What is the tern used to describe the condition in which the kidneys are fused at either the upper or lower pole>
horseshoe kidney
What is the most common site of fusion for horseshoe kidney? Which direction does the hila face with this abnormality?
lower pole
anteriorly
What is the term used to describe an abnormal location of one or both kidneys?
ectopic kidney
What is the most common location of an ectopic kidney?
lower abdomen or pelvis
In what condition do cysts affect the medullary and papillary regions of the kidney but spare the cortex?
Medullary sponge kidney
Which form of PKD is autosomal recessive?
Childhood PKD
Which form of PKD is autosomal dominant?
Adult PKD
What condition is histologically characterized by large cysts lined by flattened cuboidal epithelium and an intervening parenchyma that is fibrotic with island of bluish cartilage?
Childhood PKD
Which form of PKD is more commonly associated with concurrent liver cysts?
adult PKD
What are dialysis patients with renal cysts at an increased risk for?
renal cell carcinoma
A kidney shows a large irregular tan mass with large cysts arranged around the mass. What are you looking at?
renal cell carcinoma
What disease has a proliferation of mesangial, endothelial and epithelial cells in addition to a thickening of the basement membrane?
Glomerular disease
What specific antibodies are found in glomerular disease? What other disease might produce these antibodies?
anti-GBM antibodies (GBM=glomerular basement membrane)
SLE
How do these four diseases present? lipoid nephrosis membranous glomerulopathy focal-segmental glomerulosclerosis nodular and diffuse glomerulosclerosis
as nephrotic sydrome
What disease presents as proteinuria, decreased serum proteins, increased serum lipid levels, generalized edema?
nephrotic syndrome
What is the most common cause of nephrotic syndrome in children?
lipoid nephrosis aka minimal change disease/nil disease
What disease is known to present with selective protein, in that albumin in generally the only protein commonly lost in the urine?
lipoid nephrosis/minimal change disease/nil disease
What do the glomeruli look like in lipoid nephrosis?
little to no change
hence, the name minimal change disease/nil disease
What disease reveals flattening of the foot processes with electron microscopy?
lipoid nephrosis/minimal change disease/nil disease
t/f. lipoid nephrosis involves no immune complexes
true
What is the most common cause of adult nephrotic syndrome?
membranous glomerulopathy
This disease is known to follow infections (HBV, HCV, syphilis, etc), drugs (gold therapy, captopril) and tumors (lung, colon, melanoma, lymphomas)?
membranous glomerulopathy
In which disease are the capillary loops usually thickened and prominent while the epithelial cellularity and mesangial cellularity do not increase?
membranous glomerulopathy
In which condition is the basement membrane diffusely thickened with a “spiked” appearance?
membranous glomerulopahy
What is the most common cause of nephrotic syndrome in African American?
Focal segmental glomerulosclerosis (FSG) aka focal sclerosis
This kidney disease is commonly seen in aids patients.
FSG
NSAIDs, lithium and interferon have been said to cause this kidney disease.
FSG
Which disease is known to present with non-selective proteinuria, hematuria, progress to chronic renal failure and poor response to corticosteroid therapy?
FSG
This disease is notably hypercellular and the capillary loops are poorly defined.
post-infectious glomerulonephritis
In this disease, the immune deposits are predominantly sub-epithelial, termed “humps”. The capillary lumen is filled with a leukocyte demonstrating cytoplastic granules
post-infectious glomerulonephritis
In this disease, deposits of protein collect in the basement membrane and appear in a diffuse granular pattern by immunofluorescence.
Membranous glomerulonephritis
This disease is characterized by crescents composed of proliferating epithelial cells as seen under a microscope.
rapidly progressive glomerulonephritis
What illness is characterized by “wire loop” (capillary loops) lesions?
lupus nephritis
This form of GN shows up as a crescent, due to leakage of fibrinogen into Bowman’s space, on immunofluorescence.
rapidly progressive glomerulonephritis
What is the most common cause of chronic renal failure in the US?
DM
Those with diabetic nephropathy common have this histologic change.
What is Glomerulosclerosis :)
What do we call nodular glomerulosclerosis related to diabetes?
Kimmelstiel-Wilson Disease
What is the first laboratory abnormality in diabetic nephropathy?
microalbuminuria
This condition is characterized by amyloid deposition in one or multiple organs.
amyloidosis
Under a microscope, this substance looks homogenous, highly refractive and has a high affinity for congo red dye/
amyloid
What might be present within amyloid depositions in amyloidosis?
fibrils
What condition may present with orbital ecchymosis?
amyloidosis
What condition is characterized by the presence of gross hematuria with red bloody casts ?
nephritic syndrome
also, proteinuria, HTN, azotemia, oliguria
What are the two classic diagnoses of nephritic syndrome?
post-streptococcal glomerulonephritis
crescentic glomerulonephritis
What is the most common cause of glomerulonephritis worldwide?
IgA nephropathy
What other renal pathology is most likely in presence of celiac disease?
IgA nephropathy
Besides IgA nephropathy, what is another condition of IgA oversecretion that may present like amyloidosis but the purpura shows up in the lower extremities?
Henoch-Schonlein purpura
If mesangial IgA deposits are noted, what two conditions are likely?
IgA nephropathy
Henoch-Schonlein purpura
If mesangial IgG deposits are noted, what condition is likely?
lupus nephritis
This form of glomerulonephritis is characterized by low numbers of cells in the glomeruli.
non-proliferative GN
Do non-proliferative GN patients present with nephrotic syndrome or nephritic syndrome?
nephrotic syn
This form of GN is characterized by an increased number of cells in the glomerulus.
proliferative GN
What is the most common cause of acute nephritic syndrome?
post-streptococcal GN (PSGN)
PSGN follows a strep infection with a nephrogenic strain of group ___ ____-hemolytic strep.
A, beta
Electron microscopy shows a “lumpy “appearance with diagnostic findings of sub-endothelial “clumps of humps”. What the dx?
PSGN
What is the prognosis for children and adults with PSGN?
children: most likely total recovery
adults: 50% progress to renal failure/latent dz
What is another name for Rapidly Progressive GN (RPGN)? Why is it called that?
crescentic GM
crescents of epithelial cells form around glomerular capillaries
What condition might present with RPGN?
Goodpasture’s Syndrome (affects kidneys and lungs)
This disease is characterized by circulating anti-basement membrane antibodies
Goodpasture’s Syndrome
This disease shows a linear pattern of IgG immunofluorescence
Goodpasture’s Syndrome
This condition is a type of vasculitis, all of which present with antineutrophil cytoplasmic antibodies (serum is positive for C-ANCA)
Wegener’s granulomatosis
What condition, besides Wegener’s, might present with similar symptoms but is sero-positive for P-ANCA?
Polyarteritis nodosum (PAN)
What disease is characterized by proximal tubular epithelium necrosis and how is this dz classified?
acute tubular necrosis (ATN)
toxic or ischemic
What disease is characterized by absence of nuclei and a homogenous cytoplasm which stains intensely eosinophilic yet preserves it normal shape?
toxic ATN
What is one of the most common causes of acute renal failure?
toxic ATN
What condition does Dr. Miller want you to know might reveal intra-tubular cast formation under the microscope?
toxic ATN
What disease specifically causes skip lesions through the tubules?
ischemic ATN
What disease is most commonly caused by an allergic reaction to drugs and presents with eosinophila?
acute interstitial nephritis
In which condition is the interstitial area expanded by fibrosis with distortion of the tubules and periglomerular fibrosis without pathological changes to the glomeruli?
chronic interstitial nephritis
This is a disease of the proximal renal tubules in which glucose, AAs, uric acid, phosphate and bicarb and passed in the urine instead of being reabsorbed.
Fanconi’s Syndrome
Large amounts of aspirin and acetaminophen consumption over a long period of time is most likely to cause this kidney disease.
analgesic nephropathy
What is the term used to describe antherosclerotic changes in the renal blood vessels?
benign nephrosclerosis
The surface of the kidney appears granular (looks like grain leather). What’s up?
benign nephrosclerosis
What condition is characterized by the small renal arteries and arterioles becoming hyperplastic, taking on an “onion ring” appearance?
malignant nephrosclerosis
What is one of the most common causes of secondary HTN?
renal artery stenosis
HUS and TTP often result in this renal condition
Thrombotic microangiopathy
What condition has this presentation triad: acute renal failure, microangiopathy hemolytic anemia, thrombocytopenia
HUS
Shig-like toxin is clearly linked to this renal pathology
HUS
Verocytotoxin is related to what pathology?
classic childhood HUS
In this condition, capillary lumen are often occluded by necrotic debris and thrombi. This will appear with diffuse thickening of capillary walls and swelling of endothelial cells. Fibrin thrombi and packed red blood cells are visible in the lumina.
HUS
Most renal artery emboli come from what source?
cardiac
A look through the microscope reveals cleft-like spaces where crystals were located prior to preparation of the slide. What is the pathology?
embolic disease
What does it mean when there is poor uptake of “vital” stains by tissues?
likely renal tissue ischemia
Grossly, there is a classic wedge shaped abnormal appearance to the kidney tissue when this has occurred.
renal infarction
What part of the kidney are stones most likely to develop?
the pelvis
What is the 2 most common type of kidney stones?
calcium oxalate 75%
triple phosphate stones 15%
These stones are most associated with abnormal renal absorption of calcium.
Calcium oxalate stones. Hypercalemia is relatively rare (5%) with these times of stones.
These stones are most commonly associated with urinary tract infections by bacteria which are urea splitting and increased urine pH.
Magnesium ammonium (triple phosphate) stones
Another name for magnesium ammonium stones
staghorn calculi
These stones are associated with a urine pH of 5.5 of less
uric acid crystals
This type of stone is known for causing nephropathy due to accumulation within the kidney parenchyma
uric acid crystals
These stones are the most common stones found in pediatric patients AND often present with multiple stones
cystine stones
These stones is most readily precipitated out of acidic urin
cystine stones
What type of adenoma is known for uniform large polygonal cells and numerous prominent mitochondria in a “stacked” appearance under electron microscopy?
oncocytoma
What is the most common renal malignancy?
renal cell carcinoma
What type of cell is usually involved with renal cell carcinoma?
clear cell
This tumor is the most common primary renal tumor in children?
Wilm’s Tumor
This tumor looks like nests of primitive appearing cells (from nephrogenic zone of fetal kidney) under the microscope
Wilm’s Tumor
What are the most common sites of metastasis for RCCA?
lung, lymph nodes, bone, liver,
T/F. Those with polycystic kidney disease have an equal risk of developing renal cell carcinoma as those with renal cysts.
false
This population of people have a high risk of developing acquired cystic disease
chronic dialysis patients
What is the most common primary malignancy of the urinary tract?
TCC
When in the kidney, this malignancy is known to be found in the renal pelvis.
TCC
