Renal pathology

Question 1

What is nephritis?

Answer 1

Inflammation of the kidney

Can be infective (pyelonephritis) or non-infective (glomerulonephritis)

Question 2

What is the pathogenesis of goodpasture’s disease/

Answer 2

IgG antibodies against alpha 3 subunit of collagen 4

Present in glomeruli and alveoli

Question 3

What antibody is present in goodpasture’s disease?

Answer 3

Anti-GBM

Question 4

What vasculitis can cause glomerulonephritis?

Answer 4

GPA - cANCA

MPA - pANCA

Question 5

What is nephritic syndrome?

Answer 5

Haematuria, hypertension

Question 6

What is nephrotic syndrome?

Answer 6

Heavy proteinuria
Non-dependent oedema, hyperlipidaemia
Protein loss - antibodies, complement, and proteins in clotting cascade
Can predispose to immunosuppression and renal vein thrombosis

Question 7

What are crescents associated with?

Answer 7

BAD

Rapidly progressive GMN

Question 8

What conditions can cause granuloma formation in the glomerulus?

Answer 8

GPA

Sarcoidosis

Question 9

What is light microscopy used for?

Answer 9

Hypercellularity - inflammatory cells and reactive proliferations
Sclerosis
Crescents
Vasculitis

Question 10

What condition will show linear IgG on immunofluorescence?

Answer 10

Goodpasture’s

Question 11

Describe minimal change disease?

Answer 11

Nephrotic syndrome
Children get it
Resolves with steroids
Can only be diagnosed from EM

Question 12

What can cause FSGS?

Answer 12

Obesity
HIV
Sickle cell
PWID

Question 13

What syndrome will FSGS cause?

Answer 13

Nephrotic syndrome

Question 14

What can cause membranous glomerulonephritis?

Answer 14

Infection - streptococcus
Hepatitis
Malaria
Syphilis
Drugs: penicillamine, NSAIDs, catopril, gold
Malignancy: lung, colon, melanoma
Immunological: SLE, RA, sarcoid, sjogrens

Question 15

What syndrome will membranous glomerulonephritis cause?

Answer 15

Nephrotic

Question 16

What is the histological appearance of membranous glomerulonephritis?

Answer 16

Thick membranes
Sub-epithelial immune deposits
Spikes seen on silver stain

Question 17

What antibodies will membranous glomerulonephritis show?

Answer 17

Anti-phospholipase A2 receptors

Question 18

Who is likely to get IgA glomerulonephritis?

Answer 18

Genetic
Acquired
Coeliac
Post infectious

Question 19

What syndrome will IgA glomerulonephritis cause?

Answer 19

Nephritic syndrome - commonly asymptomatic with painless haematuria

Question 20

What will IgA glomerulonephritis show on renal biopsy?

Answer 20

IgA deposits in the mesangium

Question 21

What causes membranoproliferative glomerulonephritis?

Answer 21

Idiopathic (type 2 - infection, lupus, malignancy)

Commonly hodgkin’s lymphoma

Question 22

What type of syndrome will membranoproliferative glomerulonephritis cause?

Answer 22

Either

Question 23

What is the histological appearance of membranoproliferative glomerulonephritis?

Answer 23

Big lobulated hypercellular glomeruli with thick membranes

TRAM TRACKS

Question 24

What kidney issues can diabetes cause?

Answer 24

Diffuse and nodular glomerulosclerosis
Kimmel Stiel Wilson Lesions 
Afferent arterial sclerosis 
Pyelonephritis
Papillary necrosis

Question 25

What is the bosniak score?

Answer 25

Predicts malignant change in a kidney cyst

Question 26

What is ADPCKD due to?

Answer 26

PKD1: chromosome 16 PKD2: chromosome 4

Question 27

What is ARPCKD due to?

Answer 27

PKDH1: chromosome 6

Question 28

How will ADPCKD present?

Answer 28

``` When adult Lots and lots of cysts Haemorrhage Infarction Rupture Pain Haematuria Liver cysts Cerebral aneurysms leading to subarachnoid haemorrhage ```

Question 29

How will ARPCKD present?

Answer 29

In children Younger the age, the higher the mortality Kidney of a normal size with dilated collecting ducts

Question 30

What is xanthogranulomatous pyelonephritis?

Answer 30

Infection that creates a mass that resembles a malignancy

Question 31

What benign tumour is assoc with the kidneys?

Answer 31

Oncocytoma

Question 32

What malignant tumours are assoc with the kidneys?

Answer 32

Chromophobe Clear cell Papillary Collecting duct

Question 33

What paediatric tumour is associated with the kidneys?

Answer 33

Wilm's tumour

Question 34

Describe an oncocytoma

Answer 34

Small, oval, well circumscribed | Mahogany brown with a central stellate scar

Question 35

What is an oncocyte?

Answer 35

A pink cell with a fluffy cytoplasm due to a very high number of mitochondria

Question 36

What is the histological appearance of a chromophobe?

Answer 36

Oncocytic but with raisinoid nuclei and perinuclear halos

Question 37

What is the histological appearance of a papillary tumour?

Answer 37

Low grade | Papillary projections

Question 38

What is the histological appearance of a collecting duct carcinoma?

Answer 38

High grade appearance with a very desmoplastic stroma | Poor survival - mean around 4 month

Question 39

What are risk factors for developing clear cell carcinoma?

Answer 39

Obesity | Genetic influecnen

Question 40

What is the common presentation of clear cell carcinoma?

Answer 40

Haematuria Mass Hypertension - rare NEPHRITIC SYNDROME

Question 41

What colour is a clear cell carcinoma?

Answer 41

Yellow

Question 42

Where will clear cell carcinoma of the kidney spread?

Answer 42

Propensity to spread up the renal vein, into the IVE and into the heart Doesn't grow on the vessel walls, grows like a finger projection

Question 43

What genetic condition predisposes to renal carcinoma?

Answer 43

VHL | Codes for hypoxia inducible factor which acts as a transcription factor for VEGF, PDGFRB and EPO