Renal pathology III Flashcards Preview

Year 2 Renal > Renal pathology III > Flashcards

Flashcards in Renal pathology III Deck (59):
1

what 3 diseases are associated with asymptomatic isolated hematuria?

- IgA nephropathy (Berger disease)
- alport syndrome
- thin GBM disease

2

what is the most common type of primary glomerulonephropathy worldwide?

IgA nephropathy

3

what are the symptoms of IgA nephropathy?

- mild hematuria
- mild proteinuria

4

what are the LM, IF, and EM findings in IgA nephropathy?

- LM: mesangial proliferation / hypercellularity
- IF: mesangial IgA
- EM: mesangial deposits

5

what is alport syndrome?

defect of the GBM due to mutation in the gene encoding the alpha-5 chain of type IV collagen

6

what is the inheritance pattern of alport syndrome?

X-linked dominant (incomplete - women can get it)

7

what are the symptoms of alport syndrome?

- sensorineural hearing loss
- renal failure / microscopic hematuria
- proteinuria (indicates progression)

8

what are the key lesions of alport syndrome?

- GBM thickening / splitting / LAMINATION
- "basket-weave" pattern

9

which disease is associated with a basket weave pattern on histology?

alport syndrome

10

what are the LM, IF, and EM findings in thin GBM disease?

- LM: normal
- IF: negative
- EM: thin GBM

11

what are the secondary glomerulonephropathies?

- SLE
- diabetes
- amyloidosis

12

in SLE there is granular immune complex deposition of what factors?

- IgG
- IgA
- IgM
- C3
- C4

13

what is the only glomerular disease with all Ig deposition?

SLE

14

where does amyloid get trapped in amyloidosis?

- glomeruli
- blood vessels
- tubules

15

what is the pathogenesis of kidney amyloidosis?

- GBM becomes leaky to proteins and the patient gets nephritic syndrome

16

what stain is used to visualize amyloid? how does it appear?

- Congo Red
- apple green biorefringence

17

what is the pathogenesis of acute tubular necrosis?

destruction of renal tubular epithelium

18

what are the two types of acute tubular necrosis?

- ischemic
- nephrotoxic

19

what drugs are nephrotoxic?

- aminoglycosides
- amphotericin B
- gentamycin

20

what heavy metal is nephrotoxic?

mercury

21

what organic solvents are nephrotoxic?

carbon tetrachloride

22

how is myoglobin nephrotoxic?

causes rhabdomyolysis (in heat stroke)

23

- dilated tubules with flattened epithelium
- necrotic debris in tubules

diagnosis?

acute tubular necrosis (ATN)

24

what is the cause of acute interstitial nephritis?

drug induced hypersensitivity

25

what drugs cause acute interstitial nephritis? what is seen clinically after ingestion?

- synthetic penicillins
- rifampin
- ibuprofen
- thiazide diuretics

2 weeks later:
- fever
- eosinophilia
- rash
- acute renal failure

26

what is the main pathogen associated with pyelonephritis?

e. coli

27

what is the cause of acute pyelonephritis?

infections of the pelicalyceal system and renal parenchyma

28

how does acute pyelonephritis present? how is the diagnosis made?

- presentation: pain in the costo-vertebral angle along with other signs of infection

- diagnosis: pus (WBC) casts, urine culture

29

polymorphonuclear casts in tubules - diagnosis?

acute pyelonephritis

30

what are the key lesions in acute pyelonephritis?

- neutrophilic infiltrates in tubules
- neutrophilic casts in tubules

31

how does acute pyelonephritis differ from acute interstitial nephritis?

in acute pyelonephritis the inflammatory infiltrates include neutrophils

32

what is the main etiology of chronic pyelonephritis?

obstruction (congenital or acquired)

33

is chronic pyelonephritis more common in males or females?

females

34

what are the hallmark features of chronic pyelonephritis?

- pitting geographic scars
- thyroidization

35

- inflammatory infiltrate
- fibrosis
- pitting geopraphic scars

diagnosis?

chronic pyelonephritis

36

atrophic tubules that resemble thyroid gland is associated with what renal disease?

chronic pyelonephritis

37

- pitting geographic scars
- thyroidization

these are hallmark features of what disease?

chronic pyelonephritis

38

papillary adenomas are always located in which part of the kidney?

cortex

39

angiomyolipomas are associated with what condition?

tuberous sclerosis

40

what are the signs and symptoms of tuberous sclerosis?

- mental retardation
- multisystem hamartomas
- angiomyolipomas

41

angiomyolipomas consist of what 3 structures?

- thick walled vessels
- smooth muscle
- fat

42

what are the main risk factors for renal cell carcinoma?

- tobacco
- chronic renal failure
- acquired cystic renal disease

43

what are the primary symptoms of renal cell carcinoma?

- hematuria
- abdominal mass

44

renal cell carcinoma strongly tend to invade what vessel early in the disease?

renal VEIN

45

what are the renal cell carcinoma histotypes? which is most common?

- clear cell (most common)
- papillary
- chromophobe

46

what is the gross appearance of renal cell carcinoma?

- yellow orange
- sharp borders
- gray-white necrosis and foci of hemorrhagic discoloration

47

what is the histological appearance of renal cell carcinoma?

- rounded or polygonal cells
- clear or granular cytoplasm
- abundant capillaries

48

- rounded or polygonal cells
- clear or granular cytoplasm
- abundant capillaries

diagnosis?

renal cell carcinoma

49

what is the gross appearance of chromophil (papillary) renal cell carcinoma?

thick capsule with red / brown reactive changes and hemorrhage

50

what is the histological appearance of chromophil (papillary) renal cell carcinoma?

- papillary structures, many of which enclose clusters of foamy macrophages
- abundant eosinophilic cytoplasm and mildly atypical nuclei
- sparse capillaries

51

- papillary structures, many of which enclose clusters of foamy macrophages
- abundant eosinophilic cytoplasm and mildly atypical nuclei
- sparse capillaries

diagnosis?

chromophil (papillary) renal cell carcinoma

52

von hippel lindau syndrome is characterized by what types of lesions? where?

cavernous hemangiomas in:
- cerebellum
- brain stem
- eye

53

on hippel lindau carries a very high incidence of what type of cancer?

renal cell carcinoma

54

what is the histological appearance of urothelial carcinoma of renal pelvis?

papillary growth lined by urothelial cells mild nuclear atypia and pleomorphism

55

what is the most common renal malignancy of early childhood?

wilms tumor

56

wilms tumor is caused by what type of genetic defect? which genes? which chromosome?

- loss of function mutation of tumor suppressor genes WT1 or WT2

- chromosome 11

57

wilms tumor histology

epithelial component surrounded by metanephric blastema and tumor immature spindle cell stroma

58

epithelial component surrounded by metanephric blastema and tumor immature spindle cell stroma

diagnosis?

wilms tumor

59

what is the difference between clear cell RCC and papillary RCC?

- clear cell RCC has clear cytoplasm and abundant capillaries

- papillary RCC has eosinophilic cytoplasm and sparse capillaries