Pathology Flashcards
1
Q
nephrotic syndromes
A
- minimal change disease
- FSGS
- membranous nephropathy
- diabetic nephropathy
- amyloidosis
2
Q
nephritic syndromes
A
-post-strep
glomerulonephritis
-berger’s (IgA) nephropathy
-diffuse proliferative glomerularnephritis
-crescentic GN (RPGN)
-Alport syndrome
-Membranoproliferative glomerulonephritis (MPGN)
3
Q
nephrotic w/ foot process effacement
A
minimal change disease
FSGS
4
Q
immune complex deposition
A
membranous nephropathy
membranoproliferative glomerulonephritis
5
Q
mesangium deposition
A
diabetic nephropathy
amyloidosis
6
Q
SLE related nephrotic syndrome
A
membranous nephropathy
7
Q
SLE related nephritic syndrome
A
diffuse proliferative glomerulonephritis
*MOST COMMON SLE SYNDROME
8
Q
thin/split BM
eye/ear disturbances
A
ALPORT SYNDROME
type IV collagen defect, nephritis
9
Q
selective proteinuria
A
minimal change disease
loss of albumin due to heparin sulfate loss
10
Q
exquisite sensitivity to steroids
A
minimal change disease
11
Q
minimal change sx but no response to steroids
A
FSGS
12
Q
HIV, sickle cell, heroin
A
FGSG
13
Q
- thick BM
- subEPITHELIAL IC deposits (spike and dome)
- absence of hypercellularity
- (good prog in child, bad prog in adults
A
membranous nephropathy
14
Q
anti-phospholipase A2 receptor Abs
A
membranous nephropathy
15
Q
FSGS response to steroids
A
POOR, prog to chronic renal failure
16
Q
membranous nephropathy response to steroids
A
POOR, prog to chronic renal failure
17
Q
- recurrent hematuria
- thick BM, focal sclerosis (mesangial)
- nodular sclerosis (KIMMELSTIEL-WILSON BODIES)
- preferential hyaline arteriosclerosis in EFF a.
A
diabetic nephropathy
18
Q
diabetic nephropathy MOA
A
hyperglycemia –> nonenzymatic glycation of tissue proteins –> mesangial expansion
GBM thickening/inc perm
hyperfiltration (glomerular HTN and inc GFR) –> glomerular hypertrophy and scarring
19
Q
most comm cause ESRD in US
A
diabetic nephropathy
20
Q
deposits in mesangium (B-pleated sheets)
- congo red –> apple-green birefringence
A
amyloidosis
21
Q
SLE
solid tumors
Hepatitis (B/C)
nephrotic syndrome
A
membranous nephropathy
22
Q
nephrOtic sx
A
- proteinuria (>3.5 g/dl) –> FROTHY urine
- hypOalbuminemia
- hyperlipidiemia (fatty casts/oval bods)
- hypercoaguability (AIII loss)
- dec plasma oncotic P so fluid leaks into tissues –> dec ECV/GFR, inc RAAS –> EDEMA (LE, peri-orbital)
- infections (loss of Ig)
23
Q
tx of which nephritic syndrome is usu supportive bc IC dissipate out
A
post-strep glomerulonephritis
24
Q
M protein virulence fx
peripheral/periorbital edema
HTN
cola urine
A
post-strep glomerulonephritis
25
2-3 weeks post infection
post-strep glomerulonephritis
26
```
subEPITHELIAL humps ("lumpy-bumpy"), deposition
capillary loops w/ neutrophils
```
post-strep glomerulonephritis
27
dec complement levels (C3) due to infection
post-strep glomerulonephritis
type II membranoproliferazive glomerulonephritis
28
nephrITIC syndrome
- INFLAMM process damaging ENTIRE glomeruli
- damaged filtration barrier --> dec GFR --> inc BUN/Cr
- oliguria
- inc hydrostatic P --> HTN, edema
- filtration barrier to RBCs/protein lost (HEMATURIA)
- ->salt retention (periorbital edema +HTN)
- EM: hypercellular (neutrophils)
- UA: RBC casts (glomerular bleeding), dysmorphic RBCs
29
all nephritic syndrome have sub_____ deposition, except _______, which has sub_____ deposition.
all nephritic syndrome have subENDOTHELIAL deposition, except POST-STREP GN, which has subEPITHELIAL deposition.
30
repeated mucosal (resp/GI) infec --> Ig deposition in. mesangium --> repeated hematuria
slowly worsening renal func (BUN/Cr) over time
IgA nephropathy
31
nephritic syndrome days after infec
IgA nephropathy
32
cirrhosis
celiac
HIV
IgA nephropathy
33
IgA nephropathy w/ extra renal involvement
Henoch-Scholein Purpura
(HSPI)
deposition occurs outside kidney (GI, skin)
34
IgA nephropathy - glomeruli only
Berger disease
35
capillary loops THICKENED
| subendothelial deposition
diffuse proliferative glomerulonephritis
36
fever/rash/arthritis
| immune complex deposition (subendo)+thickened capillary loops
IgA nephropathy
37
post strep glomerulonephritis can progress to
crescentic GN (RPGN)
38
finding of inflammatory debris (FIBRIN + macrophages)
crescentic GN (rapidy progressive glomerulonephritis)
39
lupus nephritis
"full house deposition" (IgG/M/A, complement)
dx: ANA and anti-dsDNA
40
crescentic GN
Crescents composition/location
crescents in Bowman's space
fibrin + macrophages
41
crescents + ribbon like IgG deposition
anti-GBM
| Goodpasture
42
crescents + granular IgG deposition
PSGN
SLE
IgA
MPGN (idiopathic)
43
crescents + negative IF, ANCA+
```
pauci-immune
Werger granulomatosis (c-ANCA), microscopic polyangitis or Churg-Strauss (p-ANCA)
```
44
type IV collagen defect (alpha 3,4,5)
alport syndrome
45
```
thick BM
prolif mesangial cell matrix
varying renal func
chronic deposition of immune complexes
double contours, hyper cellular, subendoethelial or within BM deposition
```
membranoproliferative glomerulonephritis (MPGN)
46
MPGN (types !, II)
membranous nephropathy
location of deposits?
MPGN I --> subENDOthelial
MPGN II --> w/i BM
membranous nephropathy --> subEPIthelial
47
tram track GBM
membranoproliferazive glomerulonephritis (MPGN)
48
```
thick BM
prolif mesangial cell matrix
tram tracks
hepatitis B/C or idiopathic
sub endothelial Ig depsoits w/ granular IF
```
```
membranoproliferazive glomerulonephritis (MPGN)
type I
```
49
```
thick BM
prolif mesangial cell matrix
tram tracks
low levels of circulating C3
IF: no IgG
```
```
membranoproliferazive glomerulonephritis (MPGN)
type II
```
50
cyroglobulins
sign of active hep C
think MPGN
51
```
membranoproliferazive glomerulonephritis (MPGN)
type II MOA
```
assoc w/ C3 nephritic factor (AutoAb) --> stabilizes C3 convertase --> alternative path --> overactive complement --> buildup in GBM + inflammation
LOW circulating C3 levels
52
palpable abd mass
hematuria
flank pain
usu clear cell histo
renal cell CA
53
loss of VHL (tumor suppressor)
renal cell CA
*can also be sporadic (male, smokers)
54
renal cell CA origin
PCT cells
55
yellow mass
| highly vascular. often hemorrhage
renal cell CA
56
most common renal malignancy young child
Wilm's tumor
| nephroblastoma
57
epithelium, storm, blastema on histo
wilms tumor
58
WT1 tumor suppressor mut
Wilms tumor
59
assoc w/ wilms
wagr syndorme
beckwith wiedmann syndrome
denys-drash syndrome
60
WAGR
```
wilms tunmor
aniridia (iris absence)
genital anomalies
mental retardation
deletion of WT1 gene chrom 11
```
61
ped overgrowth disorder
- wilms
- neonatal hypoglycemia
- macrosomia
- muscular hemihypertrophy
- organomegaly (tongue)
beck with wiedemann
62
diffuse mesangial sclerosis
dysgenesis of gonads (male pseudohermaphroditism)
WT1 mut
Denys drash syndrome
63
hamartoma (vessels/smc/adipose)
benign tumor (young children)
cardiac rhabodomyomas
ash-leaf patches
angiomyolipma
64
tumor assoc w/ tuberous sclerosis
angiomyolipoma
65
benign epithelial neoplasm arising from CD
tumor oncocytic cells (eos+ granular cytoplasm)
NESTS/CORDS, myxoid stroma
oncocytoma
66
tan, well-circumscribed tumor
oncocytoma
67
malignancy assoc w/ L sided varicocele
renal cell CA
68
bladder (urothelial carcinomas)
older adults
infiltrative, difficult to completely excise
recurring
UA: hematuria w/o casts
69
transitional cell CA
most common
multifocal/recurrent ("field defect") damage to entire urothelium
old/white/smoker
NO casts in urine
flat or papillary
tx: chemo (platinum), surgery, radiation
70
tumor that is ideally tx w/ surgery (non-responsive to chemo)
renal cell CA
71
rare, need chronic inflammation of BLADDER
risk fx:
mult kidney stones
UTI (schisto)
squamous cell CA( metaplasia --> dysplasia --> squamous cell CA)
72
rare, glandular prolif of bladder
risk fx:
urachal remnant (dome of bladder-umbilicus)
long hx cystitis
exstrophy
adenocarcinoma
73
types of urothelial CA
transitional cell CA
squamous cell CA
adenocarcinoma
74
tumor with large eos cells with abundant mitochondria without perinuclear clearing
oncocytoma
75
ATN histo
dilated, denuded tubules (lacking cells)
occasional mitotic figures
76
acute interstitial nephritis
tubular atrophy
thickened BM
lymphocytes/eos/macrophages
77
mononuclear cell infiltration
| mild inc BUN/Cr
chronic interstitial nephritis
78
ESRD histo
diffuse and global glomerulosclerosis
inc glomerular mesangial cellularity/matrix
collapse of capillary tufts and capillary luminal closure
tubular atrophy
79
gross hematuria
normal renal function
sloughing of tissue
if in isolation--> no WBC casts
papillary necrosis
| coagulative necrosis of renal papillae
^where pyramids empty into CD system --> ureter
80
ischemia of renal cortex
acute onset severe renal failure
seen in very sick patients
oliguria--> anuria
cortical necrosis
81
inc doses of phenacetin, aspirin, coffee
lg calcified scars, sloughed papilla --> obstruction
chronic inflammation
analgesic nephropathy
82
tumor lysis syndrome can lead to ____ nephropathy
urate nephropathy
83
yellow blue birefringent crystals
urate nephropathy; gout
84
distended tubules w/ pus (neutrophils and cellular debris)
| interstitial microabsesses
acute pyelonephritis
UA: pyuria, WBC casts, hematuria
85
Vesicoureteral reflex is a risk fx for
chronic pyelonephritis
86
thyroidization
chronic pyelonephritis
87
```
atrophic tubules
eos protein material
fibrosis
sclerosed glomeruli
cortical atrophy
distorted pelvocalyceal system
```
chronic pyelonephritis
88
beads on a string
fibromusclular dysplasia
89
thickened intimal layer
| hyalinzed arteriole
benign hyaline arteriolosclerosis
90
concentric arteriolopathy (vasculopathy)
arterioles w/ concentric hyperplasia of media
91
punctuate small holes under renal capsule
flea bite kidney
benign arteriosclerosis
92
fibrinoid necrosis of arterial wall
thromboses
irreversible
malignant HTN
