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Renal pathology CRRABII > 10.31 > Flashcards

10.31 Flashcards

1
Q

What is the most common cause of acute renal failure (ARF)?

A

Acute Tubular Necrosis (ATN)

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2
Q

What are the two patterns of ATN?

A

Ischemic

Nephrotoxic

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3
Q

What happens to tubular epithelial cells during ATN?

A

Swelling, loss of polarity, etc. (reversible)

Necrosis and apoptosis (lethal)

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4
Q

What allows recovery from ATN?

A

Patchiness of tubular necrosis

Intact BM

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5
Q

How does ATN start?

A

Decline in urination
Increased BUN
Lasts ~36hrs…if survive this then outcome is good

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6
Q

What is the recovery process like for ATN?

A

Increase in urine volume (up to 3L/day)–> overcompensation–> hypokalemia

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7
Q

What is the difference between acute and chronic forms of Tubulointerstitial Nephritis (TIN)?

A

Acute has PMNs/Eos, edema

Chronic has fibrosis and tubular atrophy

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8
Q

What are the symptoms of TIN?

A

Polyuria
Nocturia
MIld metabolic acidosis

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9
Q

What causes TIN?

A

Lots of things…

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10
Q

What causes acute pyelonephritis?

A

Bacterial infection (gram-)

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11
Q

What causes chronic pyelonephritis?

A

Includes bacterial infection…but also reflux or obstruction

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12
Q

What are some complications of acute pyelonephritis?

A 
Papillary necrosis (diabetics and pt. with obstruction)--yellow necrosis
Pyonephrosis
Perinephric abscess (suppurative inflammation extends through the renal capsule into adjacent tissue)
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13
Q

What causes damage to the calyces?

A

Chronic pyelo and analgesic neuropathy

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14
Q

What causes chronic pyelonephritis?

A

Chronic reflux or chronic obstruction

Usually bacterial infection, but not always

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15
Q

What might be the morphology of chronic pyelonephritis?

A 
Deformed calyx(es)
Thyroidization
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16
Q

How do drugs cause TIN?

A

Trigger an interstitial immunologic reaction (methicillin)
Cause acute renal failure
Slow injury to tubules over many years–> CRI (analgesic abuse nephropathy)

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17
Q

What needs to be ingested in order for a person to develop analgesic nephropathy?

A

2 or more of the following for ~7yrs:

Aspirin, caffeine, acetaminophen, codeine, phenacetin

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18
Q

What distinguishes analgesic nephropathy from DM nephropathy?

A

In analgesic nephropathy, papillae in various stages of necrosis, with calcification and sloughing

In DM, they’d all be in the same stage

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19
Q

What is a concern with analgesic nephropathy?

A

Urothelial carcinoma of the renal pelvis

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20
Q

How do NSAIDS cause ARF?

A

Inhibition of PG synthesis–>vasoconstriction–> decreased blood volume

Hypersensitivity

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21
Q

Besides ARF, what else can NSAIDS cause?

A

Acute interstitial nephritis
MCD
MGN

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22
Q

Who is susceptible of getting urate nephropathy?

A

Chemo patients–acute uric acid nephropathy

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23
Q

What causes renal insufficiency in patients with multiple myeloma (a plasma cell neoplasm)?

A

Bence Jones proteinuria–Ig light chains

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24
Q

How does Bence Jones proteinuria cause renal insufficiency?

A

Directly toxic to tubules

Combine with Tamm-Horsfall proteins–>cast formation–>obstruction and inflammation

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25
Q

What are the gross features of benign nephrosclerosis?

A

Normal/small kidneys

Fine granular surface

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26
Q

What causes the sclerosis?

A

Hyalinization of the walls of arterioles and small arteries

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27
Q

Is benign nephrosclerosis bad?

A

Not typically

28
Q

Who is most likely to have benign nephrosclerosis?

A

Black diabetics with HTN

29
Q

What is associated with malignant hypertension?

A

Malignant nephrosclerosis

30
Q

Who has the greatest risk of developing malignant nephrosclerosis?

A

Young black men

31
Q

What are the gross features of malignant nephrosclerosis?

A

Pinpoint petechial hemorrhages…otherwise smooth

32
Q

What are the micro features of malignant nephrosclerosis?

A

Fibrinoid necrosis of arterioles

Onion-skinning of vessels

33
Q

What are the symptoms of malignant nephrosclerosis?

A

Headache
N&V
Visual impairments (scotomas–flashing lights)

34
Q

Other than HTN, how else can renal artery stenosis?

A

A bruit

35
Q

What is the primary cause of renal artery stenosis?

A

Occlusion via a atheromatous plaque

36
Q

What are Hemolytic Uremic Syndrome (HUS) and Thrombotic thrombocytopenic Purpura (TTP)?

A

Thrombotic microangiopathies…systemic thrombi

37
Q

What initiate HUS/TTP?

A

Endothelial injury and activation

Platelet aggregation…unusually large von Willebrand factor multimers

38
Q

What causes classic (childhood) HUS?

A

Verocytotoxin producing E. coli–causes endothelial lysis

39
Q

What is the typical outcome of childhood HUS?

A

Recovery with dialysis (weeks)

Some develop CRF

40
Q

What causes adult HUS?

A

Lots of things:

Infection
Antiphospholipid syndrome
Pregnancy
Vascular renal diseases
Drugs (chemo and immunorepressive)...treat with plasma exchange
41
Q

What causes familial HUS?

A

Deficient Factor H…50% mortality rate (treated with plasma exchange and corticosteroids)

42
Q

What causes the symptoms of TTP?

A

Defect in protease that cleaves large von Willebrand multimers

43
Q

What are the symptoms of TTP?

A

Fever
NEUROLOGICAL symptoms (NOT seen in HUS)
Hemolytic anemia
Purpura

44
Q

Who is most likely to get TTP?

A

Women under 40yo

45
Q

What are the gross features of HUS/TTP?

A

Patchy or diffuse renal cortical necrosis

46
Q

What are the micro features of HUS/TTP?

A

Glomeruli w/ thickened cap walls
Fibrin deposits in cap lumens, subendo, and mesangium
Fibrinoid necrosis of arterioles w/ thrombi

47
Q

What are the gross features of acute renal infarcts?

A

Solitary
White
Wedge shaped

48
Q

What are the gross features of chronic renal infarcts?

A

Depressed

Gray-white scars w/ a V shape

49
Q

What are the micro features of renal infarcts?

A

Ischemic coagulative necrosis

50
Q

What are two kinds of benign renal tumors?

A

Angiomyolipoma

Oncocytoma

51
Q

What are angiomyolipomas associated with?

A

Tuberus sclerosis–auto domininant syndrome…lots of different -omas

52
Q

What does a oncoctyoma look like w/o magnification?

A

Mahogany brown

53
Q

What does a oncoctyoma look like under a microscope?

A

Large, eosinophilic cells with round nuclei

EM shows lots of mitochondria

54
Q

Where do oncocytomas develop?

A

Collecting ducts

55
Q

What is the most common adult renal cancer?

A

Renal cell carcinoma (1-3% of ALL cancers)

56
Q

What is the biggest risk factor for renal cell carcinoma?

A

Smoking

57
Q

What is Von Hippel-Lindau syndrome?

A

Type of renal cell carcinoma
Auto dominant disorder
Hemangioblastomas of the cerebellum and retina
Renal cysts and renal carcinoma

VHL gene encodes a tumor suppressor gene

58
Q

What is the most common form of renal cell carcinoma?

A

Clear cell carcinoma

59
Q

What is lost in almost all clear cell carcinomas?

A

Losses on chromosome 3p…in region of VHL gene

60
Q

What does a clear cell carcinoma look like?

A

Bright yellow tumor

Possibly necrotic

61
Q

What is associated with trisomy 7, 16, and 17 and loss of Y?

A

Papillary carcinoma (10-15% of RCC)

62
Q

What are the micro features of papillary carcinomas?

A

Cuboidal cells with a papillary growth pattern

Foam cells in papillary cores

63
Q

What carcinoma has vegetable-like cells?

A

Chromophobe carcinoma (5% of RCC…good prognosis)

64
Q

What is the typical progression of RCC?

A

Invade/grow along renal vein
Flank pain, palpable mass, hematuria (10%)
Asymptomatic

Metastases (lung then bone…other)
5 year survival is 45%

65
Q

How can RCC be treated prior to metastases?

A

Nephrectomy

66
Q

What are urothelial carcinomas of the renal pelvis?

A

Transitional cell carcinomas (often occur with bladder TCC)

67
Q

Are urothelial carcinomas really bad?

A

Only if high grade/invasive

Renal pathology CRRABII (4 decks)

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