5 General Pathology Review & Introduction to Renal Pathology Flashcards
1
Q
Homeostasis & the normal response of cells to physiologic stress
A
- Homeostasis
- Normal physiologic balance in the body
- Normal response of cells to physiologic stress
- Adapt
- Hypertrophy (ex. muscles of body builders)
- Atrophy (ex. leg muscles after paralysis
- Necrosis
- Cell death
- Adapt
2
Q
Causes of cell injury & cell death
- Causes
- Reversible vs. irreversible cell injury
- Cell injury
- Necrotic cells
A
- Causes
- Oxygen deprivation
- Ischemia
- Physical agents (ex. radiation)
- Chemical agents
- Infections
- Immunologic reactions
- Genetic derangements
- Nutritional imbalances
- Reversible vs. irreversible cell injury
- Reversible
- Seen w/ EM but not microscope
- Cellular swelling
- Hydropic changes
- Irreversible damage
- Seen w/ EM & microscope
- Coagulation of cytoplasmic proteins
- Nuclear degeneration
- Reversible
- Cell injury
- Cell membranes are made of lipids
- Influx of Ca –> decreased ATP, decreased phospholipids, disrupted proteins, & chromatin damage
- Free radicals –> disrupted cell membranes, ribosome leakage, mitochondria problems, & lysosome rupture
- Cell damage –> lubbimg membranes, swelling, & chromatin clumping
- Normal cell –> recovery
- Further injury –> more damage, more leakage, lysosome rupture –> digest cell contents
- Necrotic cells
- Eosinophilic due to increased binding of eosin (dye) to natured proteins (eosinophilia)
- Increased red/pink cells from denatured proteins
- Cytoplasm: glassy, homogeneous, & vacuolated (moth-eaten, due to digestion by lysosomal enzymes)
- Focal, dystrophic calcification (low pH, high cytosolic Ca)
- Eosinophilic due to increased binding of eosin (dye) to natured proteins (eosinophilia)
![](https://s3.amazonaws.com/brainscape-prod/system/cm/114/461/427/a_image_thumb.png?1659434708)
3
Q
Different types of cell death
- Necrosis
- Other types
A
- Necrosis
- Coagulative
- Liquefactive
- Caseous
- Other types
- Autolysis
- Apoptosis
4
Q
Coagulative necrosis
A
- Retains structure, loses function
- Result of denaturing cellular proteins (coagulation)
- Intracellular acidosis & Ca denatures cellular structural proteins & proteolytic enzymes –> blocks proteolysis
- Basic outline of cells is preserved w/ nuclear degeneration
- Occurs in hypoxia (decreased oxygen) & ischemia (decreased blood flow –> decreased oxygen)
- Histology
- Normal: lots of nuclei
- Necrosis: destroyed nuclei, only see contours of cells
- Glomeruli maintain structure longer than tubular epithelial cells
![](https://s3.amazonaws.com/brainscape-prod/system/cm/114/471/083/a_image_thumb.png?1659434711)
5
Q
Liquefactive necrosis
A
- Cells burst from fluid, lose structure
- Seen in bacterial & fungal infections
- Accumulation of inflammatory cells bring lytic enzymes (abscess)
- –> complete digestion of dead cells
- Via spillage of active lysosomal enzymes in injured cells or via inflammatory cells
- –> liquid viscous mass (pus)
- –> complete digestion of dead cells
- Histology
- Top: abscess
- Purple = nuclei of inflammatory cells release enzymes & cause necrosis
- Bottom: lot of inflammatory cells & necrotic debris
- Top: abscess
![](https://s3.amazonaws.com/brainscape-prod/system/cm/114/472/617/a_image_thumb.png?1659434712)
6
Q
Caseous necrosis
A
- White & cheesy
- Fragmented cells w/ coagulative necrosis & amorphous granular debris
- Seen w/ mycobacterial infections or TB
- Histology
- Left: lung
- Inflammatory cells on the outside
- Homogenous stuff in the middle
- Giant cells around it
- Right
- Looks like curd
- Lots of proteins
- Can barely make out the outline of any cells
- Left: lung
![](https://s3.amazonaws.com/brainscape-prod/system/cm/114/473/527/a_image_thumb.png?1659434713)
7
Q
Inflammation
- General
- Cellular response
- Acute vs. chronic inflammation
- When inflammation can be harmful
- Repair
A
- General
- Essential for the body to defend itself against harmful agents (ex. bacterial infections)
- Destroys injurious agents, dilutes injurious agents, & walls off the process
- –> healing & reconstruction of the damaged tissues
- Cellular response
- Cells respond to chemotactic agents by exiting the blood stream into affected tissues & performing specific functions
- Acute vs. chronic inflammation
- Acute
- Short lived (minutes to a few days)
- Hallmark cell: neutrophil or granulocyte
- Chronic
- Longer duration
- Hallmark cells: mononuclear lymphocytes, plasma cells, macrophages, & eosinophils
- Acute
- W/o inflammation
- Infections go unchecked –> wounds never heal –> injured organs remain permanent sores
- When inflammation can be harmful
- Hypersensitivity rxns to insect bites or drugs
- Rheumatoid arthritis when inflammation destroys joints
- Atherosclerosis –> atheromas + decreased blood flow to organs
- Glomerulonephritis –> renal failure
- Repair
- Resolution: regeneration of native parenchyma (ex. liver)
- Organization: filling the defect w/ fibroblastic tissues or scar (ex. heart or muscles)
- Most common: combination of both (ex. kidneys)
![](https://s3.amazonaws.com/brainscape-prod/system/cm/114/474/030/a_image_thumb.png?1659434714)
8
Q
Inflammatory cells
- In blood
- Polymorphonuclear leukocytes (neutrophils)
- Leukocytes
- Platelets
- Monocytes
- Eosinophils
- Basophils
- In connective tissue
- Fibroblasts
- Macrophages
- Macrophages & giant cells
- Plasma cells
- Mast cells
- Proteoglycans, elastic fibers, & collagen fibers
A
- In blood
- Polymorphonuclear leukocytes (neutrophils)
- Small
- Multi-lobed nucleus never looks the same
- Inflammatory granules
- Leukocytes
- Thin rim of cytoplasm
- Perfectly round nucleus
- Platelets
- Monocytes
- Phagocytic
- –> macrophages when in connective tissue
- Eosinophils
- Bright red granules
- Response to IgE mediated reactions or parasitic infections
- Basophils
- Larger granules
- Darker blue
- Polymorphonuclear leukocytes (neutrophils)
- In connective tissue
- Fibroblasts
- Deposit collagen for repair
- Chemotactic properties call in inflammatory cells
- Macrophages
- First cousin of monocytes
- “Pac man,” clean debris
- Macrophages & giant cells
- See granulomas
- Engulf specific types of bacteria (ex. TB, leprosy, syphilis) or foreign bodies (ex. foreign body granulomas)
- Plasma cells
- Larger
- Halo, clock face, eccentric nucleus (on one side of the cell)
- Shouldn’t be seen in the blood
- Make immunoglobulins
- First cousin of B lymphocytes
- Mast cells
- Release histamine to bring in fluid
- Role in bee stings, etc.
- Proteoglycans, elastic fibers, & collagen fibers
- Repair
- Fibroblasts
![](https://s3.amazonaws.com/brainscape-prod/system/cm/114/484/952/a_image_thumb.png?1659434728)
9
Q
Granulomatous inflammation
A
- aka type IV hypersensitivity rxn
- Activated macrophages & multinucleate giant cells
- Seen in…
- TB
- Sarcoidosis
- Leprosy
- Syphilis
- Wegener’s granulomatosis
- Foreign body rxn
![](https://s3.amazonaws.com/brainscape-prod/system/cm/114/623/327/a_image_thumb.png?1659434834)
10
Q
Renal pathology statistics
A
- 20% of women get UTIs
- Complications: acute & chronci pyelonephritis
- 1% of ppl get renal stones
- Complications: hydronephrosis, hydroureter
- Dialysis & renal transplants keep pts alive
- Many deaths related to renal diseases are in young pts
11
Q
Gross pathology of the kidney
- Normal kidney
- Composition
- Blood vessels –> ureter
- Embryology: successive pairs
A
- Normal kidney
- Weight: 150 grams
- Length: 12-15 cm
- Composition
- Cortex: 1.2-1.5 cm thick
- Medulla: 12 pyramids + base at the corticomedullary junction
- Blood vessels –> ureter
- Blood vessels
- –> 12 minor calyces
- –> 2-3 major calyces
- –> funnel shaped renal pelvis
- –> ureter
- Embryology: successive pairs
- Pronephros
- Mesonephros
- Metanephros
![](https://s3.amazonaws.com/brainscape-prod/system/cm/114/625/169/a_image_thumb.png?1659434836)
12
Q
Kidney problems
- Congenital anomalies
- Agenesis
- Hypoplasia
- Ectopic Kidneys
- Horseshoe kidney
- Cystic diseases
- Congenital
- Cystic renal dysplasia
- Polycystic kidney disease
- Medullary cystic disease
- Acquired
- Localized
- Congenital
A
- Congenital anomalies
- Agenesis: absence of kidneys
- Hypoplasia: small & ill-formed kidneys
- Ectopic kidneys: in the wrong place
- Horseshoe kidney: 2 kidneys don’t separate & are joined at the lower poles
- Cystic diseases
- Congenital
- Cystic renal dysplasia: numerous small cysts in the kidneys, presents at a young age
- Polycystic kidney disease: AR in childhood, AD in young adults
- Medullary cystic disease: cysts mostly affect distal tubules in the medulla
- Acquired
- Associated w/ long-term renal dialysis
- Localized
- Simple
- Vary in size
- Commonly seen as incidental findings at resection or autopsy
- Mostly asymptomatic
- Congenital
![](https://s3.amazonaws.com/brainscape-prod/system/cm/114/628/844/a_image_thumb.png?1659434842)
13
Q
Renal biopsy
- Purpose
- Types
- Closed core needle biopsy
- Open biopsy
- After biopsy
- 3 portions
- Largest
- Small
- Smallest
A
- Purpose
- Provide sufficient accurate info on which to base the right diagnosis, approach to treatment, & prognosis
- Types
- Closed core needle biopsy
- Obtaiend by a tru-cut needle under ultrasound guidance & local anesthesia
- Open biopsy
- Perfomred in the OR under general anesthesia
- Closed core needle biopsy
- After biopsy
- Renal tissue is immediately submitted to pathology in normal saline for processing under a scanning microscope to ensure there’s enough cortical tissue & _>_10-12 glomeruli
- Complete study: light microscopy, special stains, IF microscopy, & EM
- 3 portions
- Largest: fixed in Bouin’s fixative for 2 hours, washed, processed, & cut at 2-3 microns for light microscopy
- Small: immediately frozen in OCT & cut at 5 micron thickness to be stained for Igs & studied under IF microscopy
- Smallest: cubed at 1mm & fixed in 2% glutaraldehyde sol’n, embedded in hard resin, cut, & examined under EM
![](https://s3.amazonaws.com/brainscape-prod/system/cm/114/629/718/a_image_thumb.png?1659434843)
14
Q
Light microscopy: stains
- H&E
- Methamine silver
- Periodic acid schiff (PAS)
- Trichrome
- Congo-red
A
- H&E
- Basic morphology
- Methamine silver
- Black
- Basement membrane morphology (thickness, splitting, & spikes)
- Periodic acid schiff (PAS)
- Fuscia red
- Basement membranes, deposits, & glycogen
- Trichrome
- Blue or green in a red background
- Amt of fibrosis, chronicity of renal damage
- Congo-red
- Pink w/ apple-green birefringence under polarized light
- Amyloidosis
15
Q
Light microscopy: glomeruli
- Cellularity
- ECM
- Peripheral capillary basement membrane
- Bowman’s space
- Image: normocellular
- Image: hypercellular
- Image: mesangial sclerosis
A
- Cellularity
- Number of cells within mesangial areas, endothelial (intraglomerular vs. extraglomerular)
- ECM
- Sclerosis, increased mesangial sustance, fibrosis, amyloidosis, etc.
- Peripheral capillary basement membrane
- Thickening, wrinkling, splitting, etc.
- Bowman’s space
- Normal or filled w/ hemorrhage, epithelial cells, proteinaceous substances, fat droplets, etc.
- Image: normocellular
- Tubules come togehter like a jigsaw puzzle
- Can’t see any interstitium
- Image: hypercellular
- Too many crowded cells
- Increased cellularity –> not enough blood goes to the tubules –> tubules don’t look good
- Image: mesangial sclerosis
- Diabetic kidney
- Fibrotic nodules
- Accentuated blood vessels & basement membranes
![](https://s3.amazonaws.com/brainscape-prod/system/cm/114/631/866/a_image_thumb.png?1659434847)