Renal and Urological Pathology Flashcards by Beth Mickel

what is nephritis

inflammation of the kidney

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2 types of nephritis

infective - pyelonephritis

non-infective -glomerulonephritis

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what holds together the glomerulus

mesangial cells

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what is glomerulonephritis

inflammation in the glomerulus

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what are the main causes of glomerulonephritis

Immune mediated

related to vasculitis

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how does immune mediated causes cause glomerulonephritis

Direct attack of the glomerulus

Caused by circulating complexes getting stuck in the sieve

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what blood tests would suggest immune glomerulonephritis

IgG antibodies against a sub unit of collagen

-goodpastures syndrome

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what can trigger an immune response leading to complexes ending up in the glomerulus

Infection - hepatitis, viruses, bacteria, HIV
Drugs - Gold, Penicillamine
Cancer - often lymphomas

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what vasculitis can cause glomerulonephritis

Granulomatosis with polyangitis

microscopic polyangitis

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what type of vasculitis is associated with cANCA

granulomatosis with poly angitis

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what type of vasculitis is associated with pANCA

Microscopic polyangitis

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what are nephritic/nephrotic syndromes

a collection of symptoms!! - tells you how the patient is presenting

gives no information about underlying cause at all

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what do patients with nephritic syndrome present with

haematuria

hypertension

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what do patients with nephrotic syndrome present with

heavy proteinuria
non-dependent oedema
hyperlipidaemia

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what is lost with proteinuria

proteins - antibodies, complement and proteins in clotting cascade

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what 3 investigations do you do in glomerulonephritis

light microscopy
electron microscopy
immunoflouresence

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what are crescents

are bad
indicate rapidly progressive disease
suggest glomerulonephritis

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what does granulomas in a renal biopsy suggest

Granulomatosis with polyangitis

Sarcoid

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what do you usually see on light microscopy in glomerulonephritis

hypercellularity (inflammatory cells and reactive proliferations)

sclerosis -on going damage

crescents - this is bad

may see vasculitis or systemic disease (sarcoid)

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what does electrommicroscopy look at in glomerulonephritis

the basement membrane

allows you to see if there are deposits and usually where they are. usually either:

subepithelial
mesangial
subendothelial

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what does immunofluorescence show in glomerulonephritis

what kind of antibodies are involved and what kind of distribution

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what does immunofluorescence show in good pasture’s syndrome

linear IgG deposits

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what is minimal change disease

type of glomerulonephritis seen in kids

present with NEPHROTIC syndrome

most common cause of glomerulonephritis in kids

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how do you treat minimal change disease

steroids

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what is focal segmental glomerulosclerosis

type of glomerulonephritis caused by: - obesity - HIV - sickle cell - IV drugs Presents with NEPHRITIC symptoms

what does FSGS look like on electron microscope?

glomerular sclerosis focal and segmental duh

what is membranous glomerulonephritis caused by

Infection (hepatitis, malaria, syphilus) Drugs (penicillamine, NSAID, captopril, gold) Malignancy (Lung, colon, melanoma) Lupus -15% of all GMN in lupus Autoimmune disease - thyroiditis

how does membranous glomerulonephritis present

adults nephrotic thich membranes, sub-epithelial immune deposits less than 40% develop renal failure

silver stain

shows basement membrane looks spikey when there are immune complexes

what causes IgA GMN

Genetic acquired defect -Coeliac (do anti-TTG test) people get it post infection

what does IgA GMN look like

IgA deposition in mesangium

what is membranoproliferative GMN

idiopathic cause or can get type 2 from infection/lupus/malignancy adults and children get it presents with either nephritic or nephrotic

how does membranoproliferative GMN present

big lobulated hyper cellular glomeruli with thick membranes instead of 1 line theres 2 tram tracks

how does diabetes affect the kidney

diffuse and nodular glomerulosclerosis nodules (Kimmel Stiel Wilson Lesion) microvascular disease - arterial sclerosis infection - pyelonephritis, papillary necrosis

what are cystic kidney diseases

Variety of congenital, inherited and acquired cysts lot of early cancers are cystic so be careful

what score predicts risk of cancer with kidney cysts

Bosniak score

what are acquired cysts

v common benign cysts often associated with long term dialysis simple cysts

what are the 2 main subtypes of polycystic kidneys

Autosomal dominant PCKD Autosomal recessive PCKD

what is ADPCKD

Due to a mutation in nephron lots and lots of cysts present over time kidney can become huge

what lines cysts in ADPCKD

simple epithelium

what secondary pathology can be seen in ADPCKD

haemorrhage infaction rupture

symptoms of ADPCKD

size of kidney - present with mass like lesion pain haematuria due to rupture systemic disease - associated with sub arachnoid haemorrhage

when does ARPCKD present

in childhood

what do kidneys look like in ARPCKD

normal size of kidney with a smooth surface

what worsens the prognosis of ARPCKD

the younger you present with it

what infection can cause a mass that is commonly mistaken for a tumour

xanthogranuomatous pyelonephritis

what is the benign kidney tumour u should know about

oncocytoma

what malignant kidney tumours should you know about

chromophobe clear cell papillary collecting duct

what does an oncocytoma look like

small oval well circumscribed mahogany brown with central stellate scar there is a v pink and granular cytoplasms in the cells

what does a chromophobe look like

looks like oncoytoma but with raisonoid nuclei and perinucler halos uncommon

what is the 2nd most common renal cancer

papillary

what does papillary renal cancer look like

papillary finger like projections generally low grade

what is collecting duct carcinoma

v bad malignant tumour least common poor survival

what does collecting duct carcinoma look like

high grade appearance with a very sesmoplastic stroma

what is the most common renal cancer

Clear cell carcinoma

what are the risk factors from clear cell carcinoma

obesity ++ | genetic influence

how does clear cell carcinoma present

haematuria mass hypertension

what does clear cell carcinoma look like

macro often partly cystic heterogenous surface BRIGHT YELLOW tumour surface (clear cell -d'oh yellow like simpsoms)

how do you stage clear cell carcinoma

size | invasion of other structures

what type of cancer tends to protrude into the renal vein

clear cell carcinoma -can go all the way to the heart

what mutation is most common causing sporadic renal cancers

VHL - codes for HIF which is associated with hypoxia

what happens when there are mutations in the TCA cycle

renal cancers

Renal and Urological Pathology Flashcards

(62 cards)