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Flashcards in Renal - Pathology Deck (92):
1

inferior mesenteric artery root implicated in this congenital problem

horseshoe kidney

most common congenital renal anomaly

2

Bilateral renal agenesis 1 problem w/3 complications

Also known as

oligohydraminos

->lung hypoplasia, flat face w/ low set ears, developmental extremity problems

-potters syndrome

3

Unilateral renal agenesis complication

hypertrophy and later hyperfiltation later on leading to renal failure risk

4

Noninherited congenital renal malformation characterized by cysts

what histology seen

dysplastic kidney (usually unilateral)

Collagen adjacent to cysts

5

inherited defect w/ cysts in the renal cortex and medulla

Polycystic kidney disease

infantile and adults

6

inherited defect w/ cysts in the medullary collecting duct

Seen grossly

Medullary cystic disease (Auto Dom)

shrunken kidneys

7

ADPCK
presents as (3)

associated w/(3)

Adults w/ HTN, hematuria and worsening renal failure

berry aneurisms
hepatic cysts
mitral valve prolapse

8

Infantile PCKD presents as

Auto recessive

presents as renal failure and infantile HTN

also have hepatic fibrosis w/ hepatic cyst formation

9

Acute renal failure seen as

Azotemia and oliguria seen w/in days

Divided into pre renal, post renal and infrarenal

10

Azotemia def

increased BUN and Creatinine in serum

11

Prerenal azotemia due to?

See:(3)

BUN:Creatinine
FENa ?
Osm?

decreased blood flow

See decreased GFR, azotremia and oliguria

BUN:Creatinine >15, low flow means BUN can resorb, renin aldosterone working to increase BUN level
FENa 500 mOSM/kg - tubes are fine

12

Postrenal azotremia ude to

See (3)

BUN:Creatinine
FENa
Osm

obstruction downstream

See low GFR, azotemia and oliguria

Depends:
Early
- BUN:Cr >15, BUN forced into serum w/ backpressur
-FENa 500 mOsm, tubes fine

Late - tubular damage - Can't resorb as well
-BUN:Cr 1%
Osm <500mOsm

13

Intrarenal Tubular necrosis is

Types(2)?

Problem w/in the kidney(block) usually resulting in BUN:Cr < 15 ( overall increase in BUN and creatinine)
FENa >1%
Osm <500 mOSM

Acute Tubular Necrosis - tubes
Acute interstitial nephritis - surrounding tissue

14

Causes of Acute tubular necrosis (2)



Ischemia
- low blood supply, preceded by pre renal azotemia

Nephrotoxic
-aminoglycosides, heavy metals. myoglobinuria(crush injury), ethylene glycol, radio contrast die, urate (tumor lysis syndrome(

15

Brown granular cases in urine seen in

necrotic cells plugging the tubule in acute tubular necrosis

16

Tumor lysis syndrome

What is it and prevention?

acute leukemia treated w/ chemo -> increased nuclear material in the blood

Rx w/ hydration and allopurinol

17

Acute interstitial nephritis Due and causes (3)

Drug induced hypersensitivity of surrounding tissue

NSAIDs, penicillin and diuretics

18

Clinical features of acute tubular necrosis (3)

oliguria w/ brown granular casts
elevated BUN and Creatine
Hyperkalemia(reduced excretion) w/ metabolic acidosis (decreased organic acid excretion)

19

eosinophils seen in urine?

acute interstitial nephritis

20

Renal papillary necrosis

Presentation(2) and causes (4)

gross hematuria and flank pain w/ necrotic renal papillae

Due to:
chronic analgesic use,
DM,
Sickle cell
severe acute pyelonephritis

21

Nephrotic syndrome = what seen

4 complications

>3.5 g.day filtered

leading to
hypoalbuminemia -edema
hypogammaglobinemia - infection risk
hypercoaguable - loss of anti thrombin III
Hyperlipidemai and hypercholesterolemia - fatty casts in urine (liver wants to thicken blood)

22

Most common syndrome in kids

Associated w/

minimal change disease

Hodgekin lymphoma - due to cytokine release leading the change

23

effacement of foot processes on electron microscopy (2)

Rx?

minimal change disease or focal glomerulosclerosis

Steroids, great response in KIDS,
not adults w/ FSGS -> renal failure

24

HIV, heroin and sickle cell associated nephrotic syndrome

Focal semental glomeulosclerosis

Usually idiopathic

MOST COMMON - hispanic and African americans

25

Membranous nephopathy is associated w/ (5)

used to be most common - usually idiopathic

HepB
HepC
solid tumors
SLE - (diffuse prolifererative glomerulinephritis more common)
Drugs (NSAIDs and penicillamine)

26

Thick glomeruli basement membrane on H and E w/ immune complex deposits (granular) (2)

Membranous nephropathy

Membranoproliferative glomerulonephritis
(can be nephritis too)

Deposits go to all 3 areas
- subepithelial - membranous nephropathy
-subendothelial - Type I membranoproliferative gom
- BM - type II membranoproliferative glom

27

Spike and dome appearance EM

Membranous nephropathy -

Podocytes like to be on BM and will lay down BL over subepithelial deposits

28

Tram Track appearance on Em

Associated w/

Membranoproliferative Glomerulonephritis Type 1

(HBV and HCV)

Mesangial cells adjacent proliferate w/ sub endothelial deposits and tries to split deposit w/ increased cytoplasm -> tram track

29

Associated w/ C3 nephritic factor

What is It?

membranoproliferative glomerulonephritis Type II

intramembranous deposit (BM)

Antibodies stabilize C3 convertase instead of destroying it -> hyperactive complement activation inflammation and decreased C

30

nonenzymatic glycosylation of vascular BM -> hyaline arteriolosclerosis

Diabetes mellatis nephrotic syndrome

31

Kimmelstiel Wilson nodules

Sclerosis of the mesangium seen in DM nephrotic syndrome

32

Protective agent in DM nephrotic syndrome

ACE inhibitors

Prevents further clamping of the efferent arteriole and associated hyper filtration (selected in the disease progression)

33

Nephrotic syndrome w/ apple green birefringence

deposits are what type and where?

Systemic Amyloidosis involves kidney most commonly

deposits in the mesangium

AL seen from original cause multiple myeloma

34

6 types of nephrotic syndrome

Minimal change disease
Focal segmental glomerulosclerosis

Membranous Nephropathy
Membranoproliferative Glomerulonephritis (nephritic as well)

Diabetes Mellitus
Systemic Amyloidosis

35

Nephritic syndrome characterized by(2)

Also see

glomerular inflammation(hyper cellular) and bleeding

limited proteinuria periorbital edema and HTN
RBC casts

36

Hypercellularity in nephritic syndrome is due to

Immune complex deposition and activation of complement -> C5a recruitment of PMNs

37

Types of nephritic syndrome(5)

Membranoproliferatve glomerulonephritis
poststreptococcal glomerulonephritis
rapidly progressive glomerulonephritis
- Linear
-Granular
- Negative IF
IgA nephopathy - Berger disease
Alport Syndrome

38

sub epithelial humps seen on EM post sore throat

More common in?

Poststreptococcal glomerulonephritis
2-3 weeks post sore throat or impetigo infection

(group A beta hemolytic strep pharynges)

More common in kids, mote dangerous in adults -> rapidly progressive glomerulonephritis

Sub endo -> sub epi (humps)-> goes away- passes (supportive Rx)

39

Crescents in Bowmans space are made of what?

Pathology called?

Made of fibrin and macrophages

Nephritic syndrome - Rapidly Progressive Glomerulonephritis

40

3 immunofloresent patterns seen in Rapidly progressive glomerulinephritis

Linear - Anti BN
Granular - Immune complex deposit
Negative IF - no immune showing

41

SLE associated nephritic syndrome

diffuse proliferative glomerulonephritis

a nephritic syndrome (rapidly progressive glomerulonephritis) w/ granular deposition

42

Ab against collagen in the glomerular and alveolar BM

Goodpasture Syndrome

Hematuria and hemoptysis

43

sub endothelial deposition of immune complexes in adults that does not get better

poststroptococcal glomerulonphritis (granular)

44

negative IF and C-ANCA nephritic syndrome

3 targets

Wegeners

lung, kidney, nasopharynx

45

2 p- ANCA disease w/ negative IF nephritic syndromes

Churg Strauss

Microscopic polyangiitis

46

Churg Struass has 3 differences from microscopic polyangiitis

granulomatous inflammation
eosinophilia
asthma

47

Most common nephropathy world wide w/ deposition in the mesangium post mucosal infection

IgA nephropathy

episodic gross or microscopic hematuria post illness progressing to renal failure

48

sensory hearing loss, ocular disturbance and isolated hematuria

All due to

Alport syndrome

Inherited defect in type Iv collagen
X linked

49

gold standard in cystitis

Other labs

>100,000 colony forming units

positive leukocyte esterase and nitrites (from bacteria converting nitrates)

Cloudy urine

50

Presentation of Cystitis(4) and notable absence

dysuria
frequency
urgency and suprapubic pain

absence of systemic signs

51

Etiology of cystitis (top 5)

E coli
Staph saprophyticus - esp if sexually active
Klebsiella pneumoniae
Proteus miabilis - alkaline urine
Enterococcus faecalis

52

Sterile urine w/ symptoms of cystitis/urethritis suggestive of

have pyuria

Chlamydia tachomatis or Nesseria gonorrhoea

53

Pyelonephritis noteable addition in presentation over cystitis (4)

fever
flank pain
WBC casts
lekocytosis

54

Chronic pyelonephritis risk increases w/(2)

vesicoureteral reflux - kids
obstruction (BPH/cervical carcinoma) - adults

55

Interstitial fibrosis and atrophy of the tubules -> cortical scarring w. blunted calyces called?

multiple bouts of pyelonephritis -> chronic pyelonephritis

56

Charactersitically scarred in vesicoureteral reflux chronic pyelonephritis

upper and lower poles

57

esosinophilic proteinaceous material resembling thyroid follicles

Atrophic tubules in chronic pyelonephritis

Waxy casts also

58

Presentation of nephrolithiasis(3)

Colicky pain
Hematuria
unilateral flank tenderness

59

Common causes of chronic renal failure(3)

DM
HTN
Glomerular disease

60

Uremia in chronic renal failure see (7)

increased nitrogenous waste products in the blood->

nausea
anorexia
pericarditis
platelet dysfunction - low adhesion and aggregation
encephalopathy w/ asterixis
deposition of urea crystals in skin

61

Clinical Features of Chronic renal disease (6)

Uremia
Na and water retention
Hyperkalemia and Metabolic alkalosis
Anemia - low EPO
Hypocalcemia -
Renal osteodystophy

62

Erythropoeitin made by?

renal peritubular interstitial cells

63

Hypocalcemia in chronic renal failure due to ?

decreased 1 alpha hydroxylation of VIt D by proximal renal tubule cells

and hyperphosphatemia

64

Bone destruction in chronic renal failure is called what and due to what 3 things?

Renal ostrodystrophy

osteritis fibrosis cystica -> hypocalcemia and secondary hyperparathyroidism

osteomalacia - low Vit D function

osteoperosis - Ca leached from bone to buffer metabolic acidosis

65

Crohn's has this renal association?

Due to?

Calcium oxalate stones

Due to increased reabsorbtion of oxalate and precipitation in the

66

Rx for most common cause of stones in kidneys

hydrochlorothiazide
Ca sparing dieuretic for Ca oxalate stones

67

Alkaline urine and infection -> this?

Major complication

Ammonium magnesium phosphate stones and urease positive organisms (Proteus or Klebsiella)

Staghorn calculi

68

Only radiolucent stone

Due to?

Uric acid

Seen in gout patients and hyperuricemia - > leukemia or myeloproliferative

69

Risk factors for Uric acid stone (3)

hot arid climate
low urine volume
acidic pH

(Rx w/ hydration and alkalination w/ bicarb)

70

Inherited renal stone risk?

Cystein stones

w/ cystinuria - defect of tubules and decreased reabsorption of cysteine

Also staghorn calculi

71

Harmatoma w/ blood vessels, smooth muscle and adipose tissue - renal neoplasia

Increased in?

Angiomyolipoma

Tuberous sclerosis

72

Classic triad of renal cell carcinoma

Hematuria
palpable mass
flank pain

- rare, usually hematuria

73

See a patient w/ reactive polycythemia or cushing syndrome or hypercalcemia or HTN w. hematuria?

Renal cell carcinoma

Has a lot of paraneoplastic potential

74

Left sided varicocele w/ hematuria

renal cell carcinoma

75

Most common subtype of renal cell carcinoma

clear cell

Grossly see a yello mass

76

Loss of VHL(3p)

Renal cell Carcinoma

A tumor suppressor gene

increased IGF-1 and HIF as a result

77

2 pathogenesis of renal cell carcinoma and associated epidemiology

Sporadic - seen in adult (>60) smokers unilaterally

Hereditary seen in younger adults bilaterally

78

Von hoppel Lindau disease - due to

Risks(2)

AD disease w/ inactivation of VHL gene

hemangioblastoma of cerebellum and renal cell carcinoma

79

METS of renal cell Carcinoma (2)

Nodes located?

Lungs and bone
w/ renal vein involvement

retroperitoneal

80

Blastema implicated in

what is it

Wilms Tumor

immature kidney mesenchyme

81

3 year old kid w/ hematuria, HTN an large unilateral flank mass

Wilms tumor

HTN w/ renin

most common malignant

82

WT1 gene

Tumor suppressor gene implicated in Wilms tumor

90% sporadic

83

WAGR syndrome(4)

due to?

wilms tumor
Aniridia
genital abnormalities
mental and motor retardation

-deletion of WT1 (llp13)

84

Denys Drash syndrome(3)

- due to ?

Wilms tumor
progressive renal disease
male pseudohemaphroditism

mutations in WT1

85

Beckwith Wiedmann Syndrome(4)

-due to?

Wilms tumor
neonatal hypoglycemia
muscular hemihypertrophy
organomegaly - tongue

WT2 gene cluster mutation

86

Risk factors of Urothelial (transitional cell) carcinoma (5)

Cigarette smoke - main
naphthalyamine
Azo dye
cyclophosphamide long use
phenacetin long use

87

Older adult presents w/ painless hematuria, what must be ruled out

urothelial (transitional cell) carcinoma

88

Field effect ?

Bladder cancer

multifocal and recur w/ chronic bath of carcinogen

89

2 types of urothelial carcinoma

- 2 major differences

Flat - starts high grade w/ p53 mutations - Progression

Papillary - starts low grade w/out p53 -> progression

90

background of squamous metaplasia in the bladder?

3 causes

- predisposes for squamous cell carcinoma

Chronic irritation
- chronic cystitis (old women)
- Schistosoma hematobium (middle east)
- nephrolithiasis

91

Cancer presents at the dome of the bladder

due to ?

Adenocarcinoma bladder
- malignant prolif of gland cells

often due to Urachal remnant

Other causes cystitis glandularis or extrophy (bladder outside)

92

string of beads on angiography leading to HTN

fibromuscular dysplasia

seen in middle age women, renal vascular sclerosis

bruits on auscultation