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Pathology I Flashcards

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1
Q

What is nephritis?

A

Inflammation of the kidney = infective (pyelonephritis) or non-infective (glomerulonephritis)

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2
Q

What is glomerulonephritis?

A

Inflammation of the glomerulus

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3
Q

What are the main causes of glomerulonephritis?

A

Immune mediated = directed at something in the glomerulus, circulating complex deposition
Related to vasculitis

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4
Q

What are some features of direct attack by the immune system causing glomerulonephritis?

A

Rare = Goodpasture’s syndrome (alpha subunit of collagen 4, IgG antibodies)

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5
Q

What are some causes of glomerulonephritis caused by circulating immune complexes?

A

Hepatitis, post-strep infection, HIV, gold, penicillamine, cancer (often lymphoma)

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6
Q

What vasculitis cause glomerulonephritis?

A

GPA = cANCA

Microscopic polyangiitis = pANCA

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7
Q

What does glomerulonephritis prevent?

A

Stop glomerular sieve working = disrupt membrane charge, block membranes

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8
Q

How is glomerulonephritis classified?

A

Nephrotic or nephritic syndrome

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9
Q

What are the features of nephritic syndrome?

A

Haematuria, hypertension

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10
Q

What are the features of nephrotic syndrome?

A

Heavy proteinuria, non-dependent oedema, hyperlipidaemia, immunosuppression, renal vein thrombosis

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11
Q

What proteins are lost in nephrotic syndrome?

A

Antibodies, complement, proteins in clotting cascade

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12
Q

How is glomerulonephritis investigated?

A

Using light microscopy, electron microscopy and immunofluorescence

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13
Q

Can the types of glomerulonephritis cause both nephrotic and nephritic syndromes depending on the person they occur in?

A

Yes = all can cause a nephritic or nephrotic syndrome but have a tendency to cause one or the other

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14
Q

What do crescents on histology mean in glomerulonephritis?

A

Poor prognostic sign = indicates rapid progression

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15
Q

What are some causes of granulomas in glomerulonephritis?

A

GPA and sarcoid

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16
Q

What does light microscopy of glomerulonephritis show?

A

Usually hypercellular = inflammatory cells and reactive proliferation
Can see sclerosis (on-going damage) or crescents
May be able to see vasculitis

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17
Q

What is the benefit of using electron microscopy in glomerulonephritis?

A

High magnification = can look at basement membrane

Can see if there are deposits and where they are

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18
Q

What does immunofluorescence show?

A

What kind of antibody is present and where it is distributed

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19
Q

What does immunofluorescence of Goodpasture’s show?

A

Linear IgG

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20
Q

What are some features of minimal change glomerulonephritis?

A

Nephrotic syndrome of unknown cause = occurs in children, good prognosis, usually resolves with steroids

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21
Q

What are some features of focal segmental glomerulosclerosis?

A

Nephrotic syndrome of adults = causes include obesity, HIV, sickle cell and IV drug use

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22
Q

What are some causes of membranous glomerulonephritis?

A

Hepatitis, malaria, syphilis, NSAIDs, penicillamine, gold, captopril, lung/colon cancer, melanoma, SLE, thyroiditis

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23
Q

How common is membranous glomerulonephritis in patients with SLE?

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A

Accounts for 15% of all glomerulonephritis in lupus patients

24
Q

What is membranous glomerulonephritis?

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A

Nephrotic syndrome of adults = thick membrane and sub-epithelial deposits

25
What is the prognosis of membranous glomerulonephritis?
Variable = slow indolent progression, <40% eventually develop renal failure
26
What is IgA glomerulonephritis?
Post-infectious nephritic syndrome = may be genetic or due to acquired defect (coeliac), prognosis depends on severity
27
How does IgA glomerulonephritis appear?
IgA deposition in mesangium
28
What causes membranoproliferative glomerulonephritis?
Idiopathic = type 2 hypersensitivity (infection, SLE, cancer), affects adults and children, either nephrotic or nephritic syndrome, prognosis depends on severity
29
What is the appearance of membranoproliferative glomerulonephritis?
Big lobulated hypercellular glomeruli with thick membranes = train track appearance
30
What conditions can diabetes cause in the kidneys?
Diffuse and nodular glomerulosclerosis Nodules = Kimmel Stiel Wilson lesions Arterial sclerosis
31
What infections can diabetes cause in the kidneys?
Pyelonephritis, papillary necrosis
32
Why is it difficult to tell cystic disease from cancer?
Many early cancers are cystic or partly cystic so is difficult to differentiate = use Bosniak score to predict cancer
33
What are some features of acquired cysts?
Very common = seen frequently at autopsy Often associated with long term dialysis Simple cysts = attenuated lining, degenerative change
34
What causes autosomal dominant polycystic kidney disease (ADPCKD)?
Uncommon = due to mutation in nephrin | Often secondary changes = haemorrhage, infarction, rupture
35
What occurs in autosomal dominant polycystic kidney disease?
Lots of cysts develop over time = kidney becomes huge | Cysts are lined by simple epithelium
36
How does autosomal dominant polycystic kidney disease present?
Mass like lesion or pain/haematuria due to secondary changes
37
What are the systemic manifestations of autosomal dominant polycystic kidney disease?
Liver cysts and cerebral aneurysms = associated with sub-arachnoid haemorrhages
38
What are the features of autosomal recessive polycystic kidney disease?
Several subtypes = all occur in childhood Kidney of normal size and has smooth surface Causes liver cysts
39
What is the only benign tumour of the kidney?
Oncocytoma
40
What are the malignant tumours of the kidney?
Chromophobe, clear cell, papillary, collecting duct
41
What tumour of the kidney occurs in the paediatric age group?
Wilm's tumour
42
How do oncocytomas appear?
Small, oval and well circumscribed Mahogany brown with central stellate scar Very pink with granular cytoplasm on histology
43
What are some features of papillary malignancy?
Second most common, low grade (type 1 and 2), finger like projections
44
What are chromophobe malignancies difficult to distinguish from?
Papillary malignancies = same histology but chromophobe has raisonoid nuclei and perinuclear haloes
45
Are chromophobe malignancies common?
No
46
What are some features of collecting duct carcinomas?
Least common, high grade appearance with very desmoplastic stroma, poor survival
47
What malignancy do most people mean when they speak of renal cancers?
Clear cell carcinomas
48
What are the risk factors for clear cell carcinomas?
Strong link to obesity, genetic influence
49
What is the presenting complaint of clear cell carcinomas?
Haematuria, mass, rarely hypertension
50
What is the macroscopic appearance of clear cell carcinoma?
Often partly cystic and very heterogenous surface = most striking feature is bright yellow tumour surface
51
What is the microscopic appearance of clear cell carcinomas?
Clear cells = artefact of processing and relate to cell hypoxia
52
How is clear cell carcinoma staged?
Size and then invasion of other structures
53
What structures do clear cell carcinomas tend to invade?
Propensity of renal vein involvement | Can even extend into vena cava and grow up towards heart
54
What is VHL associated with?
Responsible for most sporadic renal cancers = codes for hypoxia inducible factor (HIF)
55
How do VHL and HIF interact normally?
VHL ubiquinates HIF = in low 02 they dissociate and HIF acts as a transcription factor for VGEF, PDGFRB and EPO
56
What pathologies make up VHL syndrome?
``` Renal cell carcinoma Cerebellar haemangioblastoma Pancreatic serous cystadenoma Tumours of the endolymphatic sac Epididymal serous cystadenomas ```
57
What is xanthogranulomatous pyelonephritis?
Specific infection that creates a mass in the kidneys

Renal (36 decks)

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