Renal

Question 1

Crescentic GN depositions

Answer 1

• RPGN crescents:
  
  • glomerular parietal cells
  • monocytes and macrophages
  • FIBRIN on deckkk

Question 2

type 1 RPGN (Goodpasture syndrome) deposits

Answer 2

C3 and IgG-linear depositis seen on IF microscopy

Question 3

Acute PSGN depositions

Answer 3

• IF:
  
  • IgG, IgM, C3: lumpy bumpy
  • (will have DEC serum C3 levels)
• EM: subepithelial IC

Question 4

DPGN deposits

Answer 4

• EM: (subendothelial, sometimes intramembranous)
  
  • IgG based IC + C3

Question 5

MPGN deposits

Answer 5

• Type 1: subendothelial IC +granular IF
• Type 2: intramembranous IC (dense deposits)

Question 6

FSGS deposits

Answer 6

• IF: focal IgM, C1, C3

Question 7

ACE inhibitors and bradykinin

Answer 7

• ACE metabolizes brady=LESS brady
• ACE inhibitors=less brady metab=MORE brady

Question 8

TWO main causes of overflow incontinence

Answer 8

1. impaired detrusor contractility
2. bladder outlet obstruction (BOO)
   
   1. tumor obstructing the urethra

CP: involuntary+continuous urinary leakage when bladder is full

-incomplete emptying

Question 9

what is the differential diagnosis for urinary incontinence

Answer 9

1. stress
   
   1. loss of urethral support and abdo pressure>urethral sphincter pressure
   2. s/s: leaking with cough, sneeze,laugh, lift
2. urge
   
   1. detrusor overactivity (PT with MS)
   2. s/s: sudden overwhelming or freq need to empty bladder
3. overflow
   
   1. impaired detrusor contractility, BOO
   2. s/s: involuntry dribbling of urine, incomplete emptying

Question 10

classifications for RP(crescentic)GN

Answer 10

1. anti-GBM RPGN
   
   1. linear GBM of IgG and C3
   2. some: antiGBM in lungs (Goodpasture)
2. immune-complex RPGN
   
   1. lumpy bumpy d/t IgA + IgG + complement
   2. d/t:
      
      1. PSGN
      2. SLE (serum anti-PHOSPHOLIPID Ab)
      3. IgA nepropathy
      4. HSP
3. pauci-immune RPGN
   
   1. nada on BM
   2. ANCA in serum=
      
      1. granulomatosis with polyangiitis
      2. microscopic polyangiitis
      3. idiopathic

Question 11

nephrotic syndrome and aldosterone

Answer 11

• plasma oncotic pressure is DEC
• net plasma filtration into interstitium
• DEC effective circulating intravascular volume
• compensatory INC in RAAS
• elevated circulating aldosterone

Question 12

CP MCD

Answer 12

• 5yo boy w/ generalized edema after mild URI
• UA: proteinuria, albumin + trace IgG
• PP: loss of GBM anions=can no longer repell albumin=SELECTIVE albuminuria
  
  • d/t immune dysregulation, systemic T cell dysfunction= overproduce glomerular permeability factor (GPF)
  • GPF:
    
    • causes podocyte foot process fusion
    • DEC anionic properties of the glomerular basement membrane

**INC SELECTIVE FILTRATION OF PROTEINS**

Question 13

Thrombotic microangiopathy

Answer 13

• PENTAD for TTP (thrombocytopenic thrombotic purpura-HUS is a thrombotic microangiopathy-TMA)…all in the setting of a GI illness
  
  1. fever
  2. neuro symptoms (progressive lethargy)
  3. renal failure
  4. anemia
  5. thrombocytopenia

Question 14

what are the shared common clinical and pathologic features of TMA syndromes (thrombotic microangiopathy)

Answer 14

• platelet activation in arterioles and capillaries
• diffuse micro-vascular thrombosis (most commonly affect: brain, kidneys, heart)
• microangiopathic hemolytic anemia with schistocytes
• thrombocytopenia

Question 15

FSGS CP

Answer 15

• (has a collapsing variant)
• CP: heavy proteinuria
• “collapse and sclerosis of glomerular tufts”

Question 16

RP(crescentic)GN CP

Answer 16

• macroscopic hematuria
• HTN
• progresive renal failure
• three major classifications:
  
  1. anti-GBM (w/ hemoptysis in Goodpasture syndrome)
  2. immune-complex mediated (SLE)
  3. pauci-immune (w/ pulm, upper respiratory, and kidney involvement in granulomatosis with polyangiitis)

Question 17

PSGN CP

Answer 17

• childhood dz
• can follow strep pharyngitis and lead to coke-colored urine + periorbital edema
• renal biopsy: diffuse proliferation and subepithelial Ig deposits

Question 18

HSP vs. IgA nepropathy CP/renal bx

Answer 18

• HSP: childhood dz; NON-thrombocytopenic palpable purpura + arthritis
• IgA nephropathy presents w/ recurrent hematuria and low-grade proteinuria after URTI
• BOTH: IgA deposition in mesangium

Question 19

ATN renal biopsy

Answer 19

patchy necrosis of tubular epithelium and loss of basement membrane

Question 20

TMA renal bx

Answer 20

platelet-rich thrombi in glomeruli and arterioles

Question 21

What does BPH do to the kidneys

Answer 21

• intermittent BOO + overflow incontinence
• urinary retention=INC pressure in the urinary tract and resultant reflux nephropathy
• ultimately: hydronephrosis and renal intersitial atrophy (“parenchymal pressure atrophy) and scarring

Question 22

diabetic nephrosclerosis termed

Answer 22

glomerular sclerosis and hyalinosis

Question 23

long-standing systemic HTN termed

Answer 23

hyperplastic arteriolar changes (intimal fibroelastosis)

-diagnostic of hypertensive nephropathy seen in pts with poorly controlled HTN

Question 24

terms for the causes of ITN

Answer 24

• low-flow states: MI
• systemic vasodilation: sepsis
• s/s–INC sBUN & Cr: azotemia

Question 25

dysplasia termed precursor of malignancy

Answer 25

• epithelial dysplasia=alteration in cell architecture
  
  • cells change shape, size (pleomorphic) and staining (hyperchromatic); nuclei enlarge

Question 27

urate nephropathy termed

Answer 27

• d/t tubular obstruction f/m urate crystal deposition
• seen in indivs wih ACUTE HYPER-uricemia (tumor lysis syndrome)
• CP: acute renal failure d/r chemo for a malignancy