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CRAAB II > Renal Pathology Lecture 3 > Flashcards

Renal Pathology Lecture 3 Flashcards

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1
Q

Classic presentation of IgA Nephropathy

A

hematuria following a respiratory, GI or UTI

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2
Q

IgA Nephropathy often occurs

A

Post transplantation

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3
Q

Alport syndrome presentation

A

Nephritis
Nerve deafness
eye disorders (lens dislocations, cataracts, corneal dystrophy)
X linked dominant inheritance

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4
Q

Pathology of Alport?

A

EM: irregular thick and thin GBM

  • splitting of lamina densa
  • charges are widespread
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5
Q

Mutation of Alport?

A

alpha 5 chain of type IV collagen (COL4A5)

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6
Q

Clinical pearls of Alport?

A

Hematuria at age 5-20
proteinuria (sometimes)
Renal failure by age 20-50

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7
Q

Thin membrane disease

A

thinning of GBM (normal is 300 to 400 nm, thinned is 150-225 nm)

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8
Q

Prognosis of thin membrane disease

A

excellent prognosis; homozygous may progress to renal failure

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9
Q

What does this membrane disease present with?

A

Hematuria

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10
Q

Gross presentation of chronic glomerulonephritis

A

small, diffusely granular kidney

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11
Q

micro presentation of chronic glomerulonephritis

A

globally hyalinized glomeruli, atrophy and fibrosis of tubules

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12
Q

What conditions statistically progresses to chronic GN most commonly?

A

PRGN (crescentic)

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13
Q

Nearly all SLE patients show kidney involvement. True or False?

A

True. Full house on IF (stains with everything). Wire loop lesion (thickening of capillary)

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14
Q

Henoch-Schonlein Purpura presentaiton

A

Purpuric skin lesions on arms, legs, buttocks
Abodominal pain, vomitng, bleeding
arthralgia
Renal abnormalties (1/3 patients)

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15
Q

Henoch-Schonlein Purpura population

A

Most common in children 3-8 years old

Onset after URI

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16
Q

Henoch-Schonlein Purp. path

A

IgA in mesangium

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17
Q

Diabetic nephropathy

A
  • 40% of diabetics
  • Early proteinuria
  • Capillary membrane thickening
  • Diffuse mesangial sclerosis
  • Nodular glomerulosclerosis
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18
Q

Hemodynamic effects in early diabetic nephropathy

A

increased GRF and glomerular hypertrophy in early disease - results in glomerulosclerosis

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19
Q

Kimmelstiel Wilson is also know as

A

Nodular glomerulosclerosis

Hyaline masses at periphery of glom.

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20
Q

EM detects this in diabetic nephropathy

A
  • Capillary basement membrane thickening

- Diffuse mesangial scerlosis

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21
Q

Ischemic and toxic injury to the tubules leads to these three things…

A
  1. ATN ( acute tubular necrosis)
  2. ATI (acute tubular Injury)
  3. ARF
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22
Q

Inflammatory reactions of the tubules and interstitium lead to

A

Tubulointerstitial nephritis

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23
Q

MOST COMMON CAUSE OF ACUTE RENAL FAILURE

A

ATN

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24
Q

Define ATN

A

Destruction of tubular epithelial cells which clinically presents as acute loss of renal function

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25
What causes ATN?
Ischemia or nephrotoxicity
26
Pathogenesis of ATN
tubular injury | Persistent and severe changes in blood flow
27
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)
28
Prognosis for ATN
nephrotoxic: 95% if survive initial event | shock/multiorgan failure: 50%
29
Difference between acute and chronic tubulointerstitial nephritis
Acute has PMNs/Eos and edema | Chronic has fibrosis and tulular atrophy
30
Causes of tubulointerstitial nephritis?
LOTS! Infections, toxins, metabolic, neoplasms, physical factors or immuno reactions
31
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
32
Complications of Acute Pyelonephritis
Papillary necrosis (diabetics, obstruction) Pyonephrosis Perinephric abcess
33
What is a perinephric abscess
suppurative inflammation extended through renal capsule and adjacent tissue
34
What does papillary necrosis look like?
Yellow necrosis of papillary tips with coagulative necrosis
35
Acute pyelonephritis morphology?
PMNs Intratubular aggregates of neutrophils Tubular necrosis Heals by scarring (tubular atrophy and interstital fibrosis with lymphocytes)
36
Where is the kidney most commonly affected by reflux?
Upper and lower poles
37
Chronic pyelonephritis damages the ______
pelvocalyceal region
38
2 conditions that damage the calyces
chronic pyelo | analgesic nephropathy
39
thyroidization describes
chronic pyelo morphology
40
Be careful for this condition when people start chemo
Urate nephropathy
41
bence jones proteinuria (light chains) and cast nephropathy presents in
Multiple myeloma
42
Nephroscelrosis
The renal pathology associated with the sclerosis of renal arterioles and small arteries Gross: Normal to small kidneys Surface has fine, even granularity
43
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
44
High risk patients for nephrosclerosis
DM Black severe HTN
45
Onion skinning
Malignant nephrosclerosis
46
Renal artery stenosis gross appearance
one small kidney (the ischemic one)
47
Denuded endothelium causes ______
blood clots
48
Pentad for TTP
``` Fever Neuro symptoms (usually a big deal) MAHA Thrombocytopenia Renal failure ```
49
Typical patient profile for TTP?
middle aged women
50
Obstructions increase susceptibility to _____ and ______
infection | stones
51
Obstructions lead to ____ and _____
hydronephrosis | renal atrophy
52
Calcium stones (%)
70% of all stones | radio opaque
53
Struvite stones (%)
15%
54
2 types of benign renal tumors
Angiomyolipoma | Oncocytoma
55
What are angiomyolipomas composed of?
Composed of vessels, smooth muscle, fat
56
What are angiomyolipomas are associated with?
Tuberus sclerosis (an autosomal dominant syndrome, patients develop tumors)
57
Gross and micro appearance of oncocytoma
mahogany brown large, eosinophilic cells with round nuclei abundant mitochondria in cell
58
Most important risk factor in Renal cell carcinoma?
tobacco use (smokers 2x the incidence)
59
Renal cell carcinoma stats
3% of cancers 85% of renal cancer in adults most common in elderly (6-7th decade) Male predominance
60
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
61
Most common type of RCC?
Clear cell carcinoma
62
Genetic mutation in clear cell?
loss of chromosome 3p on (VHL gene)
63
Clear cell tumor appearance?
Bright yellow, may have necrosis
64
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
65
Vegetable like cells with prominent cell membranes in this type of RCC
Chromophobe
66
Renal cell carcinoma pattern of metastasis?
Renal vein IVC Right heart

CRAAB II (7 decks)

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