Renal Pathology II

Question 1

Renal damage: common terms
Azotemia- biochemical abnormality in which there is an elevation of the __________ and _______ levels resulting from __________________

Answer 1

blood urea nitrogen (BUN) and creatinine

decreased glomerular filtration rate [GFR].

Question 2

Renal damage-common terms

Uraemia- _______ associated with a constellation of signs and symptoms.

The loss of renal ______ function is accompanied by some metabolic and endocrine alterations eg uremic _________, uremic _____________

Answer 2

azotemia

excretory

gastroenteritis

fibrinous pericarditis

Question 3

Azotemia

________ Azotemia
________ azotemia
________ azotemia

Answer 3

Prerenal
Renal
Postrenal

Question 4

Azotemia Prerenal Azotemia
– Conditions that lead to _______ of the kidney eg-hypotension, excessive fluid losses, shock, CCF, liver cirrhosis etc.

Postrenal azotemia
– Urine ____________

Answer 4

hypoperfusion

outflow obstruction

Question 5

Clinical manifestations of renal diseases
These include

_____uria
______uria
______________ syndrome
_________ syndrome
Renal ________

Answer 5

Proteinuria
Hematuria
Acute nephritic syndrome
Nephrotic syndrome
Renal failure- acute and or chronic renal failure

Question 6

Clinical manifestations of renal diseases
These include

______,________, and _______ disorders- Renal tubular defects

Renal _____- from renal stones

_____________- from stones, tumours

________,_________ from pyelonephritis, UTI

Answer 6

Polyuria, nocturia and electrolyte

colic

Obstructive uropathy

Bacteriuria, pyuria

Question 7

Proteinuria

A condition in which urine contains a ______________.

Urinalysis with ______ is positive for protein. It occurs due to ______ or _______ diseases.

Answer 7

detectable amount of protein

dipstick

glomerular or tubular

Question 8

Proteinuria

It can result from _______,_______ and chronic ___________, chronic ___________.

Usually asymptomatic until ______________________

Answer 8

diabetes, hypertension

glomerulonephritis; pyelonephritis

high levels of protein are lost into urine.

Question 9

Proteinuria

Urine may appear _______.

____albuminaemia with reduced ___________ leads to _______.

Answer 9

foamy

Hypo; oncotic pressure

oedema

Question 10

Hematuria

Hematuria is the presence of ___________ in the urine.

It may be gross or microscopic.

It occurs most often due to ________ abnormalities.

It may also be due to a ________ or ________. It is often accompanied by ________.

Answer 10

red blood cells (RBCs)

glomerular

renal stone or tumour

proteinuria

Question 11

Acute nephritic syndrome

This syndrome includes _______,________ (usually _______ range), ______ GFR, and __________.

It is the classic presentation of ___________________________

Answer 11

hematuria, proteinuria

subnephrotic; diminished; hypertension

acute post- streptococcal glomerulonephritis.

Question 12

Acute nephritic syndrome

Rapidly progressive glomerulonephritis is characterized as a _____________ with __________________ (within hours to days).

Answer 12

nephritic syndrome

rapid decline in GFR

Question 13

Poststreptococcal glomerulonephritis

Post-streptococcal glomerulonephritis occurs most frequently in ______ but it can occur in ______ of any age.

It occurs __________s after a streptococcal infection of the _______ or _______(____)

Answer 13

children; adults

1-4 week

pharynx or the skin (impetigo).

Question 14

Poststreptococcal glomerulonephritis

Acute proliferative glomerulonephritis- proliferation of _______ and ________ cells as well as _________ infiltration.

By IF, granular deposits of ___,_____,_____ are seen in the ——- and along the _______ .

By EM, _______-shaped subepithelial deposits are seen.

Answer 14

endothelial and mesangial

leukocytic

IgG, IgM and C3

mesangium; basement membrane

hump

Question 15

Poststreptococcal glomerulonephritis
Post-streptococcal glomerulonephritis occurs most frequently in children but it can occur in adults of any age.
It occurs 1-4 weeks after a streptococcal infection of the pharynx or the skin (impetigo).
Acute proliferative glomerulonephritis- proliferation of endothelial and mesangial cells as well as leukocytic infiltration.
By IF, granular deposits of IgG, IgM and C3 are seen in the mesangium and along the BM.
By EM, hump-shaped subepithelial deposits are seen.

Question 16

Nephrotic syndrome

This syndrome is characterized by
– ____________ (more than ___ per day),

– ____________

– ____________

– ____________.

Answer 16

heavy proteinuria

3.5gm

– hypoalbuminaemia

– severe oedema

hyperlipidemia.

Question 17

Nephrotic syndrome

Common causes of nephrotic syndrome include

________
__________
____________

Answer 17

focal segmental glomerulosclerosis, minimal change disease and membranous nephropathy
•

Question 18

Renal failure

_______ or _____

Answer 18

Acute

Chronic

Question 19

Acute renal failure

Acute renal failure develops rapidly over _________________.

Clinical features include
_______________ or ___________, (gradual or sudden?) increase in metabolic waste-products (______ and ______) in the blood with consequent development of _______.

Answer 19

a few hours or days

reduced[oliguria] or no urine flow[anuria]

Sudden; urea and creatinine

uraemia

Question 20

Acute renal failure

Acute renal failure
Clinical features include

It may result from ____,_____,_____, or _______ injury.

_______________ is a common cause.

Answer 20

glomerular, interstitial, vascular or tubular

Acute tubular necrosis

Question 21

_______________ is the term that has recently replaced the term ARF.

Answer 21

Acute Kidney Injury (AKI)

Question 22

Chronic renal failure

_________ that has been present for longer than ________

It is usually associated with signs and symptoms of ________.

________ of all chronic renal parenchymal diseases.

Answer 22

Azotemia

3 months.

uraemia

End result

Question 23

Vascular disorders

Benign ___________
Accelerated __________
Renal artery _________
________ _________

Answer 23

nephrosclerosis

nephrosclerosis

stenosis

Thrombotic microangiopathies

Question 24

Vascular disorders: Benign
nephrosclerosis

Benign nephrosclerosis- Nephrosclerosis is the term used for the renal pathology associated with ________ of _____ and ———

Answer 24

sclerosis of renal arterioles and small arteries

Question 25

Vascular disorders: Benign
nephrosclerosis

Causes include ________,________,______.

_________ of renal parenchyma due to ________.

Ischemia leads to ______ and chronic ________ injury.

Answer 25

chronic benign hypertension, aging, diabetes

Focal ischemia; narrowed vessels

glomerulosclerosis; tubointerstitial

Question 26

Vascular disorders: Benign
nephrosclerosis

Pathogenesis.

Two processes participate in the arterial lesions:

•_____________________________, as a response to hemodynamic changes, aging, genetic defects, or some combination of these

•_________ of ________, caused by extravasation of plasma proteins through injured endothelium
and by increased deposition of basement membrane matrix.

Answer 26

Medial and intimal thickening

Hyalinization of arteriolar walls

Question 27

Vascular disorders: Benign
nephrosclerosis

Gross morphology-

____________________________ weight kidneys with ___________ of the subcapsular surfaces.

Histology shows marked _______ of the walls of the vessels with ______ deposition and a ______ lumen- _________________

Answer 27

normal or moderately reduced

fine granularity

thickening; hyaline; narrowed

hyaline arteriolosclerosis

Question 28

Vascular disorders: Accelerated
nephrosclerosis

Accelerated/________ nephrosclerosis is caused by _________,_______

Answer 28

malignant

malignant hypertension, scleroderma

Question 29

Vascular disorders: Accelerated
nephrosclerosis

Pathogenesis. The fundamental lesion in malignant nephrosclerosis is _______.

This can lead to _______ necrosis of arterioles and small arteries with activation of ________. Factors from platelets (e.g., ______), plasma, and other cells cause __________ of _____________, resulting in the __________ arteriolosclerosis .

Answer 29

vascular injury

fibrinoid; platelets

PDGF

hyperplasia of intimal smooth muscle of vessels

hyperplastic

Question 30

Vascular disorders: Accelerated
nephrosclerosis

Gross morphology shows multiple ________ on the subcapsular/ cortical surface of the kidney- ___________ appearance.

On histology, there is ________ of arterioles and small arteries. There is also proliferation of _________ within the intima (hyperplastic arteriolitis) giving the ________ appearance.

Answer 30

petechial haemorrhages

flea-bitten

fibrinoid necrosis

smooth muscle cells ; onion-skin

Question 31

Vascular disorders: Renal artery
Stenosis

A cause of ________ hypertension

A/An (common or uncommon?) cause of hypertension, it represents 2-5% of cases.

Important because it is _____________ in up to 80% of cases.

Answer 31

secondary; uncommon

potentially curable by surgery

Question 32

Vascular disorders: Renal artery
Stenosis

Constriction leads to ______ blood supply that leads to ________ and activation of the ______ causes an increase in _____ levels and increased production of vasoconstrictor, __________.

Answer 32

reduced

ischemia

juxtaglomerular apparatus

renin; angiotensin II

Question 33

Vascular disorders: Renal artery
Stenosis

Common causes include

1. _____________
2. ___________ ————-

Answer 33

atherosclerosis

fibromuscular hyperplasia

Question 34

Vascular disorders: Renal artery
Stenosis

Patients with malignant hypertension have markedly elevated levels of plasma _____.

This sets up a self perpetuating cycle in which _________ causes intrarenal vasoconstriction, and the attendant renal ______ perpetuates _____ secretion

Answer 34

renin

angiotensin II

ischemia

renin

Question 35

Vascular disorders: Thrombotic
microangiopathies

TMA is a heterogenous group characterized clinically by _______________ anaemia.

It includes _______________ and ______________

Answer 35

microangiopathic haemolytic

thrombotic thrombocytopenic purpura [TTP] and hemolytic uremic syndrome[HUS].

Question 36

Vascular disorders: Thrombotic
microangiopathies

Pathogenesis.

Within the thrombotic microangiopathies, two pathogenetic triggers dominate:
(1)__________, and (2) excessive ______________

Answer 36

endothelial injury

platelet activation and aggregation.

Question 37

_______ appears to be the primary cause of HUS, whereas __________ may be the inciting event in TTP

There is thrombosis in the arterioles and capillaries on histology. Prototype- classic/ childhood hemolytic uraemic syndrome (HUS).

Answer 37

Endothelial injury

platelet activation

Question 38

Haemolytic uraemic syndrome (HUS)

Typical (epidemic, classic, diarrhea-positive) __________ is the best xterised form of HUS.

It follows intestinal infection with strains of E. coli that produce Shiga-like toxins.
Most cases are sporadic, however epidemics have been traced to various sources, most commonly the ingestion of contaminated ground meat (as in hamburgers), drinking water, raw milk, and person-to-person transmission.
It can occur at any age but children and older adults are at highest risk.
HUS is one of the main causes of renal failure in children.
Clinical features- Following influenza like or diarrhea symptom is sudden-onset of bleeding- hematemesis, melena, severe oliguria, hematuria associated with microangiopathic hemolytic anaemia ± neurologic changes.

Answer 38

hemolytic uremic syndrome

Question 39

Haemolytic uraemic syndrome (HUS)
Typical (epidemic, classic, diarrhea-positive) hemolytic uremic syndrome is the best xterised form of HUS.
It follows intestinal infection with strains of E. coli that produce Shiga-like toxins.
Most cases are sporadic, however epidemics have been traced to various sources, most commonly the ingestion of contaminated ground meat (as in hamburgers), drinking water, raw milk, and person-to-person transmission.
It can occur at any age but children and older adults are at highest risk.
HUS is one of the main causes of renal failure in children.
Clinical features- Following influenza like or diarrhea symptom is sudden-onset of bleeding- hematemesis, melena, severe oliguria, hematuria associated with microangiopathic hemolytic anaemia ± neurologic changes.

Question 40

Haemolytic uraemic syndrome (HUS)
Typical (epidemic, classic, diarrhea-positive) hemolytic uremic syndrome is the best xterised form of HUS.
It follows intestinal infection with strains of E. coli that produce Shiga-like toxins.
Most cases are sporadic, however epidemics have been traced to various sources, most commonly the ingestion of contaminated ground meat (as in hamburgers), drinking water, raw milk, and person-to-person transmission.
It can occur at any age but children and older adults are at highest risk.
HUS is one of the main causes of renal failure in children.
Clinical features- Following influenza like or diarrhea symptom is sudden-onset of bleeding- hematemesis, melena, severe oliguria, hematuria associated with microangiopathic hemolytic anaemia ± neurologic changes.

Question 41

Haemolytic uraemic syndrome (HUS)
Typical (epidemic, classic, diarrhea-positive) hemolytic uremic syndrome is the best xterised form of HUS.
It follows intestinal infection with strains of E. coli that produce Shiga-like toxins.
Most cases are sporadic, however epidemics have been traced to various sources, most commonly the ingestion of contaminated ground meat (as in hamburgers), drinking water, raw milk, and person-to-person transmission.
It can occur at any age but children and older adults are at highest risk.
HUS is one of the main causes of renal failure in children.
Clinical features- Following influenza like or diarrhea symptom is sudden-onset of bleeding- hematemesis, melena, severe oliguria, hematuria associated with microangiopathic hemolytic anaemia ± neurologic changes.

Question 42

Haemolytic uraemic syndrome (HUS)
Typical (epidemic, classic, diarrhea-positive) hemolytic uremic syndrome is the best xterised form of HUS.
It follows intestinal infection with strains of E. coli that produce Shiga-like toxins.
Most cases are sporadic, however epidemics have been traced to various sources, most commonly the ingestion of contaminated ground meat (as in hamburgers), drinking water, raw milk, and person-to-person transmission.
It can occur at any age but children and older adults are at highest risk.
HUS is one of the main causes of renal failure in children.
Clinical features- Following influenza like or diarrhea symptom is sudden-onset of bleeding- hematemesis, melena, severe oliguria, hematuria associated with microangiopathic hemolytic anaemia ± neurologic changes.