Renal Histopath Flashcards Preview

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Flashcards in Renal Histopath Deck (30):
1

Triad of nephrotic syndrome

Proteinuria > 3g/ day Oedema (also have dys/hyperlipidaemia (liver)) Hypoalbuminaemia

2

Nephrotic syndrome oedema pattern (1)

Starts peri orbitally

3

Minimal change disease: epidemiology, Light micrscopy (1), Electron microscopy (1), immunofluorescence (1), response to steroids (1), Prognosis (1)

Most common in children - 75% rest elderly

no changes on light microscopy

Electron microscopy - loss of podycyte foot processes

IF - no deposits

Response to steroids - 90% Prognosis -<5% ESRF

4

Membranous glomerular disease: epidemiology, Light micrscopy (1), Electron microscopy (2), immunofluorescence (2), response to steroids (1), Prognosis (1)

Common in adults

Diffuse GBM thickening

EM - loss of podocyte foot processes, subepithelial deposits (spikey)

IF - Ig &amp; complement in granular deposits along GBM

Poor response to steroids 40% get ESRF after 2-20 yrs

A image thumb
5

Focal segmental glomerulonephritis: epidemiology, Light micrscopy (3), Electron microscopy (1), immunofluorescence (2), response to steroids (1), Prognosis (1)

Common in afro-carribean

LM - Focal &amp; segmental glomerular consolidation + scarring, + hyalinosis (change in tissue to less functional/lower form)

EM - loss of podocyte foot processes

IF - Ab + complement in SCARRED areas 50% respond to steroids 50% ESRF in 10 yrs can be secondary to obesity HIV nephropathy

6

What are secondary causes of nephrotic syndrome? (2)

Diabetes

Amyloidosis

7

Nephrotic syndrome secondary to diabetes: histology (2)

Diffuse GBM thickening

Mesangial matrix nodules - KIMMELSTIEL WILSON NODULES (usually asian)

8

Nephrotic syndrome secondary to amyloidosis: histology (1)

APPLE GREEN BIREFRINGENCE with CONGO red stain

9

Nephrotic syndrome secondary to amyloidosis: + hints in question (6)

May have chronic inflammation: RA

May have chronic infection: TB - causes AA protein deposition

May have Ig light chain deposition from multiple myeloma (AL protein deposition)

Clinical clues for amyloidosis - Macroglossia, HF, hepatomegaly

10

Pathology of acute tubular injury (ATI)/ ATN (4) (the most common cause for ARF)

Damage to tubular epithelial cells Blockage of tubules by casts Reduced flow + haemodynamic changes ARF

11

Causes of ATN (5)

Ischaemia - burns, septicaemia Nephrotoxins - drugs (NSAIDs, gentamicin), radiographic contrast agents, heavy metals, myoglobins

12

Histopathology of ATN (1)

necrosis of short segments of tubules

13

Acute pyelonephritis: most common causative pathogen (1) Presentation (8), What is seen in urine (1)

Bacterial infection of kidney due to ascending infection by E. coli. Presentation: fevers, chills, flank pain, renal angle tenderness, dysuria, haematuria Leukocytic casts are seen in urine

14

Chronic pyelonephritis &amp; reflux nephropathy: what is it? Causes (3)

Inflammation + scarring of the parenchyma due to recurrent &amp; persistent bacterial infection Causes: obstruction - posterior urethral valves, renal calculi Urine reflux - reflux nephropathy

15

What is acute interstitial nephritis?

A hypersensitivity rxn, usually to a drug (abx, NSAIDS) Usually begins days post exposure

16

Acute interstitial nephritis presentation (5)

Eosinophilia, haematuria, fever, skin rash, proteinuria

17

Chronic interstitial nephritis/ analgesic nephropathy, cause (1) &amp; symptoms (4)

Usually in elderly due to chronic use of NSAIDs symptoms (occur late in disease): haematuria, proteinuria, HTN, anaemia

18

What is ARF?

Rapid loss of renal function manifesting as increased Urea &amp; creatinine

19

Pre-renal causes of ARF ( 3) (most common cause of ARF)

Renal hypo perfusion - sepsis, hypovolaemia, burns, renal artery stenosis, acute pancreatitis

20

Renal causes of ARF (3)

ATN - most common renal cause Acute GN thrombotic microangiopathy

21

Post renal causes of ARF (4)

Obstruction - stones, tumours, prostatic hypertrophy, retroperitoneal fibrosis

22

What is CRF?

Progressive, irreversible loss of renal function + symptoms of uremia - itching, anorexia, fatigue &amp; confusion if severe

23

Commonest causes of CRF in UK (5) (in order)

Diabetes GN HTN Reflux nephropathy Polycystic kidneys

24

5 Stages of CRF

Stage 1 - kidney damage + normal renal function (proteinuria may be there) GFR > 90 Stage 2- mildy impaired; GFR 60-89 Stage 3 - moderately impaired; GFR 30-59 Stage 4 - severely impaired; GFR 15-29 Stage 5 - renal failure

25

Inheritance of adult polycystic kidney disease (2)

Autosomal dominant 85% due to PKD1 mutation on Cr 16 - encodes polycystin1 15% due to PKD 2 mutation on Cr 4- encodes polycystin2

26

Pathological features of PKD (3)

Large multicystic kidneys with destroyed renal parenchyma Liver cysts (in PKD1) Berry aneurysms

27

Clinical features of PKD (3)

Haematuria, flank pain, UTI clin features due to cyst complications e.g. rupture/infection/ haemorrhage

28

Lupus nephritis infor card

depending on site &amp; intensity of IC depostion clinical presentation may be: just urinary abnormalities, nephrotic syndrome, ARF, CRF

29

6 Classes of Lupus nephritis: give 1-3

1 - minimal mesangial lupus nephritis - ICs but no structural damage 2 - mesangial proliferative lupus nephritis - ICs + mild increase in mesangial cellularity 3 - focal lupus nephritis - active swelling + proliferation in less than half the glomeruli

30

Class 4-6 of lupus nephritis

Class IV - diffuse lupus nephritis - more than half glomeruli involved Class V - membranous lupus nephritis - subepithelial IC deposition Class VI - advanced sclerosing - complete sclerosis of > 90% of the glomeruli