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Flashcards in Pathology - renal Deck (41):
1

RBC casts

glomerulonephritis, malignant hypertension

2

WBC casts

tubulointerstitial inflammation, acute pyelonephritis, transplant rejection

3

fatty casts

Nephrotic syndrome

4

granular casts

acute tubular necrosis

5

Waxy casts

end-stage renal failure

6

Nephritic syndrome

sign of GBM disruption

incr. BUN/Cr, oliguria, hematuria, RBC casts

Causes: acute post-streptococcal, rapidly progressive glomerulonephritis, IgA nephropathy, Alport syndrome, membranoproliferative glomerulonephritis

7

Nephrotic syndrome

podocyte disruption --> charge barrier impaired

Massive proteinuria w/ low serum albumin, incr. lipids, edema, can lead to hyperthrombotic state (loss of antithrombin-3)

primary podocyte damage: PSGS, MCD, membranous nephropathy

secondary podocyte damage: amyloidosis, diabetic glomerulonephropathy

8

Peripheral/periorbital edema 2 weeks after GABHS infection, cola-colored urine, hypertension

Hypercellular glomeruli
IgG/IgM/C3 deposition along GBM and mesangium

Acute post-streptococcal glomerulonephritis

Subepithelial immune complex humps (Type III reaction!)

9

Rapidly deteriorating renal function, hematuria

crescents of fibrin and plasma proteins (C3b), with glomerular parietal cells, monocytes, macrophages

RPGN (incl Goodpasture's, Wegener's c-ANCA, microscopic polyangiitis p-ANCA)

10

SLE, presents often as nephrotic and nephritic syndromes concurrently

wire looping of capillaries
immune complex deposition
granular appearance on IF

Diffuse proliferative glomerulonephritis

**most common cause of death in SLE

11

Renal insufficiency and gasteoenteritis (Henoch-Schonlein Purpura)
Episodic hematuria

mesangial proliferation

IgA nephropathy

mesangial IgA-based IC deposits in mesangium

12

Eye problems, glomerulonephritis, sensorineural deafness

thinning of GBM

Alport syndrome

Type IV collagen defect

X-linked

13

Copresentation of nephritic and nephrotic syndrome

Membranoproliferative glomerulonephritis

Type 1: subendothelial IC deposits, tram-track appearance (GBM splitting)
Type 2: intramembranous IC deposits, C3 nephritic factor

14

Most common cause of nephrotic syndrome in AAs/Hispanics, secondary to sickle cell/HIV/heroin abuse/obesity

FSGS

segmental sclerosis, effacement of podocyte foot processes

inconsistent response to steroids

15

Most common cause of nephrotic syndrome in children, lots of triggers

MCD

normal glomeruli but podocyte effacement

may be secondary to lymphoma, excellent response to steroids

16

Most common cause of nephrotic syndrome in Caucasian adults, lots of triggers, assoc w/ SLE and solid tumors (lung, colon)

Diffuse granular capillary and GBM thickening, spike and dome appearance with subepithelial deposits, can have antibodies to podocyte transmembrane proteins

Membranous nephropathy

nephrotic presentation of SLE, poor response to steroids

17

Congo red stain shows apple green bifringence

Amyloidosis

Nephrotic syndrome

18

Diabetic glomerulonephropathy

Mesangial expansion, GBM thickening, esoinophilic nodular glomerulosclerosis

Glycosylation of GBM --> incr. permeability and thickening

Glycosylation of efferent arterioles --> incr. GFR --> mesangial expansion

19

Kidney stones seen in pt w/ hypercalciuria and normocalcemia

Envelope or dumbbell-shaped calcium oxalate stones

Calcium stones

Oxalate: ethylene glycol poisoning, Vit. C abuse, malabsorption, precipitate at low pH

tx: hydration, thiazides, citrate, pyridoxine, low protein diet

20

Kidney stones seen in pt w/ infection by urease + bugs (proteus, klebsiella, staph sapro)

Coffin lid-shaped stones

Struvite (ammonium magnesium phosphate)

Commonly form staghorn calculi

21

Kidney stones seen in pt w/ dehydration or incr. cell turnover

Rhomboid-shaped or rosettes

Uric acid

tx: allopurinol, alkalinization of urine, low protein diet

22

Kidney stones in pt w/ loss of cystine-reabsorbing PCT transporter

Hexagonal shaped

Cystine stones

Hexagonal shaped

Mostly seen in children, with positive sodium cyanide nitroprusside test, and they also have aminoaciduria

tx: alkalinization of urine

23

Renal cell carcinoma pathology

PCT cells, polygonal clear cells filled with accumulated lipids and carbs/glycogen

invades renal vein then IVC and spreads hematogenously

gene deletion on Ch.3 (sporadic or von Hippel Landau)

assoc. with lots of paraneoplastic syndromes

24

Renal oncocytoma

Benign epithelial cell tumor

Large eosinophilic cells with abundant mitochondria without perinuclear clearing

25

Wilms tumor

large, palpable, unilateral flank mass

loss of function of tumor suppressors WT1/WT2

May be part of Beckwith-Wiedemann or WAGR (wilms, aniridia - absence of iris, GU malformation, mental retardation)

26

SCC of bladder

chronic irritation of bladder (Schistosoma haematobium infection)

presents with painless hematuria

27

Causes of UTIs

E. coli
Staph sapro
Klebsiella
Proteus - ammonia scent

nitrites in gram negatives (E. coli)

negative cultures suggest urethritis

28

Pyelonephritis

neutrophils infiltrate renal interstitium

striated parenchymal enhancement on CT

complications: renal papillary necrosis, perinephric abscess, urosepsis

29

Chronic pyelonephritis

vesicoureteral reflux or chronic kidney stones

asymmetric corticomedullary scarring, blunted calyx

tubular can contain eosinophilic casts resembling thyroid tissue (thyroidization of kidney)

30

Signs of drug-induced interstitial nephritis

Pyuria and azotemia

Drugs act as haptens, inducing hypersensitivity

31

Muddy brown granular casts

Acute tubular necrosis

3 stages: inciting phase, maintenance phase, recovery phase

ischemic - decr. renal blood flow (hypovolemia, shock)
nephrotoxic - toxins, crush injury, hemoglobin, most common in PCT

32

Gross hematuria and proteinuria

Renal papillary necrosis

Seen in SAND...
sickle cell, acute pyelonephritis, NSAIDs, diabetes

33

incr. Cr and incr. BUN

acute kidney injury

34

FENa values for AKI

2% = intrinsic renal, postrenal

35

Low Vit. D, low serum Ca, high serum PO4

renal osteodystrophy

36

ADPKD

autosomal dominant, mutation in PKD1

assoc. w/ berry aneurysms, mitral valve prolapse, benign hepatic cysts

37

ARPKD

infantile polycystic kidney disease

congenital hepatic fibrosis, can lead to Potter sequence

38

Progressive renal insufficiency with inability to concentrate urine

Medullary cystic disease

not visualized, but shrunken kidneys on ultrasound

39

Anechoic cysts vs. solid components

Simple vs. complex renal cysts

Simple are filled w/ ultrafiltrate
Complex are septated, enhanced or solid, and must be removed due to incr. risk of RCC

40

Evaluating metabolic alkalosis

First, assess urine chloride (low = vomiting), then volume status

Three most common causes: vomiting/NG suction, thiazide/loop diuretic use, mineralocorticoid use

41

Hemolytic uremic syndrome (HUS)

s/p E.coli (O157:H7) or Shigella infection

toxins injure endothelium of preglomerular arterioles, leading to platelet aggregation and formation of microthrombi (shear stress --> hemolysis)

Look for thrombocytopenia, anemia and AKI