Renal 1

Question 1

Name the 3 main categories of clinical renal syndromes discussed in class and their major findings

Answer 1

• Acute renal failure: oliguria and rapid rise in serum creatinine
• nephrotic syndrome: proteinuria >3.5 g
• nephritic syndrome: hematuria

Question 2

What is the basic functional unit of the kidney?

Answer 2

nephron

Question 3

How can you tell proximal vs distal convoluted tubules when looking at the kidneys?

Answer 3

in the proximal convoluted tubules the “brush” border has sloughed and can be seen in the lumen; thus, the lumen appears partially filled.

Question 4

Acute renal failure is due to _______ (anatomic location) injury

Answer 4

tubular

Question 5

Nephrotic syndrome is due to __________ defects

Answer 5

glomerular capillary filtration defects

Question 6

nephritis is due to breaks in the ______ loops

Answer 6

glomerular capillary

Question 7

Name 3 causes of acute renal failure

Answer 7

1. acute tubular necrosis
2. acute interstitial nephritis
3. acute pyelonephritis

Question 8

Name 3 causes of nephrotic syndrome

Answer 8

1. membranous nephropathy
2. focal segmental glomerulosclerosis
3. minimal change disease

Question 9

Name 3 types of acute nephritic syndrome

Answer 9

1. crescentic glomerulonephritis
2. lupus nephritis (proliferative type)
3. post-infectious glomerulonephritis

Question 10

Name 2 causes of “isolated hematuria”

Answer 10

1. IgA nephropathy

2. Alport’s disease

Question 11

T/F- if untreated or non-responsive, acute renal failure, nephrotic syndrome, and nephritic syndrome can all progress to chronic renal failure

Answer 11

True

Question 12

Name 3 common histological findings of chronic renal failure

Answer 12

1. glomerular sclerosis
2. interstitial fibrosis
3. tubular atrophy

Question 13

What type of IF pattern would you see in Anti-GBM disease?

Answer 13

linear capillary loop patterns

Question 14

What type of IF pattern would you see in membranous nephropathy or lupus nephritis?

Answer 14

Granular capillary loop pattern

Question 15

What type of IF pattern would you see in IgA nephropathy or Lupus nephritis?

Answer 15

mesangial pattern

Question 16

Lupus nephritis can display what two types of IF staining?

Answer 16

mesangial or granular capillary loop pattern

Question 17

What is a podocyte?

Answer 17

glomerular epithelial cell

Question 18

What are two main classifications or mechanisms of glomerular injury?

Answer 18

1. immune mechanisms
   - immune complex (e.g. membranous glomerulonephropathy)
   - T-cell mediated (e.g. minimal change disease)
2. non-immune mechanisms (genetic structural disorders e.g. Alports syndrome)

Question 19

What disease is caused by a mutation in type IV collagen gene causing structural weakness to the GBM which is composed of type IV collagen?

Answer 19

Alport’s sydnrome

Question 20

What do they mean by focal vs diffuse vs global vs segmental?

Answer 20

Glomerular changes can be focal (<50% of all glomeruli) or diffuse (in all or almost all the glomeruli), and segmental (only a part of the glomerulus) or global (the entire glomerulus).

Question 21

Name two causes of acute pre-renal failure

Answer 21

1. cardiac shock

2. dehydration

Question 22

Name one cause of post-renal acute renal failure

Answer 22

1. obstructive stone

Question 23

Name the general example given in class for the cause of acute intrarenal failure

Answer 23

tubulointerstitial diseases (acute tubular necrosis, acute interstitial nephritis, acute pyelonephritis)

Question 24

T/F- renal tubular disease can occur secondary to severe glomerular diseases?

Answer 24

true

Question 25

What is the most common cause of acute renal failure?

Answer 25

ATN

Question 26

Is ATN usually reversible?

Answer 26

yes (very often)

Question 27

What are two common causes of ATN?

Answer 27

- hypovolemia/ischemia | - drug toxicity

Question 28

What will you see histologically in ATN?

Answer 28

- necrotic debris in tubules | - dilated tubules with flattened epithelium

Question 29

Most common cause of AIN?

Answer 29

DRUG INDUCED - antibiotics - NSAIDs

Question 30

Symptoms of AIN?

Answer 30

- fever, rash, eosinophilia | - rising serum creatinine and oliguria

Question 31

If you see eosinophils in the interstitial what should you suspect as the cause?

Answer 31

DRUGS

Question 32

T/F- acute pyelonephritis presents very similar in appearance histologically to AIN but the inflammatory infiltrates in pyelonephritis include numerous neutrophils

Answer 32

true

Question 33

If you have chronic pyelonephritis, what organ will your kidney begin to resemble?

Answer 33

The atrophic tubules look like the thyroid gland architecture and so sometimes called “thyroidization”