Renal Exam II Path

Question 1

2 major processes for tubular injury

Answer 1

ischemic and toxic (aki) or inflammatory (tubulointerstitial nephritis)

Question 2

what are the 4 causes of AKI

Answer 2

ischemia, direct toxic injury to tubules, hypersensitivity reaction, urinary obstruction

Question 3

focal tubular epithelial necrosis at multiple points

Answer 3

ischemic AKI

Question 4

when can you see tubulorrhexis, what is it?

Answer 4

ishchemic AKI - rupture of basement membranes

Question 5

this causes occlusion of tubular lumens

Answer 5

brown granular casts

Question 6

the Tamm hors fall protein composes?

Answer 6

hyaline casts

Question 7

3 main substances that cause toxic AKI

Answer 7

mercuric chlrodie, carbon tetrachlroide, ethylene glycol

Question 8

where do you see injury during toxic AKI

Answer 8

proximal convoluted

Question 9

This causes large acidophilic inclusions within cells, cells can be sloughed into lumen and have calcification

Answer 9

mercuric chloride

Question 10

this substance causes accumulation of neutral lipids

Answer 10

carbon tetrachlroide

Question 11

this causes marked ballooning and hydropic or vacuolar degeneration of proximal convoluted tubules

Answer 11

ethylene glycol

Question 12

what type of crystals are see in with ethylene glycol ingestion

Answer 12

calcium oxalate crystals

Question 13

what are the clinical findings of AKI

Answer 13

oliguria, increased BUN and creatine, hyperkalemia, metabolic acidosis

Question 14

What drugs cause acute tubulointerstitial nephritis

Answer 14

penicillins, dirutetics, NSAIDS

Question 15

what are clinical presentations of tubulointerstitial nephritis

Answer 15

eosinophilia in urine, edema, rash,

Question 16

this is characterized by chronic tubulointerstitial nephritis and renal papillary necrosis

Answer 16

analgesic nephropathy

Question 17

what people generally get analgesic nephropathy

Answer 17

women, recurrent headaches, muscle pain, neurotic patients, factory workers.

Question 18

what are the three types of irate nephropathy in people with hyperuricemic disorders

Answer 18

Acute uric acid nephropathy, Chronic irate nephropathy, nephrolithiasis

Question 19

this is likely to occur in those with leukemias or lymphomas undergoing chemo (collecting ducts)

Answer 19

acute uric acid nephropathy - precipitation of uric acid crystals

Question 20

this forms birefringeent needle like crystals and induce a typhus within distal tubules and collecting ducts

Answer 20

chronic urate nephropathy (gout)

Question 21

hypercalcemia is caused by

Answer 21

hyperparathyroidism,multiple myeloma, vitamin d intox, metastatic cancer, excess calcum intake

Question 22

where is the earliest damage with nephrocalcinosis seen?

Answer 22

mitochondiral distortion

Question 23

someone preparing for a colonoscopy might get?

Answer 23

acute phosphate nephropathy

Question 24

what is light chain cast nephropathy?

Answer 24

bence jones proteins combine with urinary glycoprotein under acidic conditions to form large tubular casts that obstruct lumen and induce inflammation

Question 25

multiple myelomas can cause

Answer 25

light chain cast nephropathy

Question 26

pink- bus amorphous masses?

Answer 26

bence jones tubular casts

Question 27

sclerosis of renal arterioles and small arteries

Answer 27

benign nephrosclerosis

Question 28

medial and intimal thickening with hyaline deposition?

Answer 28

hyaline arterolosclerosis (benign)

Question 29

malginant

Answer 29

intimal thickening - onion skinning

Question 30

diabetics and african americans are at risk for?

Answer 30

benign nephrosclerosis

Question 31

affects young males

Answer 31

malignant hypertension

Question 32

pinpoint petechial hemorrhages (flea bitten appearance)

Answer 32

malignant hypertension

Question 33

consumption of contaminated food

Answer 33

typical HUS

Question 34

diarrhea positive

Answer 34

typical HUS

Question 35

diarrhea negatie

Answer 35

atypical HUS

Question 36

inherited mutations of complement-regulatory protein

Answer 36

atypical HUS

Question 37

what is injuried in HUS

Answer 37

endothelium

Question 38

TTP trigger

Answer 38

adamts13 dysfunction resulting in increased von willebrand factor

Question 39

what is the main morphological finding in thrombotic renal diseases?

Answer 39

double counters/ tram racks

Question 40

what generally causes diffuse cortical necrosis?

Answer 40

obstretic emergency

Question 41

what is the morphology of of diffuse cortical necrosis?

Answer 41

massive ischemic necrosis limited to the cortex

Question 42

most renal infarcts are due to embolism from?

Answer 42

left atrium and ventricle

Question 43

3 reasons why kidneys are favored sites for infarct development?

Answer 43

extensive blood flow to kidneys | end organ nature of arterial blood supply, limited collateral

Question 44

hydronephrosis

Answer 44

dilation of renal pelvis and calyces associated with progressive atrophy of kidney due to obstruction

Question 45

most common type of renal calculi

Answer 45

calcium oxalate

Question 46

formed after proteus infections that cause alkaline urine

Answer 46

struvite (magnesium, ammonium, phosphate)

Question 47

what shape do struvite stones form?

Answer 47

staghorn calculi

Question 48

Uric acid stones are radio opaque? t/f

Answer 48

false - they are radioluscent so can't be seen

Question 49

stones formed in ppl with leukemia

Answer 49

uric acid

Question 50

stones caused by a genetic defect int enal reabsorption

Answer 50

angulated cystine

Question 51

Benign tumors of the kidney are

Answer 51

Renal papillary adenoma, angiomyolipoma, oncocytoma

Question 52

this is a tan/mahogany brown tumor that is well encapsulated

Answer 52

oncocytoma (large nucleoli

Question 53

tumor of vessels, smooth muscle, fat?

Answer 53

angiomyolipoma

Question 54

angiomyolipoma is generally seenw ith

Answer 54

tuberous sclerosis

Question 55

males or females are more likely to get renal cell carcinoma?

Answer 55

males, smokers.

Question 56

what is a autosomal dominant familial variant of renal cell carcinoma

Answer 56

Von Hippel Lindau Syndrome (loss of VHL 3p gene)

Question 57

most common type of renal cell carcinoma

Answer 57

clear cell

Question 58

where do the cells for clear cell carcinoma come from?

Answer 58

proximal tubule

Question 59

papillary carcinoma / chromophil carcinoma

Answer 59

foamy macrophages and intracellular hemosiderin

Question 60

trisomy of 7,16, loss of Y

Answer 60

sporadic papillary carcinoma

Question 61

just trisomy 7

Answer 61

familial form of papillary carcinoma

Question 62

where does chromophobe renal carcinoma arise from?

Answer 62

intercalated cells of collecting ducts

Question 63

what are the gross findings of renal cell carcinoma

Answer 63

well-circumscribed, tan brown

Question 64

Collecting duct (bellini duct)

Answer 64

arise from collecting duct cells in medulla

Question 65

HOBNAIL CELLS

Answer 65

collecting duct bellini duct (poor prognosis)