Flashcards in XIV - The Kidneys and Its Collecting System (with pics) Deck (154)
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121
An 18 y/o female presented with decreased in urine volume and edema. BP = 150/100. RBC cast was present in the urine. What is the most likely light microscopy pattern of this condition?
Acute glomerulonephritis (TOPNOTCH)
122
An 18 y/o female presented with decreased in urine volume and edema. BP = 150/100. RBC cast was present in the urine. Two weeks prior, patient had sore throat and tonsillar swelling. What is the clinical impression?
PSGN (TOPNOTCH)
123
Patient presented with fever, nausea, and flank pain. Urinalysis showed gross hematuria, increased pus cells, and presence of WBC cast. The most likely diagnosis is:
Acute pyelonephritis (TOPNOTCH)
124
A 10 y/o male presents with generalized edema. BP is 90/60. Urinalysis showed Protein 3+, and presence of fatty cast. The most likely diagnosis is:
Nephrotic syndrome (TOPNOTCH)
125
A 50 y/o patient with long standing hypertension and diabetes presented with complaints of pruritus, lower extremity edema, nausea and vomiting. Urinalysis showed presence of protein and waxy casts. Presence of waxy casts may indicate:
Chronic kidney disease (TOPNOTCH)
126
A 5 y/o child presents with short history of facial edema that has now progressed to swelling of the feet and abdomen. Other symptoms include nausea, vomiting and abdominal pain. High levels of protein was noted in the urine. The parents reported that the child had fever few days before the development of the swelling. Biopsy was done. On light microscopy, no significant structural changes were noted except for the few lipids in the tubules. What can be expected on electron microscopy?
Loss of foot processes (TOPNOTCH)
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Characterized by rapid decline in GFR, with concurrent dysreglation of fluid and electrolyte balance, and retention of metabolic waste products.
Acute kidney injury(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 898
128
Most frequent clinical presentation of this disease is rapidly progressive glomerulonephritis (with crescent formation). The anti-GBM antibodies cross react with pulmonary alveolar basement membranes to produce pulmonary hemorrhage, associated also with renal failure.
Goodpasture syndrome. SEE SLIDE 14.9. (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 912
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The most common cause/mechanism of acut nephritic syndrome
immune-mediated glomerular injury(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 914
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Its presence in the urine represents lipoprotein resorbed by tubular epithelial cells and then shed along with injured tubular cells.Present in Nephrotic syndrome
Oval fat bodies(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 914
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Most frequent systemic causes of nephrotic syndrome
Diabetes, amyloidosis, SLE(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 914
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Most common cause of nephrotic syndrome in older adults
FSGS 35%, Membranous glomerulopathy 30% (TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 524
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A 6 y/o male presented with massive proteinuria and edema. There is no hypertension or hematuria noted. Patient responded well to corticosteroid. The principal lesion in this condition:
Uniform and diffuse effacement of foot processes(Minimal change disease) (TOPNOTCH)
134
Most common type of glomerulonephritis worldwide
IgA Nephropathy/Berger Disease(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 923
135
Presents with gross hematuria after an infection of the respiratory, GIT or urinary tract, microscopic hematuria, with or without proteinuria. Hematuria last for several days, only to return every few months. These are the clinical features of what renal pathology?
IgA Nephropathy/Berger Disease(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 923
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This childhood syndrome consists of purpuric skin lesions, abdominal pain, intestinal bleeding, and arthralgia along with renal abnormalities.
Henoch Schonlein Purpura (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 926
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Most common renal manifestation of multiple myeloma
Chronic kidney disease (TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 938
138
True or False. Patients with malignant hypertension have markedly elevated levels of plasma renin.
True (TOPNOTCH)
139
Most common cause of renal artery stenosis
Narrowing by an atheromatous plaque (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 940
140
Following a prodrome of influenza-like or diarrheal symptoms, this syndrome presents with sudden onset of bleeding manifestation, severe oliguria, hematuria, associated with microangiopathic hemolytic anemia, thrombocytopenia and prominent neurologic changes.
Hemolytic Uremic Syndrome(TOPNOTCH)Robbins Basic Pathology, 9th Ed. p. 942
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Earliest manifestation in bilateral partial obstruction of the ureter
Polyuria and nocturia(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 951
142
Patient presents with flank pain, hematuria, and flank mass. Abdominal CT revealed a mass on the upper pole of the left kidney. CT guided biopsy showed a tumor that are made up of cell with basophilic cytoplasm and are non-papillary. The most likely histologic type of renal carcinoma described is:
Clear cell carcinoma(TOPNOTCH)
143
Most common site of metastasis of renal cell carcinoma
Lungs(TOPNOTCH) Robbins Basic Pathology, 9th ed. P. 955
144
A 32 year old woman develops tea-colored urine, periorbital edema, and decreasing urine output. A renal biopsy shows glomeruli with collapsed glomerular tufts and crescent-shaped masses of proliferating cells and leukocytes internal to the Bowman's capsule. Which immunofluorescence pattern indicates that she is amenable to plasmapheresis? (A) linear staining of IgG and C3 along the GBM (B) granular "lumpy bumpy" deposits of Ig and/or complement in the GBM and/or mesangium (C) no distinct Ig or complement deposition (D) none of the above
linear staining of IgG and C3 (Anti-GBM antibody CrGN/Type I) (B - Type II - immune complex mediated; C - Type III - pauci immune; neither are helped by plasmapharesis). SEE SLIDE 14.9. (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 557-558.
145
An 18 year old female has sore throat and fever. The next day, she develops tea-colored urine for a week, which spontaneously resolves. Six months later, her hematuria recurs. She is also found to have increased serum IgA. Which of the following renal biopsy findings is consistent with her disease? (A) presence of C1q and C4 deposits in the glomeruli (B) IgA deposits in the mesangium (C) granular deposits of IgG and complement (D) subepthelial "humps" on electron microscopy
IgA deposits in the mesangium (Berger disease) (all other choices are seen in PSGN, which develops 1 to 4 weeks after infection). SEE SLIDE 14.8.
146
A 10 year old male presents with periorbital edema. Urinalysis shows persistent albuminuria. Which renal biopsy finding will indicate that he will respond to short coursse corticosteroid therapy? (A) normal-looking glomerulus by light miscroscopy, with podocyte foot process effacement on electron microscopy (B) some glomeruli with segmental increased mesangial matrix and hyaline deposits (C) diffusely thickened GBM on light microscopy, with subepithelial deposits in a "spike and dome" pattern on electron microscopy (D) a "tram track" appearance of the thickened GBM on PAS stain
normal-looking glomerulus on light microscopy, with podocyte foot process effacement on electron microscopy (minimal change disease) (B - FSGS; C - membranous GN; D - membranoproliferative GN) (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 550-554
147
A 38 year old male presents with gross hematuria. Imaging workup shows three renal masses. He undergoes radical nephrectomy, where gross examination of the kidney specimen showed yellowish masses with foci of hemorrhage. The mass nearest the hilum appears to infiltrate into the renal vein. On histopathology, the masses are composed of sheets of clear, vacuolated cells with round to oval nuclei, and occasional mitoses. The patient also had a history of brain surgery at 14 years old for a cerebellar hemangioblastoma. This association raises the possibility which syndrome? (A) Li Fraumeni (B) Von Hippel-Lindau (C) Tuberous sclerosis (D) Gardner
von Hippel-Lindau (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 573-74
148
Which of the following is the most important prognostic factor in bladder tumors? (A) histologic grade (B) painless hematuria (C) histologic type (D) depth of invasion
depth of invasion (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 576
149
One of the most common causes of nephrotic syndrome in adults. Initially presents as increased mesangial matrix, obliterated capillary lumina, with deposition of hyaline masses and lipid droplets. In time, causes global sclerosis.
FSGS (TOPNOTCH) Robbins Basic Pathology, 9th ed. P.526
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