Pathology Flashcards by Molly Kat

……. is a syndrome characterized by a rapid deterioration of renal function (typically within days to a week), resulting in the accumulation of nitrogenous wastes in the blood that would normally be excreted in the urine.

Acute kidney injury

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ACUTE KIDNEY INJURY/ACUTE TUBULAR
INJURY is characterized by inc of which substances?

increase in blood urea nitrogen (azotemia) increase in serum creatinine
oliguria(low urine output)

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What is the reason for prerenal acute kidney injury?

Inadequate kidney perfusion

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Reason of inadequate kidney perfusion?

-More advanced volume depletion
➢ excessive volume loss (renal, gastrointestinal or cutaneous origin)
➢ low fluid intake
➢ low effective circulating volume (cardiorenal syndrome)

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ACUTE TUBULAR INJURY-Prerenal causes?

-Hypotension
• Hypovolemia associated with hemorrhage or fluid loss (e.g., burns)
• Sepsis
• Inadequate cardiac output (e.g., myocardial infarct [heart attack])
• Renal vasoconstriction (e.g., caused by NSAIDs or radiocontrast agents)
• Renal artery stenosis

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What is the outcome of prerenal acute tubular injury ?

• OUTCOME: INADEQUATE RENAL PERFUSION, DECREASE IN FILTRATION PRESSURE, DECREASE IN GLOMERULAR FILTRATION
RATE

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Hypotension associated with Hypovolemia or shock may cause the activation of which nervous system ?

Activation of Sympathetic nervous system, renin-angiotensin-aldosterone system activation, which leads to Vasoconstriction in the renal vasculature—> increased resistance —> dec flow and dec blood pressure

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NSAIDs leads to a pathological………. renal arterioles leading to a decrease in GFR

ACE inhibitors leads to a pathological………. renal arterioles leading to a decrease in GFR

Vasoconstriction of afferent

Vasodilation of efferent

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……is one of the most common causes of acute kidney injury and the injury results from a combination of prerenal and intrarenal factors.

Sepsis

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Which part of the kidney is mainly is mainly involved in pyelonephritis ?

Renal pelvis

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In cases of tubulointerstitial nephritis caused by bacterial infection, the renal pelvis is prominently involved: this is known as ……….

Pyelonephritis

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Tubulointerstitial nephritis cases that are nonbacterial in origin are known as ………………. (Caused by drugs, metabolic disorders such as hypokalemia, irradiation, viral infections, and immune reactions)

INTERSTITIAL NEPHRITIS

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What type of bacteria is Escherichia coli : the most common cause of acute pyelonephritis?

Enteric gram negative bacilli

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What is the mode of transportation in in acute pyelonephritis?

*ascending infection (from the lower urinary tract): Most important source

bloodstream

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What is acute pyelonephritis pathogenesis?

Adhesion to the urothelial lining by bacterial FIMBRIAE

—> bacterial colonization of the lining—>

Colonies reaching the bladder (opposite to the flow of urine; during urethral instrumentation, including catheterization and cystoscopy)

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Why do UTI most commonly affect females even in the absence of instrumentation?

Due to the close proximity of the female urethra to the rectum( colonization by enteric bacteria)

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Which clinical manifestation is associated with poor prognosis of acute pyelonephritis?

Papillary necrosis

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What are the histological morphology of Acute pyelonephritis?

1)necrosis and abscess formation within the renal –parenchyma-
pus formation (suppuration) in the tubular lumina—> neutrophils in collecting duct—> white blood cells in urine.

(Typically, the glomeruli are not affected.)
PYONEPHROSIS:Filling of the renal pelvis, calyx, and ureter with pus

2) papillary necrosis: due to diabetes, UT obstruction, or sickle cell anemia
—> poor prognosis

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If bacteriuria is not treated during pregnancy, ………… will occur.

symptomatic UTI (leading to pyelonephritis)

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Why does acute pyelonephritis occur in men with advanced age?

Increasing prostatic hyperplasia BPH —>Urinary outflow obstruction

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What are the symptoms of acute pyelonephritis?

-Flanking dull pain in costovertebral area that extends to umbilicus
- chills, fever, nausea, malaise (systemic sympt)
-dysuria, frequency, and urgency (UT sympt)
-unilateral involvement (early stage)
- no renal failure
-papillary necrosis(poor prognosis)
-pyuria(WBC in urine) & nitrates in urine

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Asymmetric contractions (Atrophy) of the kidneys is present in ……….

Chronic pyelonephritis

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Symmetrical Kidney scarring occurs in …….

Chronic glomerulonephritis vascular necrosis

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What is the main histological finding in chronic pyelonephritis?

Fibrosis

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What are the histomorphological features of chronic pyelonephritis?

Fibrosis inflammatory infiltrate of lymphocytes, plasma cells, eosinophils, and occasionally neutrophils, Eosinophilic casts Dilation or contraction of tubules, with atrophy of the epithelial lining (PAS positive casts-colloid casts) thyroidization in tubules Arteriolosclerosis (Hypertension) Glomerulosclerosis (causes nephron loss)

What are the clinical features of chronic pyelonephritis?

Kidney Atrophy (The affected kidneys are asymmetrically contracted) Tubular dysfunction Polyuria( urinating more than usual) Nocturia( urinating during sleep)

Azotemia?

Inc blood urea nitrogen Inc creatinine Dec GFR

Uremia?

Worsening of kidney function Occurs due to azotemia

Nephrotic syndrome is characterized by which manifestations?

Proteinuria(increased protein in urine <3.5) Hypoalbuminemia (dec plasma albumin in blood<3] Edema Hyperlipidemia (increased lipids in blood) Lipiduria (increased lipids in urine)

A person presents with proteinuria (inc. of protein in urine), generalized edema, hypoalbuminemia(dec plasma albumin in blood), hyperlipidemia &lipiduria, which kidney syndrome does this person have?

NephrOtic syndrome

A person presents with hematuria*( presence of blood&WBC casts in urine), proteinuria (inc. of protein in urine), azotemia , hypertension*, which kidney syndrome does this person have?

Nephritic syndrome

……….. is the only upper respiratory tract infection that needs treatment and causes acute glomerulonephritis?

Rheumatic fever

What are the clinical manifestations of asymptomatic hematuria or (NON-NEPHROTIC PROTEINURIA)?

IgA nephropathy, Alport syndrome

Which type of kidney injury is characterized by hyperphosphatemia, dyslipidemia, and metabolic acidosis

CHRONIC KIDNEY DISEASE

Which disease is characterized by pain and hematuria without red blood cell casts

Nephrolithiasis

What is nephrolithiasis?

formation of stones in the collecting system

fixed =intrinsic glomerular antigens or with extrinsic molecules that are planted in the glomerulus occur in which type of glomerular injury mechanism?

antibodies reacting in situ within the glomerulus

Which type of hypersensitive reaction occurs in glomerular injury?

Type 3 hypersensitivity

The complement activation system, which is a pathway of antibody-initiated glomerular injury, is activated via which pathway?

Classical pathway using the C5b-C9 membrane attack complex

planted antigens → which cause granular pattern of deposition, occurs in which type of immune mediated injury?

Glomerulonephritis Caused by Immune Complexes Formed in SITU

Give an example of Anti-Glomerular Basement Membrane Antibody–Mediated GN Immune mediated injury (antibodies are directed against fixed antigens causing a *linear pattern*)?

Goodpasture disease(causes renal injury)

Glomerulonephritis Caused by Immune Complexes Formed in Situ causes (granular/linear) pattern deposition of antigens

Granular immunofluorescence

*Anti-Glomerular Basement Membrane Antibody–Mediated glomerulonephritis* (e.g. Goodpasture disease) causes (glomerular/linear) pattern deposition of antigens?

Linear immunofluorescence

The ...........is also crucial to the maintenance of glomerular barrier function

podocyte

Alport syndrome, diabetes mellitus, systemic lupus erythematosus, all of these syndromes may have an affect on which part of the nephron?

GLOMERULUS

what are the two forms of antibody-associated injury ?

(1) injury resulting from deposition of soluble circulating antigen-antibody complexes in the glomerulus and (2) injury by antibodies reacting in situ within the glomerulus, either with insoluble fixed (intrinsic) glomerular antigens or with molecules planted within the glomerulus

Mechanisms of Glomerular Injury and Disease: Mediators of Immune Injury are activated by which pathway?

classical pathway

Causes of nephrotic syndrome?

-(Imp) Minimal-change disease (**most common in children) -*Focal segmental glomerulosclerosis – when the glomerulus becomes scarred.(**most common in Heroin addicts) -*membranous neuropathy: immune system attacks glomerular basement membrane GBM -Membranous glomerulonephritis(**most common in adults) -diabetes milletus.

……. is the initiating event of primary FOCAL SEGMENTAL GLOMERULOSCLEROSIS (FSGS)?

Injury to podocytes (then hyalinosis which causes sclerosis/hardening of glomeruli)

Which Syndrome is characterised by the derangement(change) In the capillary walls of the glomeruli resulting in —>increased permeability of the glomerular basement membrane to plasma proteins

NephrOtic syndrome

Which syndrome is characterized by the *inflammation of glomeruli* caused by proliferation of cells within the glomeruli accompanied by an infiltrate of leukocyte, *due to antibody-antigen complexes being present in the glomeruli*

Nephritic syndrome (i for inflammation)

Since both focal segmental Glomerulosclerosis FSGS and minimal change disease are associated with podocyte injury and nephrOtic syndrome, what is the difference between them?

FSGS is associated with hematuria, hypertension, proteinuria, and can develop End-stage renal disease more than Minimal change disease

Which disease is characterised by subepithelial immunoglobulin-containing deposits along the Glomerular basement membrane resulting in diffuse thickening of the capillary wall?

Membranous neuropathy (dense deposit disease)

Antibodies against the podocyte antigen phospholipase A2 receptor (PLA2R) are frequently present in which disease?

Membranous neuropathy (or dense deposit disease

What is the immunofluorescence microscopy staining of membranous neuropathy?

Granular deposits of immunoglobulins and compliments along the glomerular basement membrane

which nephrotic disease is most common in adults?

Membranous glomerulonephritis

which nephrotic disease is most common in children (2-3 yrs of age)?

minimal change disease

common finding in spontaneous abortion?

polyploidy

what causes acute urinary obstruction?

urethral stones

what causes chronic urinary obstruction?

prostatic hyperplasia

what are the causes of nephritic syndrome?

-an infection – such as HIV or hepatitis. -lupus erythematous -postinfectious glomerulonephritis -crescentic glomerulonephritis -primary glomerular disease

which layer of the glomerular corpuscle is damaged in nephrotic syndrome?

epithelial layer (it's where podocytes are found)

patients with *deep vein thrombosis and pulmonary embolisms* are known to have which glomerular syndrome?

NephrOtic syndrome

Plasmocytes are found in ..,,…

Chronic endometritis

Polymorphonuclear leukocytes are found in ………

Acute endometrisis

What is the most common malignant germ cell tumor?

Dysgermynoma

Schiller-Duval body is a characteristic patern in histopathology of which tumor?

Endodermal sinus tumor

Call – Exner body is an important microscopic finding and E2 and inhibin B are tumor markers for this tumor?

Granulosa cell tumor

What is an eg of mucinous carcinoma characterized by accumulation of intra-abdominal mucin (presence of mucin in the abdominal (peritoneal) cavity.)secretions and the morbidity is secondary to intestinal obstruction.

Pseudomixoma peritonei

What is the most common benign epithelial cell neoplasm?

Serous cystadenoma

What is the most common benign solid tumor of the ovary and may coexist with meigs syndrome (ascites + hydrothorax + benign ovarian tumor) ?

Fibromas

What is an imp marker that can differentiate benign from malignant tumors in Adnexal masses?

CA125

Papillary necrosis is an important finding in ……..?

Acute pyelonephritis and diabetic people

What are the findings in acute pyelonephritis?

WBC casts and papillary necrosis

Hemolytic anemia, thrombocytopenia, and renal failure are seen in …….

Thrombotic microangiopathies TMA (hemolytic Uremic syndrome)

…… loss of chromosomes 1 and Y →distinguish them from other renal neoplasms

Oncocytoma

Occupational exposure to cardimium ….

Renal cell carcinoma

……. Contains features the triad of → painless hematuria, a palpable abdominal mass, and dull flank pain is characteristic

Chromophobe-type renal cell carcinoma

............... is a common cause of recurrent kidney stones, hypercalcemia, and hypophosphatemia

hyper PTH

,,,,,,,,,,,,,,,is a spherical, yellow tumor on gross examination. On cut section, it is golden yellow in color due to high lipid content. presence of areas of hemorrhage, necrosis, and calcifications. it may invade perinephric fat and renal vein. On histology, this kidney neoplasm may show cuboidal or polygonal cells with clear cytoplasm. it cause hematuria and hypertension. Which kidney neoplasms is this?

Hypernephroma (clear cell renal cell carcinoma)

which type of renal carcinoma is associated with von hippel-Lindau disease?

clear cell carcinoma(most common)

mutations of the MET germ line and chrom. 7q are a common finding in which kidney neoplasm?

familial cases of Papillary renal cell carcinoma

which syndrome causes manifestations such as polycythemia, hypertension, hyperparathyroidism, painless hematuria?

Paraneoplastic syndromes of Renal cell carcinoma

what is the most common bladder tumor?

non-invasive papillary (urolethelial) tumor

which type of neoplasms in the bladder causes intestinal metaplasia?

adenocarcinoma of the bladder

which type of neoplasms in the bladder causes extensive keratinization?

squamous cell carcinoma of the bladder

where is the inflammation occurring in acute tubular injury?

proximal tubules

corpora amylacea is present in which disease?

benign prostatic hyperplasia

what are the clinical symptoms of benign prostatic hyperplasia?

hesitancy urgency frequency nocturia

where in the prostate does BPH occur?

inner transitional zone

an imp complication of vulvitis is ...........?

Bartholin cyst and abscess formation

which disease of the vulva affects postmenopausal woman and prepubertal girls and is characterized by the disappearance of rete pegs and leukoplakia (white plaques)?

Lichen sclerosus

what is an imp histopathological finding of lichen simplex chronicus?

elongated rete ridges

condylomata acuminata is caused by ?

HPV 6 and 11

which disease is characterized by intraepidermal proliferation of atypical epithelial cells that occurs in vulva or nipple of breast?

extramammary paget disease

...........is seen in MPGN type I .........is seen in MPGN type Ii .............is seen in MPGN type Iii

deposits in subendothelial areas dense deposit disease subepithelial and subendothelial

Pathology Flashcards

(96 cards)