Renal Path Flashcards
1
Q
Bladder cancer and Kidney stones present with:
A
Hematuria
no casts
2
Q
acute cystitis
shows what on UA
what type of cast are present, if any?
A
pyuria (WBCs in pee)
no casts
3
Q
Hypertensive emergency can precipitate Glomerulonephritis.
What type of casts can be seen?
A
RBC casts
4
Q
Tubulo-interstitial inflammation
acute pyelonephritis
transplant rejection
what type of casts form?
A
WBC casts
5
Q
Acute tubular necrosis (ATN)
Rhabdomyelosis
what type of casts form?
A
Granular Casts
Can be “muddy-brown” in appearance
*Tubular epithelial cell debri
6
Q
NephrOtic syndrome casts
Associated with “Maltese cross” sign
A
Fatty casts
aka oval fat bodies
(Look like target sign with a dark cross super imposed)
7
Q
End-stage renal disease/chronic kidney disease/ chronic pyelonephritis
what type of casts form?
A
Waxy Casts
(Fat/broad rectangles, a little granular/ rough looking
can also be tortuous, but still wide/finely grainy)
8
Q
Nonspecific, can be a normal finding.
Benign urinary cast
A
Hyaline casts
(can be long skinny smooth rectangles or tortuous, skinny, smooth cylinders)
*made of Tomm-Horsefall mucoprotein
9
Q
Form via solidification of Tamm-Horsfall mucoprotein (secreted by renal tubular cells)
A
Hyaline casts
10
Q
Thickening of glomerular basement membrane (GBM)
A
Membranous Nephropathy
11
Q
Ureteral dilation recurrent flank pain (acute) Hydro-nephrosis Normal RBC morphology \+/– Calyceal dilation
A
Ureterolithiasis
12
Q
2 nephritic-nephrotic syndromes
A
Diffuse proliferative glomerulonephritis (DPGN)
Membrano–proliferative glomerulonephritis (MPGN)
13
Q
Specific gravity < 1.005 =
Specific gravity > 1.015 =
A
dilute pee
concentrated pee
normal range for urine specific gravity is 1.005 to 1.015
14
Q
Specific gravity > 1.015
A
concentrated pee
15
Q
NSAIDs, Diuretics, Penicillins, PPIs, Sulfa drugs, Rifampin can all cause
A
Allergic (Acute) Interstitial Nephritis
16
Q
Fever, Maculopapular Rash, new/recent Drug taken
eosinophilia in urine
A
Allergic (Acute) Interstitial Nephritis
17
Q
Hematuria Flank Pain associated with: chronic NSAIDs Diabetes Sickle Cell Disease, severe Pyelonephritis
A
Renal Papillary necrosis
18
Q
Hypoalbuminemia (edema)
Hypogammaglobinemia (infections)
Hypercoagulable (loss of ATIII)
Hyperlipidemia/Hypercholesterolemia (fat casts)
A
Nephrotic Syndrome
19
Q
Associated with Hodkins Lymphoma (HY)
A
Minimal change disease
*Most common cause of NEPHROTIC in kids
20
Q
Effaced/Flatten podocytes
CYTOKINES fault
A
Minimal change
21
Q
H&E: Normal
EM: Effacement of foot processes
IF: Negative
A
Minimal Change
22
Q
Selective proteinemia loss of albumin
HYPOalbuminemia (other protein levels ok)
excellent response to steroids
A
Minimal Change
23
Q
Hispanics, Blacks, HIV, Heroin, Sickle cell
A
FSGS
24
Q
EM: Effacement of foot process
H&E: some glomeruli has parts that have a pink & plain, acellular areas.
Poor response to steroids
A
FSGS
25
part of glomeruli is just a flat, empty pink
FSGS
26
Caucasian white boys
(H&E): Thick/dark outlines on the glomeruli basement
Don't fuck with steroids
Membranous Nephropathy
27
LUPUS, HBV, HCV, Syphilis, Solid Tumors, Drugs (NSAIDs/ Penicillins)
Membranous Nephropathy
28
EM : Spike and Dome
(Ig blobs in the light grey area underneath black podocyte aka subepithelial layer)
IF: Granular (Ig-Immune complex deposits )
H&E: Swollen/puffy , packed pink cells
Membranous Nephropathy
29
Nephritic & Nephrotic Syndrome:
Mesangial cell proliferation separates the immune complex deposits
creates a tram-track appearance on H&E and PAS
due to BM splitting
Large, Hypercellular Glomeruli
Membranoproliferative Glomerulonephritis (MPGN)
H&E: the hot pink outline of the cells are now 2 separate/ split pink outlines with light pink in the middle)
30
Granular IF
Tram-Track H&E
Subendothelial deposits on EM
HBV/HCV association
Type 1
| Membranoproliferative Glomerulonephritis
31
Granular IF
Tram-Track H&E
Intramembranous (inside the BM) deposits on EM
Type 2
Membranoproliferative Glomerulonephritis
aka dense deposit disease
32
associated with C3 nephritic factor
overactivation of complement
low levels of circulating C3
Type 2
| Membranoproliferative Glomerulonephritis
33
Hyaline arteriosclerosis from _______ of vascular basement eventually leading to a HYPERFILTRATION injury of the kidney
(↑ GFR due to ↑permeability despite thickened membrane)
non-enzymatic glycosylation
| Diabetic Nephropathy
34
Hyaline arteriosclerosing has a predilection towards the ____ arteriole thus narrowing the lumen & causing hyper-filtration resulting in _____
efferent
| Microalbuminemia
35
Eosinophilic acellular nodules from glomerular sclerosis.
Kimmelstiel-Wilson Nodules
| Diabetic Nephropathy
36
What can help slow the progression of Diabetic Nephropathy
ACE-I
| ARBs
37
Oliguria and Azotemia
Nephritic syndrome
38
Hypercellular, inflammed glomeruli
Nephritic syndrome
39
PERIORBITAL edema
| HTN
Nephritic syndrome
40
Immune complex deposition + C5a attracting neutrophils
Nephritic syndrome
41
EM: SubEPIthelial (under podocytes) HUMPS IC
IF: Granular (blobs–Starry sky–lumpy bumpy) due to IgG, IgM, and C3 deposits on GBM/ mesangium
H&E: Hypercellular glomeruli with HOT pink outlines
PSGN
Blood → Foot process → subepithelial → GBM (intramembranous) → subendothelium→ Endothelium → Tubular lumen
42
Periorbital edema
dark urine
recent infection
Kid
PSGN
43
Crescents in bowman's space of RPGN made up of (2)
Fibrin and MQs
44
Nephritic syndrome that may progress to Renal Failure in a few days
RPGN
45
List 6 RPGNs
```
Goodpastures
PSGN
Diffuse Proliferative GN
Wegener's
Churg-Strauss
Microscopic polyangiitis
```
46
Linear IF RPGN
Goodpastures
47
Granular IF RPGN
PSGN
| Diffuse Proliferative GN
48
```
Negative IF (Pauci-Immune) RPGN
c-ANCA
```
Granulomatosis with Polyangiitis
| Wegener
49
```
Negative IF (Pauci-Immune) RPGN
MPO/ p-ANCA
```
Microscopic polyangiitis
| Eosinophilic Granulomatosis with Polyangiitis (Churg- Strauss)
50
```
Negative IF (Pauci-Immune) RPGN
P-ANCA
esosinophilia
granulomatous inflammation
asthma
```
Churg-Strauss
51
anti-type 4 collagen in alveoli and renal BM
Goodpastures
52
most common type of renal disease in SLE
| subendothelial Ig-Ic deposits
Diffuse Proliferative Glomerulonephritis
53
IgA deposits in Mesangium seen in IF
Berger's (IgA nephropathy)
54
Most common nephropathy world wide
Berger's (IgA nephropathy)
55
Child with episodic hematuria after getting sick with mucosal (respiratory or GI like Diarrhea) infection
Berger's (IgA nephropathy)
56
Berger's (IgA nephropathy) is a Type ___ HSR
3 *so is PSGN
57
X-linked
DEFECTIVE type 4 collagen
thinning splitting of GBM
Irregular thickening (Basket Weave) of GBM
Alport Syndrome
| *eye problems, sensorineural deficits
+/– hemturia
58
Hematuria
Hearing Loss
Ocular disturbances
Alport Syndrome
*findings might only be seen in family tree
59
+Leukocyte esterase (Bacterial infection)
+nitrites (Gram – bacteria)
cloudy pee
Cystitis (bladder infection)
60
dysuria, urgency, frequency, suprapubic pain
Cystitis
61
Alkaline pee with an ammonia scent caused by what microbe
Proteus Mirabilis
62
Top 4 UTI causing microbes
```
E coli
Saphrophyticus
Klebsiella
Proteus
Pseudomonas
Enteroccous
```
63
Ascending infection
increased risk with Vesicoureteral reflux (HY)
increased risk with posterior ureters (BOYS ONLY)
Pyelonephritis
64
Fever, CVA tenderness, WBCs, Leukocytosis
| dysuria, urgency, frequency, suprapubic pain
Pyelonephritis
65
interstitial fibrosis and atrophy of tubules
Chronic Pyelonephritis
66
Due to Vesicoureteral reflux in kids
or
obstruction in adults (BPH, Cervical tumor)
Chronic Pyelonephritis
67
Cortical Scarring, blunted Calyces
Chronic Pyelonephritis
68
Eosinophilic proteinaceous material resembling THYROID
(OMG PLESASE DON'T FORGET THIS) in Kidney tubules
+/– waxy casts
Chronic Pyelonephritis
69
Unilateral Flank pain
Colicky pain
Hematuria
Nephrolithiasis
70
Stones associated with Chron's disease
Calcium oxalate/phosphate
71
Hydrochlorothiazide treats what Stones
Calcium oxalate/phosphate
72
Calculi caused by infection with a urease positive organism
Microscopic: Ammonium, Magnesium, Phosphate (Coffin lid rectangle studs) STRUVITE
Gross: Staghorn Calculi
73
Radiolucent kidney stone
| seen in leukemia and myeloproliferative diseases
Uric acid
| romboid/rosette/ parallelogram/ diamond shaped
74
Hydrate and alkalanize urine with potassium bicarb to treat what stones
Uric Acid
| *Allopurinol with Gout
75
Cysteine stones may form ____ calculi
Staghorn (Gross)
Hexagonal 6 sided (Micro)
76
Cysteinuria results in what shape of stones?
| Gross and Microscopic
Staghorn
| Hexagonal Cystine stones
77
2 common causes of end-stage-renal failure
(Malignant) HTN
| Diabetes
78
Uremia cause Urea crystals in skin and (3)
encephalitis
Nausea
Asterixis
79
Hyperkalemia with anion gap can be a sign of
End Stage Renal Failure
80
Why does End Stage Renal Failure present with anemia sometimes?
JGC make less EPO
81
Why does End Stage Renal Failure present with Hypocalcemia sometimes?
decreased 1 alpha hydroxylation of
Vit. D by PCT cells
*hyperphosphatemia due to decreased excretion
82
CKD can cause what related to elevated pTHr?
| 3
elevated pTHr
causes Renal Osteodystrophy
Osteomalacia
Osteoporosis
83
Cysts often develop in CKD during Dyalisis which increases the risk of _____
RCC
Cysts
Kancer
Dialysis
84
Renal Neoplasm associated with Tuberous Sclerosis
Angiomyolipoma
85
RCC classic triad, GO:
painless Hematuria
palpable Mass
pain in the Flank
86
Left Renal vein can be blocked by RCC causing
Varicocele
*right spermatic vein drains to IVC not the renal vein like left one does
87
Loss of VHL in RCC causes increased IGF & HIF which are transcription factors for (2)
VEGF
| PDGF
88
Major risk factor of random RCC not from VHL is
Smoking
89
VHL mutation causes RCC & what other illnesses
Cerebellar Hemangioblastoma of cerebellum
| Pheochromacytoma
90
Most Common Renal Tumor in children
WILMS Tumor
91
HTN, Renin, Unilateral Mass, Child
WILMS Tumor
92
Smoking, Napthylamine, Hair dyes,
CYCLOPHOSPHAMIDE and PHENACETIN
use can all cause
Urothelial cancer of
Renal pelvis, Ureter, bladder, and/or urethra
Painless Hematuria
93
p53 mutant
| flat lamina propia tumor
Urothelial cancer
| pathway 1
94
Papillary tumor that becomes a high grade papillary tumor
Urothelial cancer
| pathway 2
95
Multifocal tumor that can reoccur due to field defect
Urothelial cancer
96
Young Middle Eastern EGYPTIAN) or AFRICAN Man
Schistosoma H. infection
or
women with Chronic Cystitis
Has an Increased risk for what malignancy & where?
Squamous cell carcinoma of Lower UT
97
Tumor from Urachal remnant
DOME of bladder
increases risk of what cancer where?
Adenocarcinoma of Lower UT
98
Extrophy (congenital failure to form top part of anterior abd/bladder wall) can increase risk of what type of cancer and where?
Adenocarcinoma of Lower UT
99
Hematuria
Clear Cytoplasm on Histo
Yellow Mass
RCC
100
Hyperkalemia
granular casts
elevated BUN:CRE
Oliguria
ATN
*takes 2-3 weeks for tubular stable cells to regenerate
so oliguria can last as long
101
BUN:CR MORE than 15
Pre-Renal Azotemia (early intrinsic)
102
BUN:CR LESS THAN 15
Post-Renal Azotemia (late intrinsic)
103
FeNa >2%
| FeNa <1%
Post-Renal Azotemia (ATN)
| Pre-renal Azotemia (Early intrinsic)
104
Urine Osm>500
| Urine Osm<500
Pre-renal Azotemia (Early intrinsic)
Post-Renal Azotemia (ATN)
>500 (concentrated)
<500 (dilute)
105
Pre-renal Azotemia from
low RBF
| cardiac failure, stenosis
106
6 Things that can cause ATN
```
Aminoglycosides
Heavy Metal (lead)
Myoglobinuria (crush injury/ over exertion)
Ethylene Glycol (Anti freeze)
Radiocontrast Dye
Urate (Tumor Lysis Syndrome)
```
107
How to prevent ATN with Tumor Lysis Syndrome
Hydration
Allopurinol
Rasberrycase (Rasburicase)
108
Flat Face, Low Ears, Bad lungs
POTTERS from Oligohydraminos
109
non-inherited
| Cysts and weird tissue in kidneys
Dysplastic kidney
110
Bilateral enlarged Kidneys with Cysts everywhere
HTN, Portal HTN, Fibrotic- cystic liver
+/- POTTERS
AR-PKD-1/2
111
Renin, HTN, Bilateral enlarged Kidneys with Cysts everywhere. Associated with Berry Aneurysm, MVP, and Hepatic Cysts
YOUNG ADULT
AD-PKD-1/2
112
What 3 illnesses present with Hematuria and/or Pyuria
| but NO casts?
Cystitis (bladder infection)
Bladder cancer
Kidney stones
*Casts= glomerular or tubular illness
113
Kidney problems associated with
| HBV & HCV
Membranous nephropathy
| Membrano–proliferative Glomeurolnephritis I
114
Forms rhomboid/rosette/ parallelogram/ diamond
| shaped shaped renal calculi
Uric Acid
| Radiolucent (seen on US)
115
Forms dumbbell/envelope/stud
Radiopaque
shaped shaped renal calculi
Calcium Oxalate
116
Forms Wedged shaped/Prism
Radiopaque
shaped shaped renal calculi
Calcium phosphate
117
Forms Coffin lid/ rectangle studs
Radiopaque
shaped shaped renal calculi
Ammonium, Magnesium, Phosphate
| STRUVITE
118
Forms Staghorn Calculi
Cysteinuria
| Ammonium, Magnesium, Phosphate (STRUVITE)
