Renal/Endocrine Flashcards
Renal cortex or medulla?
Renal cortex
Renal cortex or medulla?
Renal medulla
What part of the nephron is shown here?
Apical transporters? Basolateral transporters? Diuretics?
Proximal Convoluted Tubule
Apical transporters: NHE3 antiporter (Na+ in, H+ out); vH+ ATPase transporter (H+ out)
Basolateral transporters: Na+/K+ ATPase; NBCe1 transporter (HCO3- out)
Carbonic anhydrase IV (lumen) and II (cytoplasm) function to shuttle HCO3- into the cell, which it is then shuttled out into interstitial tissue by NBCe1
acetazolamide blocks carbonic anhydrase
What part of the nephron is shown here?
Apical transporters? Basolateral transporters? Diuretics?
Distal Convoluted Tubule
Apical transporters: TRPV5 (Ca++ in), TRPV6 (Mg++ in), NCC (Na+ and Cl- in)
Basolateral transporters: NCX1 (Ca++ out, 3Na+ in), Na+/K+ ATPase, gCl- (Cl- out)
NCC is blocked by thiazides
impermeable to H2O
What part of the nephron is shown here?
Apical transporters? Basolateral transporters? Diuretics?
Collecting Duct
Apical transporters: ENaC (Na+ in), K+ channel (K+ out)
Basolateral transporters: Na+/K+ ATPase
amilorine, triamterene block ENac; spironolactone block aldosterone effects (prevent upregulation of ENac)
Pathology?
Acute Tubular Necrosis
often ischemic in nature
FENa >2% (except in contrast-induced nephropathy), BUN/creatinine < 20:1, SG = 1.010, muddy brown casts
Pathology?
Acute Tubular Necrosis
often ischemic in nature
FENa >2% (except in contrast-induced nephropathy), BUN/creatinine < 20:1, SG = 1.010, muddy brown casts
Pathology?
Acute Tubular Necrosis
muddy brown casts
Pathology?
Acute Tubular Necrosis
muddy brown casts
Pathology?
Acute Interstitial Nephritis
acute disease characterized by interstitial infiltrates; often reversible
causes: drug hypersensitivity reactions (antibiotics/sulfa drugs, proton pump inhibitors, NSAIDs), infection, autoimmune
microscopic hematuria, leukocyturia, WBC casts; eosinophiluria
treated with prednisone
Pathology?
Acute Interstitial Nephritis
acute disease characterized by interstitial infiltrates; often reversible
causes: drug hypersensitivity reactions (antibiotics/sulfa drugs, proton pump inhibitors, NSAIDs), infection, autoimmune
microscopic hematuria, leukocyturia, WBC casts; eosinophiluria
treated with prednisone
Pathology?
Granulomatous AIN
renal sarcoidosis
caused by nephrocalcinosis, interstitial nephritis, or glomerular disease (FSGS, membranous nephropathy)
Pathology?
WBC cast in AIN
Pathology?
WBC cast in AIN
Pathology?
WBC cast in AIN
Pathology?
Calcium oxalate crystals in urine
can be caused by ethylene glycol poisoning (treated with fomepizole to inhibit alcohol dehydrogenase)
Pathology?
Calcium oxalate crystals in urine
can be caused by ethylene glycol poisoning (treated with fomepizole to inhibit alcohol dehydrogenase)
Pathology?
Oxalate crystals
Pathology?
Oxalate crystals
Pathology?
Cast nephropathy from multiple myeloma
Bence Jones protein not detected on urine dipstick - urine protein electrophoresis required for diagnosis
Pathology?
Cast nephropathy from multiple myeloma
Bence Jones protein not detected on urine dipstick - urine protein electrophoresis required for diagnosis
Pathology?
Chronic Interstitial Kidney Disease
Interstitial infiltration with lymphocytes, monocytes, or macrophages; tubular atrophy/dilation; glomerulosclerosis; interstitial fibrosis
Urinary sediment is bland; anemia; nephrogenic diabetes insipidus can occur
Pathology?
Chronic Interstitial Kidney Disease
Interstitial infiltration with lymphocytes, monocytes, or macrophages; tubular atrophy/dilation; glomerulosclerosis; interstitial fibrosis
Pathology?
Chronic Interstitial Kidney Disease
Interstitial infiltration with lymphocytes, monocytes, or macrophages; tubular atrophy/dilation; glomerulosclerosis; interstitial fibrosis
Pathology?
Papillary necrosis
Seen in diabetics with urinary tract obstruction, analgesic nephropathy, sickle cell disease
Pathology?
Renal calculi
Pathology?
Polycystic Kidney Disease
Pathology?
Polycystic Kidney Disease
Pathology?
Double ureters
Congenital anomaly; increases risk of developing UTI, pain, stones, hydronephrosis
Pathology?
Hydronephrosis
Grossly dilated renal pelvis and collecting system; result of obstruction
Pathology?
Staghorn calculus
Triple phosphate stones, made of magnesium ammonium phosphate
Linked to proteus infection (urea-splitting), produces alkaline urine
Pathology?
Bladder exstrophy
Bladder is outside of the abdominal wall and everted; requires surgical repair
Pathology?
Acute cystitis
Mucosal erythema and edema
Pathology?
Interstitial cystitis (aka Hunner’s Ulcer)
Mucosal erythema in fissures in bladder as it is distended by fluid
Intermittent or continuous pain over 6 months
Pathology?
Malakoplakia
Peculiar host reaction to chronic infection wherein macrophages can’t expel lysosomes containing bacteria (mostly E. coli)
Pathology?
Cystitis with malakoplakia
PAS stains macrophage cytoplasm; dark Michaelis Gutman bodies (arrow)
Pathology?
Brunn’s buds & nests
Reaction to a variety of noxious agents; invagination of urothelium into lamina propria that can be detached
Common (>90% of autopsies)
Pathology?
Cystitis glandularis et cystica
Brunn’s nests with dilated lamina (yellow star) and glandular metaplasia (black star)
Sign of prolonged stimulation of urothelium
Pathology?
Nephrogenic metaplasia (adenoma)
Reactive process anywhere in urothelium, usually bladder
Small tubules with single layer epithelium
Pathology?
Transitional cell papilloma
Benign bladder neoplasm; exophytic growth with multiple delicate branching structures attached to the mucosa by a stalk
Pathology?
Low grade papillary transitional cell carcinoma
Most common malignant neoplasm of the bladder
Pathology?
High grade papillary transitional cell carcinoma
Most common malignant neoplasm of the bladder
Pathology?
Papillary transitional cell carcinoma
Most common malignant neoplasm of the bladder
Pathology?
Post-streptococcal GN
Pathology?
Post-streptococcal GN
Scattered, irregularly spaced capillary wall and mesangial coarse granular staining for IgG and starry sky pattern for C3
Pathology?
IgA nephropathy
Hypercellularity
Pathology?
IgA nephropathy
IF: IgA, C3, properdin
EM: mesangial deposits
Pathology?
Goodpasture syndrome
Breaks in the GBM
Pathology?
Goodpasture syndrome
Linear IF staining (IgG)
Pathology?
ANCA-associated GN
See crescent formation and collapse of the glomerular tuft with fibrinoid necrosis
Pathology?
Lupus nephritis - class II
Glomeruli normal or slight increase in mesangial cells; mesangial deposits of IgG and C3
Pathology?
Lupus nephritis
Subendothelial deposits
Pathology?
Membranoproliferative glomerulonephritis
Pathology?
Minimal change disease
Effacement of podocyte foot processes => nephrotic disease
Pathology?
Membranous nephropathy
Immune complexes with Ab directed at podocytes activate complement pathway => damages podocytes => nephrotic disease
Image shows spikes on membranes in silver stain
Pathology?
Membranous nephropathy
Immune complexes with Ab directed at podocytes activate complement pathway => damages podocytes => nephrotic syndrome
IF: granular pattern of polyclonal IgG, variable C3, granular capillary wall PLA2R staining
Pathology?
Focal segmental glomerulosclerosis
Nephrotic syndrome
Pathology?
Diabetic nephropathy
Nephrotic syndrome
Pathology?
Diabetic nephropathy
Nodular glomerulosclerosis (Kimmelsteil-Wilson lesions)
Nephrotic syndrome
Pathology?
Amyloidosis
Congo-Red stain
Nephrotic syndrome
Pathology?
Renal amyloidosis
Nephrotic syndrome
Pathology?
Craniopharyngioma
Cystic neoplasm of the hypothalamus
Pathology?
Craniopharyngioma
Cystic neoplasm of the hypothalamus
Pathology?
Pituitary adenoma
All cells are the same
Pathology?
Adrenal adenoma
Pathology?
Waterhouse Friedrichsen syndrome
Hemorrhagic necrosis of adrenals
Pathology?
Pheochromocytoma
Catecholamine-secreting tumor; large, fleshy mass
Pathology?
Pheochromocytoma
Large cells with granular cytoplasm arranged in nets (zellballen)
Pathology?
Neuroblastoma
Pseudorosettes
Pathology?
Lymphocytic insulinitis
T cell invasion of pancreas; near time of T1DM clinical presentation
Pathology?
Amyloid deposition in islets of Type II DM
Pathology?
Increased islets
Seen in non-diabetic newborns of diabetic mothers
Pathology?
Nodular glomerulosclerosis in diabetes
Pathology?
Thickened glomerular basement membrane in DM
Pathology?
Thickened renal tubular basement membranes in PAS stain (DM)
Pathology?
Diabetic arteriolar sclerosis
Pathology?
Hashimoto thyroiditis
Lymphoid infiltrate, including germinal centers
Pathology?
Hashimoto thyroiditis
Thyroid follicles showing atrophy with some colloid, and chronic inflammation with a lymphoid area on the right
Pathology?
Subacute granulomatous thyroiditis
See multinucleated giant cells and fibrosis
Pathology?
Graves’ disease
Crowded, tall follicular cells project into the lumen; see scalloped margins of colloid
Pathology?
Thyroid adenoma
Adenoma is top half of photo with capsule and non-lesional tissue below
Pathology?
Papillary carcinoma
See papillary architecture and ground glass (Orphan Annie eye) nuclei
Pathology?
Papillary thyroid carcinoma
See several Psammoma bodies and papillary architecture
Pathology?
Follicular thyroid carcinoma
See monotonous, small follicles packed together tightly; small deposits of colloid
Pathology?
Medullary thyroid carcinoma
See groups of polygonal cells and areas of dense stroma containing amyloid
Pathology?
Parathyroid adenoma
Pathology?
Parathyroid carcinoma (rare)
