Renal - Pathoma Flashcards
(161 cards)
1
Q
Pathoma Renal
Unilateral renal agenesis leads to __________ of the existing kidney.
Bilateral renal agenesis leads to __________ __________.
A
Unilateral renal agenesis leads to hypertrophy of the existing kidney.
Bilateral renal agenesis leads to Potter Sequence.
2
Q
Pathoma Renal
Are there any long-term sequelae of unilateral renal agenesis in the extant kidney?
A
Yes: increased risk of renal failure later in life due to hyperfiltration
3
Q
Pathoma Renal
What condition is a non-inherited congenital malformation of the kidneys resulting in cysts and abnormal tissue in the renal parenchyma?
A
Dysplastic kidney
(usually unilateral, but must be distinguished from PKD if bilateral)
4
Q
Pathoma Renal
Which form of PKD is associated with hepatic fibrosis and portal hypertension?
Which form is associated with hepatic cysts?
A
ARPKD
Both ADPKD and ARPKD
5
Q
Pathoma Renal
A patient presents with shrunken kidneys, parenchymal fibrosis, and worsening renal failure.
You note cysts specifically in the medullary collecting ducts. What disease is this?
A
Medullary cystic kidney disease
6
Q
Pathoma Renal
What is the expected BUN:Cr ratio, FENa, and OsmolarityUrine for prerenal azotemia?
A
> 15
< 1%
> 500 mOsm/kg
7
Q
Pathoma Renal
Explain the BUN:Cr ratio (> 15), FENa (< 1%), and OsmolarityUrine (> 500 mOsm/Kg) seen in prerenal azotemia.
A
BUN:Cr ratio — The kidneys increase fluid and BUN reabsorption
FENa — Tubular function remains intact
OsmolarityUrine — Tubular function remains intact
8
Q
Pathoma Renal
What is the expected BUN:Cr ratio, FENa, and OsmolarityUrine for postrenal azotemia?
A
> 15
< 1%
> 500 mOsm/kg
9
Q
Pathoma Renal
Explain the BUN:Cr ratio (> 15), FENa (< 1%), and OsmolarityUrine (> 500 mOsm/Kg) seen in prerenal azotemia.
A
BUN:Cr ratio — Increased tubular pressure forces BUN back into serum
FENa — Tubular function remains intact
OsmolarityUrine — Tubular function remains intact
10
Q
Pathoma Renal
What is the expected BUN:Cr ratio, FENa, and OsmolarityUrine for intrarenal azotemia?
A
< 15
> 2%
< 500 mOsm/kg
11
Q
Pathoma Renal
Explain the BUN:Cr ratio (< 15), FENa (> 2%), and OsmolarityUrine (
A
BUN:Cr ratio — Tubular function decreases, resulting in decreased BUN reabsorption
FENa — Tubular function is impaired
OsmolarityUrine — Tubular function is impaired
12
Q
Pathoma Renal
In what condition might post-renal azotemia lead to a low BUN:Cr ratio (< 15) and an elevated FENa (> 2%)?
A
Long-standing post-renal azotemia
13
Q
Pathoma Renal
What are the two major etiologies of acute tubular necrosis?
A
(1) Ischemia (i.e. secondary to prerenal azotemia)
(2) Nephrotoxicity
14
Q
Pathoma Renal
Name some of the nephrotoxic substances associated with acute tubular necrosis:
A___________
H___________
M___________
U___________
R___________
E___________
A
Name some of the nephrotoxic substances associated with acute tubular necrosis:
Aminoglycosides**
Heavy metals
Myoglobinuria
Urate
Radiocontrast dye
Ethylene glycol
15
Q
Pathoma Renal
How can urate-induced acute tubular necrosis be avoided in patients undergoing chemotherapy?
A
Hydration + allopurinol
16
Q
Pathoma Renal
What are the serum changes associated with acute tubular necrosis [think ion change(s) and pH]?
A
Hyperkalemia
+
metabolic alkalosis
17
Q
Pathoma Renal
True/False.
Patients with acute tubular necrosis may require dialysis to treat their electrolyte imbalances, but they typically recover completely within a few weeks.
A
True.
18
Q
Pathoma Renal
What cause of intrarenal azotemia is associated with drugs that act like haptens?
A
Acute interstitial nephritis
19
Q
Pathoma Renal
Name some of the drugs that act like haptens and are associated with acute interstitial nephritis.
NPD
A
NSAIDs,
penicillins,
diuretics
20
Q
Pathoma Renal
In addition to a case of severe acute interstitial nephritis resulting from hapten-like drugs (e.g. NSAIDs, penicillins, diuretics, etc.), name a few potential etiologies of renal papillary necrosis:
C________________
D________________
S________________
S________________
A
In addition to a case of severe acute interstitial nephritis resulting from hapten-like drugs (e.g. NSAIDs, penicillins, diuretics, etc.), name a few potential etiologies of renal papillary necrosis:
Chronic analgesic abuse
Diabetes mellitus
Sickle cell trait or disease
Severe acute pyelonephritis
21
Q
Pathoma Renal
A patient presents with puffy eyes, foamy urine, hypoalbuminema, and hyperlipidemia. What is the likely generic diagnosis requiring further work-up?
A
Nephrotic syndrome
(may also present with hypertension, infection, clotting, etc.)
22
Q
Pathoma Renal
Nephrotic syndrome is characterized by a proteinuria of what amount?
A
> 3.5 g / day
23
Q
Pathoma Renal
What are the four serum characteristics of nephrotic syndrome?
(Two hypos- and two hypers-)
A
Hypoalbuminemia
Hypogammaglobulinemia
Hypercoagulable states
Hyperlipidemia and Hypercholesterolemia
24
Q
Pathoma Renal
Why does nephrotic syndrome result in a hypercoagulable state?
A
Loss of antithrombin III
25
# Pathoma Renal
What result may be seen in the urine due to the hyperlipidemia and hypercholesterolemia seen in nephrotic syndrome?
Fatty casts
26
# Pathoma Renal
Name the major causes of nephrotic syndrome:
**M**\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**F**\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**M**\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**M**\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**D**\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**S**\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Name the major causes of nephrotic syndrome:
**M**_inimal change disease_
**F**_ocal segmental glomerulosclerosis_
**M**_embranous nephropathy_
**M**_embranoproliferative glomerulonephritis_
**D**_iabetes mellitus_
**S**_ystemic amyloidosis_
27
# Pathoma Renal
What is the most common cause of nephrotic syndrome in children?
And in Caucasians?
And in Hispanics?
And in African-Americans?
Minimal change disease
Membranous nephropathy
Focal segmental glomerulosclerosis
Focal segmental glomerulosclerosis
28
# Pathoma Renal
Although minimal change disease is idiopathic, it may be associated with what disease?
Hodgkin lymphoma
29
# Pathoma Renal
How does minimal change disease appear on H&E?
Normal glomeruli;
maybe some lipids in proximal tubule cells
30
# Pathoma Renal
How does minimal change disease appear on electron microscopy?
Foot process effacement
31
# Pathoma Renal
**True/False**.
Minimal change disease is associated with loss of albumin and gammaglobulin in the urine.
**False**.
Minimal change disease is associated with loss of albumin ***only*** (**selective proteinuria**).
32
# Pathoma Renal
Good response to steroids is seen in which etiology(ies) of nephrotic syndrome?
Minimal change disease _only_
33
# Pathoma Renal
The damage in minimal change disease is mediated by what?
**T cell cytokines**
| (hence the excellent response to steroids)
34
# Pathoma Renal
Which major causes of nephrotic syndrome are immunofluorescence-negative?
Minimal change disease
Focal segmental glomerulosclerosis
*(also DM and amyloidosis)*
35
# Pathoma Renal
**True/False**.
Focal segmental glomerulosclerosis is the most common cause of nephrotic syndrome in Hispanics and African-Americans. It is IF-negative and typically idiopathic (although also associated with HIV, heroin use, and sickle cell disease).
True.
36
# Pathoma Renal
How does focal segmental glomerulosclerosis appear on H&E?
**Exactly what the name says**:
Some glomeruli (*focal*) and only some parts of those glomeruli (*segmental*) are sclerosed
I.e. _focal_ _segmental_ _glomerulosclerosis_
37
# Pathoma Renal
How does focal segmental glomerulosclerosis appear on electron microscopy?
Foot process effacement
38
# Pathoma Renal
**True/False**.
Membranous nephropathy is usually idiopathic, but it may be associated with HIV, heroin use, and sickle cell disease.
**False** *(The previous description matched focal segmental glomerulosclerosis.).*
Membranous nephropathy is usually idiopathic, but it may be associated with ***hepatitis B and C, solid tumors, SLE, and some drugs (e.g. NSAIDS, penicillamine)***.
39
# Pathoma Renal
How does membranous nephropathy appear on immunofluorescence?
Subepithelial 'spike and dome' deposits
40
# Pathoma Renal
How does membranous nephropathy appear on H&E?
Thick glomerular basement membrane
41
# Pathoma Renal
How does membranoproliferative glomerulonephritis appear on H&E?
Thick glomerular basement membrane;
'tram-track' appearance
42
# Pathoma Renal
Both membranous nephropathy and membranoproliferative glomerulonephritis present with thickened glomerular basement membranes, but a 'tram-track' appearance is only associated with which?
Membranoproliferative glomerulonephritis
43
# Pathoma Renal
What antibody is associated with membranous nephropathy?
**Anti-phospholipase A2 receptor** antibodies
44
# Pathoma Renal
Granular, subepithelial, 'spike and dome' IF on EM is characteristic of which etiology of nephrotic syndrome?
Membranous nephropathy
45
# Pathoma Renal
Granular, subendothelial IF on EM is characteristic of which etiology of nephrotic syndrome?
Type I membranoproliferative glomerulonephritis
46
# Pathoma Renal
Granular, intramembranous IF on EM is characteristic of which etiology of nephrotic syndrome?
Type II membranoproliferative glomerulonephritis
47
# Pathoma Renal
Type I membranoproliferative glomerulonephritis is associated with ___________ immune complex deposits.
Type II membranoproliferative glomerulonephritis is associated with ___________ immune complex deposits.
Type I membranoproliferative glomerulonephritis is associated with **_subendothelial_** immune complex deposits.
Type II membranoproliferative glomerulonephritis is associated with **_intramembranous_** immune complex deposits (***dense deposit disease***).
48
# Pathoma Renal
Which form of membranoproliferative glomerulonephritis is associated with HBV and HCV?
Type I
| (subendothelial deposits)
49
# Pathoma Renal
Which form of membranoproliferative glomerulonephritis is associated with C3 nephritic complement (an autoantibody that stabilizes C3 convertase)?
Type II
## Footnote
*(intramembranous deposits - dense deposit disease)*
50
# Pathoma Renal
Type II (intramembranous) membranoproliferative glomerulonephritis is associated with ___________ complement, an autoantibody that stabilizes \_\_\_\_\_\_\_\_\_\_\_.
Type II (intramembranous) membranoproliferative glomerulonephritis is associated with **_C3 nephritic_** complement, an autoantibody that stabilizes **_C3 convertase_**.
51
# Pathoma Renal
Which etiologies of nephrotic syndrome typically respond very poorly to steroids and progress to chronic renal failure?
Focal segmental glomerulosclerosis
Membranous nephropathy
Membranoproliferative glomerulonephritis
52
# Pathoma Renal
The nonenzymatic glycosylation of vascular basement membranes seen in DM leads to what form of sclerosis?
Which arteriole is most affected?
Hyaline arteriolosclerosis;
efferent
53
# Pathoma Renal
How do the glomeruli appear in patients with DM?
Mesangial sclerosis;
Kimmelstiel-Wilson nodules
54
# Pathoma Renal
How can the progress of hyperfiltration-induced damage associated with diabetes mellitus be slowed?
ACE inhibitors
55
# Pathoma Renal
**True/False**.
After the lungs, the kidneys are the most commonly involved organs in systemic amyloidosis.
**False**.
***The kidneys are*** the most commonly involved organs in systemic amyloidosis.
56
# Pathoma Renal
Amyoidosis-induced nephrotic syndrome is characterized by amyloid deposits in what location(s)?
The mesangium
57
# Pathoma Renal
After staining with \_\_\_\_\_\_\_\_\_, amyloidosis can be seen under polarized light as ___________ birefringence.
After staining with **_congo red_**, amyloidosis can be seen under polarized light as **_apple-green_** birefringence.
58
# Pathoma Renal
Casts in the urine indicate a pathology of which organ(s)?
The kidneys _only_
59
# Pathoma Renal
What is the main sign that a renal disorder is likely a nephritic syndrome (rather than nephrotic)?
**RBC casts** and dysmorphic RBCs in urine
| (signs of glomerular inflammation)
60
# Pathoma Renal
Nephritic syndromes are characterized by the presence of urinary ________ casts, \_\_\_\_\_\_\_uria, _______ proteinuria, \_\_\_\_\_\_\_tension, and _______ retention.
Nephritic syndromes are characterized by the presence of urinary **_RBC_** casts, **_olig_**uria, **_limited_** proteinuria, **_hyper_**tension, and **_salt_** retention.
61
# Pathoma Renal
Which may be characterized by puffy eyes (due to salt retention) and hypertension, nephrotic syndrome or nephritic syndrome or both?
Both.
62
# Pathoma Renal
Which is usually characterized by oliguria, nephrotic syndrome or nephritic syndrome or both?
Nephritic syndrome
63
# Pathoma Renal
Describe the proteinuria associated with nephritic syndrome.
**Limited**;
\< 3.5 g / day
64
# Pathoma Renal
What would renal biopsy show in a patient with a nephritic syndrome?
Hypercellular, inflammed glomeruli
65
# Pathoma Renal
What is the main etiology for all the forms of nephritic syndrome?
**Immune-complex** deposition
(and C5a activation attracting neutrophils)
66
# Pathoma Renal
What is the most common nephropathy worldwide?
**IgA nephropathy**
(Berger disease - a form of nephritic syndrome)
67
# Pathoma Renal
Describe the classic presentation for IgA nephropathy (Berger disease).
**Hematuria** (gross or microscopic) with RBC casts following some form of **mucosal** **infection** (e.g. a gastroenteritis)
## Footnote
*(usually in an individual between their teens and early 30s)*
68
# Pathoma Renal
Why are mucosal infections associated with IgA nephropathy (Berger disease)?
Mucosal infections **ramp up IgA production**
69
# Pathoma Renal
Does IgA nephropathy (Berger disease) cause any immunofluorescence findings?
**Yes**;
**mesangial** immune-complex deposition
70
# Pathoma Renal
**True/False**,
IgA nephropathy is known to sometimes slowly progress to renal failure.
True.
71
# Pathoma Renal
Name the nephritic syndrome caused by inherited defects in type IV collagen.
Name the nephritic syndrome caused by acquired autoantibodies to type IV collagen.
**Alport** syndrome
**Goodpasture** syndrome
72
# Pathoma Renal
What, if any, effect does Alport syndrome have on the glomerular basement membrane?
Thinning and splitting
73
# Pathoma Renal
Describe the major presentation of Alport syndrome.
Isolated **hematuria**;
**sensory** **hearing** loss;
**ocular** disturbances
*('can't see, bloody pee, can't hear a bee')*
74
# Pathoma Renal
Name a nephritic syndrome that typically follows infection and that progresses to rapidly progressive glomerulonephritis in some cases.
Poststreptococcal glomerulonephritis
75
# Pathoma Renal
**1**% of pediatric cases of poststreptococcal glomerulonephritis progress to what?
**25**% of adult cases of poststreptococcal glomerulonephritis progress to what?
Renal failure;
rapidly progressive glomerulonephritis
76
# Pathoma Renal
**True/False**.
## Footnote
25% of pediatric cases of poststreptococcal glomerulonephritis progress to full-blown renal failure.
1% of pediatric cases of poststreptococcal glomerulonephritis develop into a rapidly progressive glomerulonephritis.
**False**.
## Footnote
***1*** % of pediatric cases of poststreptococcal glomerulonephritis progress to full-blown renal failure.
***25*** % of ***adult*** cases of poststreptococcal glomerulonephritis develop into a rapidly progressive glomerulonephritis.
77
# Pathoma Renal
Poststreptococcal glomerulonephritis typically results from \_\_\_\_\_\_genic strains of *S. pyogenes* but may also result from non\_\_\_\_\_\_\_\_\_\_\_ organisms as well.
Poststreptococcal glomerulonephritis typically results from **_nephrito_**genic strains of *S. pyogenes* but may also result from non**_streptococcal_** organisms as well.
78
# Pathoma Renal
Poststreptococcal glomerulonephritis is typically seen in _________ (children/adults) but may also be seen in _________ (children/adults).
Poststreptococcal glomerulonephritis is typically seen in **_children_** but may also be seen in **_adults_**.
79
# Pathoma Renal
How long after a pharyngeal or cutaneous infection with group A streptococcus will development of poststreptococcal glomerulonephritis usually arise?
2 - 3 weeks
80
# Pathoma Renal
Describe the appearance on EM, if any change from normal, of the immune-complex deposits seen in poststreptococcal glomerulonephritis.
**Granular** immunofluorescence in **subepithelial**'**humps'**
81
# Pathoma Renal
What is the treatment for poststreptococcal glomerulonephritis?
Supportive
82
# Pathoma Renal
A patient presents with fibrin/macrophage crescent structures in their Bowman capsules.
What form of renal pathology does this indicate?
Rapidly progressive glomerulonephritis
83
# Pathoma Renal
How long does it typically take for rapidly progressive glomerulonephritis to develop into renal failure?
Weeks to months
84
# Pathoma Renal
A patient presents with fibrin/macrophage crescent structures in their Bowman capsules, indicating rapidly progressive glomerulonephritis.
What can be used to differentiate the many different etiologies?
Immunofluorescence
85
# Pathoma Renal
A patient presents with fibrin/macrophage crescent structures in their Bowman capsules, indicating rapidly progressive glomerulonephritis.
You note linear immunofluorescence. **Name the most likely potential etiology(ies)**.
Goodpasture syndrome
86
# Pathoma Renal
A patient presents with fibrin/macrophage crescent structures in their Bowman capsules, indicating rapidly progressive glomerulonephritis.
You note granular immunofluorescence. **Name the** **most likely** **potential etiology(ies)**.
(1) **Poststreptococcal** glomerulonephritis (most common)
(2) **Diffuse proliferative** glomerulonephritis (seen in SLE)
87
# Pathoma Renal
A patient presents with fibrin/macrophage crescent structures in their Bowman capsules, indicating rapidly progressive glomerulonephritis.
You note pauci-immune immunofluorescence. **Name the most likely potential etiology(ies)**.
(1) **Granulomatosis** with **polyangiitis**
(2) **Microscopic** **polyangiitis**
(3) **Churg-Strauss**
88
# Pathoma Renal
What does it mean that the renal immunofluorescence associated with granulomatosis with polyangiitis, microscopic polyangiitis, and Churg-Strauss are all **pauci-immune**?
It means there is no immunofluorescence
89
# Pathoma Renal
What form of renal disease is most common in patients with SLE?
**Diffuse proliferative** glomerulonephritis
(a form of rapidly progressive glomerulonephritis)
90
# Pathoma Renal
Identify the immunofluorescence pattern for each of the following etiologies of rapidly progressive glomerulonephritis:
## Footnote
**Microscopic polyangiitis**
**Goodpasture syndrome**
**Diffuse proliferative glomerulonephritis**
**Negative** (pauci-immune)
**Linear**
**Granular** (usually sub-endothelial)
91
# Pathoma Renal
Identify the immunofluorescence pattern for each of the following etiologies of rapidly progressive glomerulonephritis:
## Footnote
**Granulomatosis with polyangiitis**
**Poststreptococcal glomerulonephritis**
**Churg-Strauss**
**Negative** (pauci-immune)
**Granular**
**Negative** (pauci-immune)
92
# Pathoma Renal
Identify each of the following renal pathologies as either nephrotic or nephritic syndromes:
## Footnote
**Alport syndrome**
**Membranous nephropathy**
**Poststreptococcal glomerulonephritis**
Nephritic
Nephrotic
Nephritic
93
# Pathoma Renal
Identify each of the following renal pathologies as either nephrotic or nephritic syndromes:
## Footnote
**Minimal change disease**
**Membranoproliferative glomerulonephritis**
**IgA nephropathy**
Nephrotic
Nephrotic
Nephritic
94
# Pathoma Renal
Identify each of the following renal pathologies as either nephrotic or nephritic syndromes:
## Footnote
**Focal segmental glomerulosclerosis**
**Systemic amyloidosis**
**Rapidly progressive glomerulonephritis**
Nephrotic
Nephrotic
Nephritic
95
# Pathoma Renal
Identify each of the following pathologies as being more associated with either nephrotic or nephritic syndromes:
**SLE**
**HIV**
***Streptococcus pyogenes***
**Nephritic** _or_ **nephrotic** (usually diffuse proliferative glomerulonephritis; *may also be membranous nephropathy*)
**Nephrotic** (focal segmental glomerulosclerosis)
**Nephritic** (poststreptococcal glomerulonephritis)
96
# Pathoma Renal
Identify each of the following pathologies as being more associated with either nephrotic or nephritic syndromes:
## Footnote
**Diabetes mellitus**
**Hepatitis B**
**Sickle cell disease**
**Nephrotic**
**Nephrotic** (membranous nephropathy; membranoproliferative glomerulonephritis)
**Nephrotic** (focal segmental glomerulosclerosis)
97
# Pathoma Renal
Identify each of the following pathologies as being more associated with either nephrotic or nephritic syndromes:
## Footnote
**Hepatitis C**
**Solid tumors**
**Mucosal infections**
**Nephrotic** (membranous nephropathy; membranoproliferative glomerulonephritis)
**Nephrotic** (membranous nephropathy)
**Nephritic** (IgA nephropathy)
98
# Pathoma Renal
Identify each of the following pathologies as being more associated with either nephrotic or nephritic syndromes:
## Footnote
**Goodpasture syndrome**
**Alport syndrome**
**Churg-Strauss**
**Nephritic** (rapidly progressive glomerulonephritis)
**Nephritic**
**Nephritic** (rapidly progressive glomerulonephritis)
99
# Pathoma Renal
**True/False**.
A patient presenting with hematuria almost certainly has a nephritic syndrome.
**False**.
## Footnote
*This could be a _urinary tract tumor_, kidney stone, polycystic kidney disease, BPH, renal cyst(s), sickle cell disease, hydronephrosis, pyelonephritis (if fever present), benign familial hematuria, idiopathic hematuria, etc.*
100
# Pathoma Renal
In cases of cystitis, fever is usually \_\_\_\_\_\_\_\_\_.
In cases of cystitis, fever is usually **_absent_**.
101
# Pathoma Renal
Describe the gold standard lab findings for a typical UTI:
**Culture** ---
Describe the lab findings in a typical UTI:
**Culture** --- \> _100,000 colony-forming units (**g****old standard**)_
102
# Pathoma Renal
Describe the lab findings in a typical UTI:
**Urinalysis** ---
Describe the lab findings in a typical UTI:
**Urinalysis** --- _Cloudy urine + \> 10 WBCS / hpf_
103
# Pathoma Renal
Describe the lab findings in a typical UTI:
**Dipstick** ---
Describe the lab findings in a typical UTI:
**Dipstick** --- _Positive leukocyte esterase + nitrites_
104
# Pathoma Renal
What urine dipstick result indicates pyuria?
Leukocyte esterase
105
# Pathoma Renal
**True/False**.
Urinary dipstick in case of UTIs is will typically show the presence of nitrates.
**False**.
Urinary dipstick in case of UTIs is will typically show the presence of ***nitrites***.
*(Bacteria convert nitrates to nitrites.)*
106
# Pathoma Renal
What urine dipstick result indicates presence of bacteria?
(*Why?*)
**Nitrites**
(*Bacteria convert nitr**a**tes to nitr**i**tes.*)
107
# Pathoma Renal
What are the two main etiologies for UTI development?
*Escherichia coli* (80%)
## Footnote
*Staphylococcus saprophyticus*
108
# Pathoma Renal
Name three culture-positive etiologies for UTI besides *E. coli* (80%) and *S. saprophyticus.*
* Klebsiella pneumoniae*
* Proteus mirabilis*
* Enterococcus faecalis*
109
# Pathoma Renal
Name two culture-negative etiologies for UTI (i.e. which bacteria cause pyuria with a negative urine culture?).
* Chlamydia trachromatis*
* Neisseria gonnorrheae*
(_Note_: dysuria due to urethritis is a dominant presenting sign.)
110
# Pathoma Renal
Name the three most common etiologies of pyelonephritis.
*E. coli* (90%)
## Footnote
* Enterococcus faecalis*
* Klebsiella spp.*
111
# Pathoma Renal
What condition can lead to 'thyroidization' of the kidney(s)?
## Footnote
*(I.e. tubules are atrophic and contain eosinophilic proteinaceous material.)*
Chronic pyelonephritis
112
# Pathoma Renal
What is a major instigating factor for chronic pyelonephritis in children?
Vesicoureteral reflux
113
# Pathoma Renal
What is a major instigating factor for chronic pyelonephritis in adults?
**Obstruction**
| (e.g. BPH or cervical carcinoma)
114
# Pathoma Renal
What renal scarring pattern is characterstic of the effects of vesicoureteral reflux?
Scarring at the upper **and** lower poles; blunted calyces
115
# Pathoma Renal
Risk factors for nephrolithiasis mainly center around a high _________ in the urinary filtrate and a low _________ in the urinary filtrate.
Risk factors for nephrolithiasis mainly center around a high **_[solute]_** in the urinary filtrate and a low **_volume_** in the urinary filtrate.
116
# Pathoma Renal
What are the main ways that the pain of nephrolithiasis is described?
**Colicky**,
**unilateral**,
**flank**
(in conjunction with hematuria)
117
# Pathoma Renal
What is the most common type of renal stone?
**Calcium** (oxalate or phosphate salts)
118
# Pathoma Renal
What is the most common cause of calcium oxalate (or phosphate) nephrolithiasis?
What is the treatment?
Idiopathic **hypercalcuria**;
**hydrochlorothiazide**
119
# Pathoma Renal
After calcium (phosphate or oxalate), what are the next two most common types of nephrolithiasis?
(1) Calcium (oxalate or phosphate)
(2) **Ammonium magnesium phosphate**
(3) **Uric acid**
120
# Pathoma Renal
A patient presents with colicky right flank pain and hematuria.
Urinalysis shows radiolucent crystals.
**Radiolucence** most likely indicates what type of stone?
**Uric acid** nephrolithiasis
121
# Pathoma Renal
Identify if each of the following nephrolithiasis is radiopaque or radiolucent:
**Calcium** (oxalate or phosphate)
**Struvite** (ammonium magnesium phosphate)
**Uric acid**
Identify if each of the following nephrolithiasis is radiopaque or radiolucent:
**Calcium** (oxalate or phosphate) - **_Radiopaque_**
**Struvite** (ammonium magnesium phosphate) - **_Radiopaque_**
**Uric acid** - **_Radiolucent_**
122
# Pathoma Renal
Which form of nephrolithiasis has the strongest association with infection (e.g. due to *Proteus vulgaris* or *Klebsiella spp.*)?
**Struvite** (ammonium magnesium phosphate)
123
# Pathoma Renal
What is the major predisposing factor for uric acid nephrolithiasis?
**Hyperuricemia**
(e. g. due to gout, leukemia, myeloproliferative disorders)
* (Other factors include hot and arid conditions, low urine volume, and low pH.)*
124
# Pathoma Renal
*Name the mainstay treatment for each of the following forms of nephrolithiasis:*
**Calcium** (oxalate or phosphate)
**Struvite** (ammonium magnesium phosphate)
**Uric acid**
**Calcium** - **_Hydrochlorothiazide_**
**Struvite** - **_Surgery + antibiotics_**
**Uric acid** - **_Hydration + urine alkalinization_** (+ allopurinol for gout)
125
# Pathoma Renal
Name a rare form of nephrolithiasis most commonly seen in children with a certain genetic defect.
**Cystine** stones
126
# Pathoma Renal
Treatment is extremely similar for which two forms of nephrolithiasis?
**Uric acid** stones
**Cystine** stones
*(hydration + urine alkalinization)*
127
# Pathoma Renal
Describe the microscopic appearance of the following types of nephrolithiasis:
**Calcium** (phosphate or oxalate)
**Struvite** (ammonium magnesium phosphate)
128
# Pathoma Renal
Describe the microscopic appearance of the following types of nephrolithiasis:
**Uric acid**
**Cystine**
129
# Pathoma Renal
Name the **three** **most common** causes of end-stage renal disease (i.e. chronic renal failure).
1. **Diabetes mellitus**
2. **Hypertension**
3. **Glomerular disease**
130
# Pathoma Renal
ESRD treatment includes dialysis and renal transplant. The dialysis often leads to ________ development, increasing risk of subsequent ________ carcinoma.
ESRD treatment includes dialysis and renal transplant. The dialysis often leads to **_cyst_** development, increasing risk of subsequent **_renal cell_** carcinoma.
131
# Pathoma Renal
*List the major effects of chronic renal failure:*
\_\_\_\_\_\_\_emia
\_\_\_\_\_\_\_tension
\_\_\_\_\_\_\_kalemia
Metabolic \_\_\_\_\_osis
\_\_\_\_\_\_\_calcemia and renal osteo\_\_\_\_\_\_\_\_\_\_\_\_
Anemia due to decreased \_\_\_\_\_\_\_\_\_\_\_\_\_
*List the major effects of chronic renal failure:*
**_Azot_**emia
**_Hyper_**tension
**_Hyper_**kalemia
Metabolic **_acid_**osis
**_Hypo_**calcemia and renal osteo**_dystrophy_**
Anemia due to decreased **_erythropoietin_**
132
# Pathoma Renal
List some of the major effects of the azotemia (~uremia) associated with chronic renal failure (ESRD).
(E.g. appetite, inflammatory, hematogenous, and motor effects)
_Mnemonic: ESRD makes you **NAP**-**PE**._
**Nausea**
**Anorexia**
**Pericarditis**
-
**Platelet** dysfunction
**Encephalopathy** (and **asterixis**)
133
# Pathoma Renal
Which substance is the main controlling factor over the diameter of the afferent arteriole lumen?
PGE2
(Hence, why NSAIDs restrict blood flow to the glomeruli.)
134
# Pathoma Renal
Which substance is the main controlling factor over the diameter of the efferent arteriole lumen?
Angiotensin II
(Hence, why ACE inhibitors dilate the efferent arteriole.)
135
# Pathoma Renal
Angiomyolipomas are \_\_\_\_\_\_omas more commonly seen in patients with \_\_\_\_\_\_\_\_\_\_\_\_.
Angiomyolipomas are **_hamart_**omas more commonly seen in patients with **_tuberous sclerosis_**.
136
# Pathoma Renal
Renal cell carcinomas arise from what tissue(s)?
Renal tubule epithelium
137
# Pathoma Renal
What are the three classic S/Sy of which some mix is typically seen in renal cell carcinoma?
**Hematuria**
Palpable mass
Flank pain
138
# Pathoma Renal
Name some of the paraneoplastic syndromes associated with renal cell carcinoma.
**EPO**-, **renin**-, **PTHrP**-, and **ACTH**-secreting tumors
139
# Pathoma Renal
Renal cell carcinomas are rarely associated with left-sided \_\_\_\_\_\_\_\_\_.
Renal cell carcinomas are rarely associated with left-sided **_varicoceles_**.
140
# Pathoma Renal
What are the most common gross and microscopic findings in renal cell carcinomas?
Gross - **yellow mass**
Microscopic - **clear cells**
141
# Pathoma Renal
Loss of *VHL* leads to increases in what factors?
**IGF-1**
**HIF** transcription factor (increasing **VEGF** and **PDGF**)
142
# Pathoma Renal
What is the classic anatomical location and demographic associated with sporadic renal cell carcinoma?
Upper renal pole;
60-year-old male
143
# Pathoma Renal
What is the major risk factor for sporadic renal cell carcinoma?
Cigarette smoke
144
# Pathoma Renal
Although renal cell carcinomas are especially at-risk for hematogenous spread (via the renal vein), what lymph nodes are most likely to be involved?
The **retroperitoneal** nodes
145
# Pathoma Renal
What tumor arises from renal blastema and is characterized by primitive glomeruli, tubules, and stromal cells?
Wilms tumor
146
# Pathoma Renal
Wilms tumors are _________ (benign/malignant).
Wilms tumors are **_malignant_**.
147
# Pathoma Renal
**True/False**.
Renal cell carcinoma is the most common renal malignancy in children.
**False**.
***Wilms tumor*** is the most common renal malignancy in children.
148
# Pathoma Renal
What is the classic presentation for Wilms tumor?
**Unilateral** **flank** **mass**, **hematuria**, and **hypertension**
149
# Pathoma Renal
Why do Wilms tumors present with hypertension?
Tumor **renin** secretion
150
# Pathoma Renal
Name the three syndromes associated with Wilms tumor.
WAGR
Denys-Drash
Beckwith-Wiedmann
(*'**W**h**a**t could **g**o w**r**ong **d**ining and **d**ashing at **BW**s?'*)
151
# Pathoma Renal
Besides the presence of a nephroblastoma (Wilms tumor), name the main aspects of **WAGR** syndrome.
**A**niridia, **G**enital abnormalities, mental/motor **R**etardation
152
# Pathoma Renal
Besides the presence of a nephroblastoma (Wilms tumor), name the main aspects of **Denys-Drash** syndrome.
**P**rogressive glomerular disease,
male **p**seudohermaphroditism
*('**double Ds** get the **PP**')*
153
# Pathoma Renal
Besides the presence of a nephroblastoma (Wilms tumor), name the main aspects of **Beckwith-Wiedmann** syndrome.
Neonatal hypoglycemia,
muscular hemihypertrophy,
organomegaly
154
# Pathoma Renal
Name the respective mutation associated with each of the following syndromes:
**WAGR** -
**Denys-Drash** -
**Beckwith-Wiedmann** -
Name the respective mutation associated with each of the following syndromes:
**WAGR** - _*WT1* (deletions)_
**Denys-Drash** - _*WT1* (mutations)_
**Beckwith-Wiedmann** - *_WT2_*
155
# Pathoma Renal
What is the major risk factor for urothelial (transitional cell) carcinomas?
## Footnote
*Name some others.*
**Cigarette smoke**;
## Footnote
*naphthylamine, azo dyes, long-term cyclophosphamide or phenacetin use*
156
# Pathoma Renal
Describe the flat form of urothelial (transitional cell) carcinoma.
Early *p53* mutations:
high-grade, flat tumor with early invasion
157
# Pathoma Renal
Describe the papillary form of urothelial (transitional cell) carcinoma.
Low-grade papillary tumor that progresses to high-grade and then invades
158
# Pathoma Renal
**True/False**.
Urothelial (transitional cell) carcinomas are often multifocal and recurrent.
True.
159
# Pathoma Renal
What must occur before squamous cell carcinomas can arise in the bladder or other lower urinary tract locations?
**Squamous metaplasia**
| (from transitional epithelia)
160
# Pathoma Renal
Name three very distinct risk factors for squamous cell carcinoma of the bladder.
Chronic **cystitis** (older woman)
***Schistosoma haematobium*** (Egyptian male)
Long-standing **nephrolithiasis**
161
# Pathoma Renal
Name three structural risk factors for adenocarcinoma of the bladder.
**Urachal** remnant
**Cystitis glandularis**
**Extrophy** of the bladder
