10
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11
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necrotized and organizing glomerulus

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12
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glomerulosclerosis: fibrous scar replacing glomerulus

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13
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segmental glomerulosclerosis

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14
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normal RBC in urine

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15
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dysmorphic RBC in urine

nephritic syndrome

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16
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oval fat bodies

Nephrotic

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17
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MCD: normal looking

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18
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MCD: effacement and detachment of foot processes

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19
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MCD: effacement of foot processes

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20
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FSGS

one segmentally involved glomerulus, 2 uninvolved glomeruli

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21
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FSGS

bottom: hyalinosis
left: adhesion of involved segment to Bowman capsule

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22
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FSGS

green arrow: hyalinosis

black: small accumulation of hylanosis

Hyalinosis: accumulation of leaked plasma protein and lipids

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23
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foot process effacement

FSGS: just like MCD

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24
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collapsing FSGS

left: collapsed BM with 2 adhesions
right: EM of collapsing FSGS

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25
thickened BM without increased cells membranous nephropathy
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membranous nephropathy thick BM with subendothelial depostis separated by spikes of new GBM Spike and dome
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membranous nephropathy thick BM with subendothelial deposits (blue) separated by spikes of new GBM
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PSGN diffuse endocapillary proliferation and infiltration by neutrophils
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PSGN dome shaped subepithelial humps (blue)
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MPGN enlarged glomeruli, increased mesangial matrix and cellularity thickened, split BM: tram track
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MPGN with abundant mesangial matrix
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MPGN highlighting increased cellularity
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MPGN silver stain: highlights thickened split BM due to new membrane fromation and deposits in BM
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MPGN depostis in BM
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MPGN: Dense Deposit Disease dense dark material in glomerular BM
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Goodpasture's: right: linear left: necrotizing crescentric glomerulonephritis, not specific
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rapidly progressive (crescentic) glomerulonephritis
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rapidly progressive (crescentic) glomerulonephritis can be Goodpasture's or other immune complex (pauci-immune)
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type II crescentic glomerulonephritis
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Pauci-immune crescentic glomerulonephritis type III
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hereditary nephritis Alport syndrome BASKETWEAVE: thin BM with splintering of lamina densa
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hereditary nephritis/Alport basket weave
43
segmental transmural necrotizing vasculitis top arrows: neutrophils bottom arrow: fibrinoid necrosis of vessel wall Polyarteritis nodosa
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renal arteriogram with infarct polyarteritis nodosa
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white arrow: renal infarct black arrow: arterial aneurysms red arrow: hole in kidney: lead to hypotension polyarteritis nodosa
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numbers: multinucleated giant cells blue haze: necrosis necrotizing granulomatous inflammation granulomatosis with polyangiitis
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vascular necrosis and thrombosis granulomatosis with polyangiitis
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crescentic glomerulonephrtiis granulomatosis with polyangiitis
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crescentic glomerulonephrtis granulomatosis with polyangiitis
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arrow: thrombosed capillary thrombotic microangiopathy in glomerulus
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thrombosed arteriole thrombotic microangiopathy
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mesangial proliferative lupus nephritis class II: mild
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focal proliferitive lupus nephritis class III: moderate
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diffuse proliferative: lots of excess cells (inflammatory, mesangial, capillary endothelial cells) lupus nephritis class IV: severe
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diffuse proliferative: wireloop lesions, hyaline thrombosis in capillary Lupus nephritis class IV: severe
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diffuse proliferative: gamaged glomerulus, crescent formation, excess cells of various types lupus nephritis class IV: severe
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membranous lupus nephritis class V: nephrotic
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subendothelial and mesangial deposits lupus nephritis
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subendothelial deposits Lupus nephritis
60
intimal thickening of interlobar arteries: ONION SKIN scleroderma: systemic sclerosis
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enlarged, pale cortex, congested medulla (esp. at cortico-medullary junction) acute tubular necrosis
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cortical hemorrhages acute tubular necrosis
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normal renal tubules
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blebbing of luminal side cell membranes: an early ischemic change acute tubular necrosis
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diffuse edema of tubular cells: vacuolization acute tubular necrosis (also seen in osmotic diuresis)
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loss of brush border and flattening of epithelium (1,2,3) necrosis and sloughing of epithelial cells (4) acute tubular necrosis
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necrosis and sloughing of tubular cells mixing into casts with proteinaceous material acute tubular necrosis
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muddy brown granular cast acute tubular necrosis
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apoptosis of tubular epithelial cells (less common that coagulative necrosis) acute tubular necrosis
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flattened epithelium and necrosis and sloughing of epithelium 1 and 2: myoglobin from rhabdomyolysis
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vacuoliztion black arrow: calcium oxalate acute tubular necrosis Dx: Ethylene glycol
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right arrow: cast debris left: mitosis recovery phase of acute tubular necrosis
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dark red congestion and areas of light tan suppurative inflammation some with necrosis and some with coalescing abscesses (upper right) Acute pyelonephritis
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congestion with mild hemorrhage, heavy infiltration by leukocytes (PMNs) acute pyelonephritis
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diffuse infiltration by leukocytes (PMNs) acute pyleonephritis
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early renal abscesses severe acute inflammation and necrosis but not much liquefaction dimples in cortex: liquefaction acute pyelonephritis
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nuclear debris from breakdown of dead cells, especially neutrophils cracks: later abscesses will have holes in them renal abscess acute pyelonephritis
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acute papillary necrosis acute pyelonephritis complication
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pyonephrosis and perinephric abscess acute pyelonephritis complication
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healing by scar formation and deformation of calyx complication of acute pyelonephritis
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scarring chronic pyelonephritis depressions: due to scarring through entire parenchyma
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inflammation, primarily lymphocytes and plasma cells, primarily interstitial chronic pyelonephritis
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thyroidization: fibrosis and tubules distended with insipissated urine chronic pyelonephritis
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edema, lympohcytes, macrophages, neutrophils, EOSINOPHILS interstitial nephritis
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right: variavle tubular damage and edema left: inflammatory cells
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chronic interstitial nephritis and papillary necrosis analgesic nephropathy
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elderly females longterm combination analgesic use analgesic nephropathy: papillary necrosis
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AD (adult) polycystic kidney disease
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AR (infant) polycystic kidney disease
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nephronophthisis: meduallary cystic disease
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medullary sponge kidney common and benign
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hydronephrosis with marked dilatation of renal caylces secondary to compresion of renal parencyma urinary tract obstruction
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adenoma
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oncocytoma MAHOGANY BROWN, STELLATE scar
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modified tubular cells, nuclei big and regular, no mitotic figures oncocytoma
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Oncocytoma mahogany brown, stellate scar
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mitochondria oncocytoma
99
solitary, polar, yellow, with cysts, necrosis, hemorrhage clear cell carcinoma
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solitary, polar, yellow with cysts, necrosis, hemorrhage clear cell carcinoma
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solitary, polar, yellow with cysts, necrosis and hemorrhage clear cell carcinoma
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clear cell carcinoma small nuclei, clear cell, no mitotic figures
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tiny nuclei, no nucleoli, no mitotic figures, eosinophilc cytoplasm clear cell carcinoma
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small regular nuclei low grade clear cell carcinoma
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variable irregular nuclei high grade clear cell carcinoma
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papillary carcinoma
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renal cystic disease due to dialysis papillary carcinoma
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finger like papillary carcinoma
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big tumor, lots of hemorrhage chromophobe carcinoma
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chromophobe carcinoma thick walled vessels
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Hale's collidal iron stain chromophobe carcinoma
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central location renal pelvis carcinoma: urothelial or transitional cell
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renal pelvis carcinoma: urothelial/transitional cell hyperchromatic nuclei extending into lumen and invading submucosa
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renal pelvis carcinoma: squamous cell
115
Wilm's tumor/nephroblastoma
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Wilm's tumor
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Wilm's tumor blastema: all of background of image epithelial: abortive glomeruli or tubules clear cells lower left: stromal component: fibroblastic cells with young myxoid light blue matrix around them
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tumors all over metastatic renal cell carcinoma RARE
119
small cell carcinoma from lung in glomerulus looks like crescentic glomerulonephritis: know it isn't because of Hx metastatic renal cell carcinoma
120
sickle cell anemia blue: sickle cells black: howell jolly red: target cell
121
glomeruli largely occluded by sickled RBC extensive congestionin peritbular capillaries Sickle cell nephropathy
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glomerulomegaly and mesangial expansion tubular epithelial hemosiderin accumulaiton interstial fibrosis and vascular sclerosis Sickle cell nephropathy
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renal artery thrombosis in sickle cell: rare to thrombose large vessels in SICKLE cell nephropathy
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hyaline eosinophilic; glomerulus and arterial wall amyloidosis
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CONGO RED + amyloid in glomerulus often has false negatives
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amyloid kidney CONGO RED under polarized light: APPLE GREEN BIREFRINGENCE
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amyloid immunoperoxidase stain often has false postitives
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bone marrow; plasmacytosis arrow: perinuclear Hof of plasma cell Plasma cell dyscrasis AL amyloid
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Bence jones protein precipitate in urine or in tubules and tubular epithelial cells can coalesce into a syncytium around them AL amyloid
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AB2M amyloid
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AB2M amyloid
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nodular glomerulosclerosis resembling diabetic nephropathy deposits along outer part of tubular BM may be seen Light chain disease
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endothelial side depostion: sand on beach light chain disease
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collapsing FSGS HIV associated nephropathy
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prominent microcystic tubular dilation, interstitial inflammation and fibrosis collapsed glomeruli HIV associated nephropathy
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membranoproliferative glomerulonephrtits; can have pseudo-thrombi in capillaries cryoglobulinemia
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normal glomerulus
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diffuse mesangial thickening: early diabetic nephropathy
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hyaline sclerosis of arteriole and small nodular lesion diabetic nephropathy: late
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141
kimmelstiel wilson lesion and small capsular drop diabetic nephropathy: later
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BM thickening of capsule and glomerular capillaries and nodule Diabetic Nephropathy
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fibrin cap exudative lesions (red): crescentic depostis of condensed leaked plasma protein overlying peripheral capillaries between endothelial cell and BM or BM and epithelial cells diabetic nephropathy
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thickened arteriole with aneurysm and capsular drop capsular drop: ONLY in diabetic glomerulopathy, deposits of plasma protein and BM in parietal layer of Bowman's capsule protruding into urinary space
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numerour nodular lesions: Kimmelstiel-Wilson nodules diabetic nephropathy Nodulat glomerulosclerosis: correlates with renal failure
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END STAGE diabetic nephropathy: looks like hypertensive nephropathy diffuse fine granularity of cortical surface

SS- Renal (11 decks)

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