- Glomerulonephritis - Ischemia - Malignant HTN - Indicates that hematuria is of renal origin

- Tubulointerstitial inflammation - Acute pyelonephritis - Transplant rejection - Indicates pyuria is of renal origin

- Muddy Brown casts - Acute tubular necrosis

- Advanced renal disease - Chronic renal failure

- Acute poststreptococcal glomerulonephritis - Rapidly progressive glomerulonephritis - Berger's IgA glomerulonephropathy - Alport Syndrome

- Focal segmental glomerulonephritis - Membraneous glomerulonephritis - Minimal Change disease - Amyloidosis - Diabetic glomerulonephropathy

- IgA nephropathy - Related to Henoch-Schonlein (small vessel vasculitis w/ IgA) - Mesangial proliferation & immune complex deposits - IgA complex deposits in mesangium - Often presents/flares w/ URI or acute gastroenteritis - Nephritic: Inflammatory process - In glomeruli: hematuria & RBC casts - Azotemia (elevated BUN) - Oliguria - HTN due to salt retention - Proteinuria <3.5g/day

Renal Pathology Flashcards by Chelsea Garner

RBC Casts

Glomerulonephritis
Ischemia
Malignant HTN
Indicates that hematuria is of renal origin

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WBC casts

Tubulointerstitial inflammation
Acute pyelonephritis
Transplant rejection
Indicates pyuria is of renal origin

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Granular casts

Muddy Brown casts

- Acute tubular necrosis

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Waxy Casts

Advanced renal disease

- Chronic renal failure

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Hyaline casts

Nonspecific

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Nephritic Syndrome

Acute poststreptococcal glomerulonephritis
Rapidly progressive glomerulonephritis
Berger’s IgA glomerulonephropathy
Alport Syndrome

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Nephrotic Syndrome

Focal segmental glomerulonephritis
Membraneous glomerulonephritis
Minimal Change disease
Amyloidosis
Diabetic glomerulonephropathy

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Both Nephritic and Nephrotic

Diffuse proliferative glomerulonephritis

- Membrano-proliferative glomerulnephritis

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Acute poststreptococcal Glomerulonephritis

Glomeruli are enlarged and hypocellular
Neutrophils
lumpy bumpy appearance
Subepithelial immune complex humps
Immunofluorescence shows granular appearance due to IgG, IgM and C3 deposition along GBM & mesangium
Most frequently in children
Peripheral & periorbiral edema
dark urine
Resolves spontaneously
Nephritic: Inflammatory process
- In glomeruli: hematuria & RBC casts
- Azotemia (elevated BUN)
- Oliguria
- HTN due to salt retention
- Proteinuria <3.5g/day

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Rapidly Progressive (Crescentic) Glomerulonephritis (RPGN)

Crescent moon shaped
Crescent consists of fibrin & plasma protiens (C3b)
- Also glomerular parietal cells and macrophages
Caused by:
- Goodpasture syndrome: type II hypersensitivity
  - antibodies GBM & alveolar basement membranes
  - Linear immunofluorescence
  - Hematuria and hemoptysis
- Wegner’s granulomatosis
  - c-ANCA
- Microscopic polyangiitis
  - p-ANCA
Poor prognosis
Rapidly deteriorating renal function
Nephritic: Inflammatory process
- In glomeruli: hematuria & RBC casts
- Azotemia (elevated BUN)
- Oliguria
- HTN due to salt retention
- Proteinuria <3.5g/day

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Diffuse Proliferative Glomerulonephritis

Due to SLE or MPGN
Wire looping of capillaries
Subendothelial & Intramembranous IgG immune complexes
- Often w/ C3 deposits
Immunofluorescence: granular
Nephritic: Inflammatory process
- In glomeruli: hematuria & RBC casts
- Azotemia (elevated BUN)
- Oliguria
- HTN due to salt retention
- Proteinuria <3.5g/day
Most common cause of death in SLE
- Can present w/ nephritic and nephrotic

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Berger’s Disease

IgA nephropathy
Related to Henoch-Schonlein (small vessel vasculitis w/ IgA)
Mesangial proliferation & immune complex deposits
IgA complex deposits in mesangium
Often presents/flares w/ URI or acute gastroenteritis
Nephritic: Inflammatory process
- In glomeruli: hematuria & RBC casts
- Azotemia (elevated BUN)
- Oliguria
- HTN due to salt retention
- Proteinuria <3.5g/day

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Focal Segmental glomerulosclerosis

Segmental sclerosis & hyalinosis
Most common glomerular disease in HIV patients
Nephrotic: massive proteinuria (>3.5 g/day)
- Hyperlipidemia (low oncotic pressure triggers apoproteinB)
- Fatty casts
- Edema
- Increased risk of infection b/c loss Ig

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Membraneous glomerulonephritis

Diffuse membranous glomerulopathy
Diffuse capillary & GMB thickening
Spike & Dome appearance w/ subepithelial deposits
Granular immunofluorescence
- SLE nephrotic presentation
Caused by:
- Drugs
- Infection
- SLE
- Solid tumors
Most common cause of adult nephrotic sydnrome
Nephritic: Inflammatory process
- In glomeruli: hematuria & RBC casts
- Azotemia (elevated BUN)
- Oliguria
- HTN due to salt retention
- Proteinuria <3.5g/day

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Minimal Change Disease

Lipoid nephrosis
Normal glomeruli
Foot process effacement
Selective loss of albumin
- Not globins due to GBM polyanion loss
May be triggered by recent infection or immune stimulus
Most common in children
Responds to corticosteroids
Nephritic: Inflammatory process
- In glomeruli: hematuria & RBC casts
- Azotemia (elevated BUN)
- Oliguria
- HTN due to salt retention
- Proteinuria <3.5g/day

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Amyloidosis

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Congo red stain w/ apple green bifiringence
Associated w/ chronic conditions
- Multiple myeloma, TB, RA
Nephritic: Inflammatory process
- In glomeruli: hematuria & RBC casts
- Azotemia (elevated BUN)
- Oliguria
- HTN due to salt retention
- Proteinuria <3.5g/day

Membraneoproliferative glomerulonephritis

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-Subendothelial immunocomplexes w/ granular IF
-Type 1: tram-track appearance due to GBM splitting from mesangial ingrowth
-HBV, HCV
-Type 2: dense deposits
-C3 nephritic factor
-

Diabetic glomerulonephropathy

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Nonenzymatic glycosylation of GBM
- Increases permability and thickening
Nonenzymatic glycosylation of efferent arterioles
- Increases GFR
- Mesangial expansion
Mesangial expansion and GBM thickening
- eosinophilic nodular granulosclerosis
- Kimmelsteil-Wilson lesion

Calcium Kidney Stones

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Calcium: 75-85% (Ca oxalate or Ca phosphate)
precipitates at low or neutral pH
Radiopaque
Hypercalcemia (cancer or increased PTH)->hypercalciuria
Oxalate crystals from antifreeze or Vit C abuse

Ammonium Magnesium Phosphate Kidney Stones

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15%
Precipitates at increased pH
Radiopaque
Caused by urease positive Mg or radiolucent bugs
- Staphylococcus or phosphate Klebsiella
Can form staghorn calculi
- huge stone in whole calyx
- Can be nidus for UTI
WOrsened by alkaluria

Uric Acid Kidney Stone

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5%
Precipitates at lower pH
Radiolucent
Strong association w/ hyperuricemia
Often seen in diseases w/ increased cell turnover (leukemia)

Cystine Kidney Stones

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1%
Precipitates in decreased pH
Radiopaque
Most often secondary to cystinuria
Hexagonal
Treat w/ alkalinization of urine

Renal Cell Carcinoma

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Originates in renal tubular cells
Polygonal clear cells filled w/ lipid accumulations
Most common in men 50-70
Increased incidence in smoking and obesity
Clinical: hematuria, masses, flank pain, fever, wt loss
Invades IVC and spreads
Metastasizes to lungs and bone
Most common renal malignancy
Associate w/ von-Hippel-Lindau Syndrome
Associated w/ chromosome 3p deletion
Paraneoplastic syndrome
- Ectopic EPO, ACTH, PTHrP, & prolactin

Wilms’ Tumor

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Most common renal malignancy of early childhood
Contains embryonic glomerular structures
Presents w/ huge palpable flank mass & hematuria
Deletion of tumor suppressor gene WT1 on chromosome 11p
WAGR complex
- Wilm’s tumor
- Aniridia (absent iris)
- Genitourinary malformation
- Retardation

Transitional Cell Carcinoma

- Most common tumor of the urinary tract - Can occur in renal calyces, renal pelvis, ureters, & bladder - Painless hematuria, no casts - Associated with: - Phenacetin - Smoking - Aniline dyes - Cyclophosphamide

Acute Pyelonephritis

- Affects cortex w/ relative sparing of glomeruli/vessels - Fever - CVA tenderness - Nausea and vomiting - Neutrophilic infiltration into renal interstitium

Chronic pyelonephritis

- Coarse asymmetric corticomedullary scarring - Blunted calyx - Tubules can contain eosinophilic casts - Thyroidization of kidney - White casts in urine are classic - Vesicoureteral reflux required

Drug Induced interstitial nephritis

- Acute interstitial renal inflammation - Pyuria (Typically eosinophils) - Azotemia 1-2 weeks after drugs - Diuretics, NSAIDs, penicillins, sulfonamides, rifampin - Drugs act as haptans and induce hypersensitivity

Acute Tubular Necrosis

- Most common cause of acute renal failure - Self-reversible but fatal if left untreated - Three stages: 1. Inciting event 2. Maintenance phase - oliguria: lasts 1-3 weeks - Risk of hyperkalemia 3. Recovery phase: - Polyuric - BUN & creatinine fall - Risk of hypokalemia - Associated with: - renal ischemia: shock or sepsis - Crush injury: myoglobinuria - Toxins - Key finding: granular casts

Renal Papillary Necrosis

- Sloughing of renal papillae - Hematuria, proteinuria - May be triggered by recent infection or immune stimulation - Associated with: - Diabetes mellitus - Acute pyelonephritis - Chronic phenacetin use (acetaminophen) - Sickle cell anemia and trait

Acute Renal Failure: Prerenal

- Prerenal azotemia: due to decreased RBF (Hypotension) - decreased GFR - Na+/H2O and urea retained to conserve volume - BUN/Creatinine ratio increases - Urine osmolality: >500 - Urine Na: 20

Acute Renal Failure: Intrinsic

- Abrut decline in renal function w/ increased creatine and BUN - ATN, ischemia/toxins, glomerulonephritis - Patchy necrosis: obstructs tubule - Fluid backflow across necrotic tubule - Decreased GFR - Urine has epithelial/granular casts - BUN reabsorption impaired: decreased BUN/creatinine ratio - Urine osmolality: 20 - FeNa: >2% - BUN/Cr: <15

Acute Renal Failure: Postrenal

- outflow blockage - Stones, BPH, neoplasia, congenital anomalies - Develops only w/ bilateral obstruction - Urine osmolality: 40 - FeNa: >4% - BUN/Cr: >15

Consequences of Renal Failure

- Inability to make urine and excrete nitrogenous wastes - Na+/H2O retention: CHF, pulmonary edema, HTN - Hyperkalemia - Metabolic acidosis - Uremia - Increased BUN & creatinine - Nausea/anorexia - Pericarditis - Asterixis - Encephalopathy - Platelet dysfunction - Anemia (failure of EPO production) - Renal osterodystrophy - Dyslipidemia - Growth retarded & developmental delay in children

AD Polycystic Kidney Disease (ADPKD)

- Multiple, large, bilateral cysts - Destroy kidney parenchyma - Presents with: - Flank pain - hematuria - HTN - Urinary infection - Progressive renal failure - Autosomal Dominant mutation in PKD1 or PKD2 - Complications from chronic kidney disease and HTN - Associated with: - polycystic liver disease - berry aneurysm - mitral valve prolapse

AR polycystic Kidney Disease (ARPKD)

- Infantile presentation in the parenchyma - Autosomal recessive - Associated with: - congenital hepatic fibrosis - Significant renal failure can leads to Potter's

Renal Pathology Flashcards

(36 cards)