Flashcards in Pathology 3 Deck (17):
What is chronic kidney disease?
structural or functional abnormalities in kidney lasting 3 months or longer
What are the different stages of ckd?
stage 1: kidney damage with normal or relatively high GFR (at least 90)
stage 2: mild reduction in GFR (60-89)
Stage 3: moderate reduction in GFR (30-59)
stage 4: severe reduction in GFR (15-29)
stage 5: established kidney failure (GFR less than 15 or dialysis)
What is uremia?
azotemia associated with constellation of clinical signs and symptoms
What are causes of established CKD in the US?
cystic kidney diseases and interstitial nephritis
diabetes and HTN account for >60%
What are the clinical manifestations of advanced uremia?
accumulation of nitrogenous waste products
HTN and cerebral manifestations
What are the general clinical manifestations of CKD?
urine output to virtually nothing
patients survived only weeks before dialysis era
What does sclerosis do in glomerular diseases?
reduces glomerular filtration
elevated serum creatinine and BUN
example is hypertensive nephrosclerosis
What does tubular damage lead to that means ATI can cause AKI?
arteriolar vasoconstriction - further reduces GFR
cast formation and tubular obstruction blocks urine outflow
back leak of tubular fluid
reduced ultra filtration
What are the four different classifications of renal cell carcinoma in order of decreasing frequency?
Chromophobe renal cell
What is seen grossly for clear cell carcinoma?
large spherical expansile mass
bright yellow with areas of hemorrhage and necrosis
What is clear cell carcinoma?
sporadic or familial (VHL gene on ch 3)
What is seen on LM with clear cell carcinoma?
tumor cells with clear cytoplasm that form solid sheets or trabecular and tubular structures
prominent delicate vasculature
What is papillary carcinoma?
frequently multifocal and bilateral
sporadic or familial (activation of MET gene on ch 7 = tyrosine kinase receptor for growth factor)
What does one see microscopically in papillary carcinoma?
papillae formation with fibrovascular cores
cells have pink or clear cytoplasm
What is seen in chromophobe renal cell carcinoma?
grossly tan brown
combo of clear and pink cells with wrinkled raisinoid nuclei and perinuclear halos
What are the different types of renal stones?
calcium oxalate or calcium phosphate - most due to idiopathic hypercalciuria
magnesium ammonium phosphate (struvite) - ppl with alkaline urine from UTIs esp proteus
uric acid - gout and leukemias, acid urine favors uric acid stone formation