Renal Pathology Lecture 3 Flashcards
Classic presentation of IgA Nephropathy
hematuria following a respiratory, GI or UTI
IgA Nephropathy often occurs
Post transplantation
Alport syndrome presentation
Nephritis
Nerve deafness
eye disorders (lens dislocations, cataracts, corneal dystrophy)
X linked dominant inheritance
Pathology of Alport?
EM: irregular thick and thin GBM
- splitting of lamina densa
- charges are widespread
Mutation of Alport?
alpha 5 chain of type IV collagen (COL4A5)
Clinical pearls of Alport?
Hematuria at age 5-20
proteinuria (sometimes)
Renal failure by age 20-50
Thin membrane disease
thinning of GBM (normal is 300 to 400 nm, thinned is 150-225 nm)
Prognosis of thin membrane disease
excellent prognosis; homozygous may progress to renal failure
What does this membrane disease present with?
Hematuria
Gross presentation of chronic glomerulonephritis
small, diffusely granular kidney
micro presentation of chronic glomerulonephritis
globally hyalinized glomeruli, atrophy and fibrosis of tubules
What conditions statistically progresses to chronic GN most commonly?
PRGN (crescentic)
Nearly all SLE patients show kidney involvement. True or False?
True. Full house on IF (stains with everything). Wire loop lesion (thickening of capillary)
Henoch-Schonlein Purpura presentaiton
Purpuric skin lesions on arms, legs, buttocks
Abodominal pain, vomitng, bleeding
arthralgia
Renal abnormalties (1/3 patients)
Henoch-Schonlein Purpura population
Most common in children 3-8 years old
Onset after URI
Henoch-Schonlein Purp. path
IgA in mesangium
Diabetic nephropathy
- 40% of diabetics
- Early proteinuria
- Capillary membrane thickening
- Diffuse mesangial sclerosis
- Nodular glomerulosclerosis
Hemodynamic effects in early diabetic nephropathy
increased GRF and glomerular hypertrophy in early disease - results in glomerulosclerosis
Kimmelstiel Wilson is also know as
Nodular glomerulosclerosis
Hyaline masses at periphery of glom.
EM detects this in diabetic nephropathy
- Capillary basement membrane thickening
- Diffuse mesangial scerlosis
Ischemic and toxic injury to the tubules leads to these three things…
- ATN ( acute tubular necrosis)
- ATI (acute tubular Injury)
- ARF
Inflammatory reactions of the tubules and interstitium lead to
Tubulointerstitial nephritis
MOST COMMON CAUSE OF ACUTE RENAL FAILURE
ATN
Define ATN
Destruction of tubular epithelial cells which clinically presents as acute loss of renal function
What causes ATN?
Ischemia or nephrotoxicity
Pathogenesis of ATN
tubular injury
Persistent and severe changes in blood flow
Pathology of ATN
-Tubular epithelial necrosis
-Sloughing of tubular cells into the lumen
-Hyaline and granular casts
-Interstitial edema and increased lymphocytes
-Toxic ATN may show specific changes
(Ethylene glycol poisoning has calcium oxalate crystals in tubular lumens)
Prognosis for ATN
nephrotoxic: 95% if survive initial event
shock/multiorgan failure: 50%
Difference between acute and chronic tubulointerstitial nephritis
Acute has PMNs/Eos and edema
Chronic has fibrosis and tulular atrophy
Causes of tubulointerstitial nephritis?
LOTS! Infections, toxins, metabolic, neoplasms, physical factors or immuno reactions
What is vesicoureteral reflux
Incompetence of the vesicoureteral valve allows bacteria to enter ureter and renal pelvis
Usually due to congenital shortening of the intravesicle portion of the ureter
Bladder infection, spinal cord injury increases reflux
Complications of Acute Pyelonephritis
Papillary necrosis (diabetics, obstruction)
Pyonephrosis
Perinephric abcess
What is a perinephric abscess
suppurative inflammation extended through renal capsule and adjacent tissue
What does papillary necrosis look like?
Yellow necrosis of papillary tips with coagulative necrosis
Acute pyelonephritis morphology?
PMNs
Intratubular aggregates of neutrophils
Tubular necrosis
Heals by scarring (tubular atrophy and interstital fibrosis with lymphocytes)
Where is the kidney most commonly affected by reflux?
Upper and lower poles
Chronic pyelonephritis damages the ______
pelvocalyceal region
2 conditions that damage the calyces
chronic pyelo
analgesic nephropathy
thyroidization describes
chronic pyelo morphology
Be careful for this condition when people start chemo
Urate nephropathy
bence jones proteinuria (light chains) and cast nephropathy presents in
Multiple myeloma
Nephroscelrosis
The renal pathology associated with the sclerosis of renal arterioles and small arteries
Gross: Normal to small kidneys
Surface has fine, even granularity
Pathogenesis of Nephrosclerosis
- Medial and intimal vessel thickening is secondary to hemodynamic changes, aging, genetics, or a combination of these factors
- Hyaline deposition in arterioles due to endothelial cell injury with extravasation of plasma proteins and increased basement membrane matrix
High risk patients for nephrosclerosis
DM
Black
severe HTN
Onion skinning
Malignant nephrosclerosis
Renal artery stenosis gross appearance
one small kidney (the ischemic one)
Denuded endothelium causes ______
blood clots
Pentad for TTP
Fever Neuro symptoms (usually a big deal) MAHA Thrombocytopenia Renal failure
Typical patient profile for TTP?
middle aged women
Obstructions increase susceptibility to _____ and ______
infection
stones
Obstructions lead to ____ and _____
hydronephrosis
renal atrophy
Calcium stones (%)
70% of all stones
radio opaque
Struvite stones (%)
15%
2 types of benign renal tumors
Angiomyolipoma
Oncocytoma
What are angiomyolipomas composed of?
Composed of vessels, smooth muscle, fat
What are angiomyolipomas are associated with?
Tuberus sclerosis (an autosomal dominant syndrome, patients develop tumors)
Gross and micro appearance of oncocytoma
mahogany brown
large, eosinophilic cells with round nuclei
abundant mitochondria in cell
Most important risk factor in Renal cell carcinoma?
tobacco use (smokers 2x the incidence)
Renal cell carcinoma stats
3% of cancers
85% of renal cancer in adults
most common in elderly (6-7th decade)
Male predominance
Von Hippel - Lindau syndrome
- AD genetic disorder
- Hemangioblastomas of cerebellum and retina
- Renal cysts and carcinomas
- VHL gene on chromosome 2p25.3
- tumor supp. gene
Most common type of RCC?
Clear cell carcinoma
Genetic mutation in clear cell?
loss of chromosome 3p on (VHL gene)
Clear cell tumor appearance?
Bright yellow, may have necrosis
Papillary carcinoma?
10-15% of RCC
cuboidal cells with papillary growth pattern and foam cells
NO 3p loss
Trisomy 7, 17 and loss of Y
Vegetable like cells with prominent cell membranes in this type of RCC
Chromophobe
Renal cell carcinoma pattern of metastasis?
Renal vein
IVC
Right heart
