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USLME Kiss my ass and pray > Renal - Pathology > Flashcards

Renal - Pathology Flashcards

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1
Q

inferior mesenteric artery root implicated in this congenital problem

A

horseshoe kidney

most common congenital renal anomaly

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2
Q

Bilateral renal agenesis 1 problem w/3 complications

Also known as

A

oligohydraminos

  • > lung hypoplasia, flat face w/ low set ears, developmental extremity problems
  • potters syndrome
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3
Q

Unilateral renal agenesis complication

A

hypertrophy and later hyperfiltation later on leading to renal failure risk

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4
Q

Noninherited congenital renal malformation characterized by cysts

what histology seen

A

dysplastic kidney (usually unilateral)

Collagen adjacent to cysts

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5
Q

inherited defect w/ cysts in the renal cortex and medulla

A

Polycystic kidney disease

infantile and adults

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6
Q

inherited defect w/ cysts in the medullary collecting duct

Seen grossly

A

Medullary cystic disease (Auto Dom)

shrunken kidneys

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7
Q 
ADPCK
presents as (3)

associated w/(3)

A

Adults w/ HTN, hematuria and worsening renal failure

berry aneurisms
hepatic cysts
mitral valve prolapse

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8
Q

Infantile PCKD presents as

A

Auto recessive

presents as renal failure and infantile HTN

also have hepatic fibrosis w/ hepatic cyst formation

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9
Q

Acute renal failure seen as

A

Azotemia and oliguria seen w/in days

Divided into pre renal, post renal and infrarenal

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10
Q

Azotemia def

A

increased BUN and Creatinine in serum

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11
Q

Prerenal azotemia due to?

See:(3)

BUN:Creatinine
FENa ?
Osm?

A

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

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12
Q

Postrenal azotremia ude to

See (3)

BUN:Creatinine
FENa
Osm

A

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

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13
Q

Intrarenal Tubular necrosis is

Types(2)?

A

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

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14
Q

Causes of Acute tubular necrosis (2)

A

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(

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15
Q

Brown granular cases in urine seen in

A

necrotic cells plugging the tubule in acute tubular necrosis

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16
Q

Tumor lysis syndrome

What is it and prevention?

A

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

Rx w/ hydration and allopurinol

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17
Q

Acute interstitial nephritis Due and causes (3)

A

Drug induced hypersensitivity of surrounding tissue

NSAIDs, penicillin and diuretics

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18
Q

Clinical features of acute tubular necrosis (3)

A

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

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19
Q

eosinophils seen in urine?

A

acute interstitial nephritis

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20
Q

Renal papillary necrosis

Presentation(2) and causes (4)

A

gross hematuria and flank pain w/ necrotic renal papillae

Due to:
chronic analgesic use, 
DM, 
Sickle cell
severe acute pyelonephritis
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21
Q

Nephrotic syndrome = what seen

4 complications

A

> 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)

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22
Q

Most common syndrome in kids

Associated w/

A

minimal change disease

Hodgekin lymphoma - due to cytokine release leading the change

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23
Q

effacement of foot processes on electron microscopy (2)

Rx?

A

minimal change disease or focal glomerulosclerosis

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

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24
Q

HIV, heroin and sickle cell associated nephrotic syndrome

A

Focal semental glomeulosclerosis

Usually idiopathic

MOST COMMON - hispanic and African americans

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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

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