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Case 10: Urinary System > Anat Path: Renal Pathologies > Flashcards

Anat Path: Renal Pathologies Flashcards

1
Q

What is the 5 causes of renal failure

A
  1. Congenital abnormalities
  2. Glomerular disease
  3. Tubulointerstitial inflammation
  4. Necrosis/infarction
  5. Renovascular disease
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2
Q

What is the 3 clinical syndromes of glomerular disease

A
  1. Nephrotic
  2. Nephrotic
  3. Renal failure
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3
Q

What does segmental & focal mean

A

Segmental affecting a part of glomerulus
Focal involving a portion of a glomeruli

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4
Q

What does global & diffuse mean

A

Global involving the entire glomerulus
Diffuse involving all glomeruli

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5
Q

What does mesangial histological change mean

A

Affecting predominantly the mesangial region

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6
Q

What is the 2 main categories of mechanism of immune mediates glomerular disease

A
  1. Immune complex disease w/ granular deposit is which clump together
  2. Anti-BM disease w/ linear deposits which are due to antibodies specific against glomerular basement membrane
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7
Q

Where is the 2 sites where granular deposits can be w// examples

A
  1. Circulating immune complexes in the blood which are deposited in the sub endothelium of glomerulus & activates complement. Post-infectious nephritic
  2. Entrapped or deposited foreign antigen in glomerular basement membrane which lead to antibody attached & deposits in sub-epithelial (podocytes) & complement activation
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8
Q

What is nephritic glomerular disease

A

Endothelial & basement damage

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9
Q

What is nephrotic glomerular disease

A

Podocytes damage

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10
Q

What is the clinical features nephritic glomerular disease

A

Blood is not getting filtered:
Hypertensions due to attempt to increase fluid to be filtered leading to oedema in peripheral
Haematuria due to damage to endothelial cells & basement membrane
Deposits in subendothelium

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11
Q

What is the clinical features of nephrotic glomerular disease

A

Too much filtration:
Proteinuria leading to hypoalbuminaemia
Generalised oedema that decrease oncotic pressure leads to increase production of proteins by liver resulting in hypercholesteraemia
Inflammatory cells in urine w/ sub-epithelial deposits

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12
Q

What is the 2 causes nephrotic glomerular disease

A
  1. Immunological
  2. Systemic disease
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13
Q

What is the causes of acute proliferative GN

A

Acute post-infection usually post-streptococcal

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14
Q

What is the clinical feature of acute proliferative GN

A

Low s-complement due to deposition in glomeruli
High ASO titre due to streptococcal infection

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15
Q

What appearance in prominent under a electron microscope of acute proliferative GN

A

A hump due to electron dense deposit on sub epithelial side of basement membrane

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16
Q

Is acute proliferative GN nephrotic or nephritic

A

Nephritic that changes to nephrotic due toe change in location of deposit

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17
Q

What is the light microscope appearance of acute proliferative GN

A

Glomeruli is enlarged, hypercellular & contains neutrophils showing mesangial & endothelial cell proliferation

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18
Q

What is the prognosis of acute proliferative GN in children & adults

A

Children <5% die in acute stage (cardiac or renal failure) & 5% progress to crescent in or chronic GN
Adults 30% progress to crescent in/chronic GN

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19
Q

What is the prognosis of crescentic GN

A

Poor

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20
Q

What is the 4 causes of crescentic GN

A
  1. Following acute proliferative GN
  2. Autoimmune
  3. SBE
  4. Anti-BM disease
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21
Q

What is characteristic of crescentic GN

A

Proliferation of cells in capsular space that appears crescentic
Cells can either be podocytes stimulated by fibrin or macrophages reflecting severe glomerular damage

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22
Q

What is a serious clinical consequences of crescentic GN

A

Renal failure w/i weeks/months

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23
Q

When is it classified at crescentic GN

A

When it breaks through the basement membrane

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24
Q

What is the 3 stages of progress of crescents GN

A

Cellular
Fibrocellular
Fibrosed

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25
Q

What is the 5 causes of membranous GN

A
  1. Idiopathic
  2. Infection
  3. Neoplasm
  4. Drug therapy
  5. Autoimmune
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26
Q

In who is acute proliferative GN most common

A

Children & more in male than female

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27
Q

What is the appearance of the glomeruli & basement membrane w/ membranous GN

A

Glomeruli normocellular
Basement membrane uniformal thickening to wall off the growth

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28
Q

What is the appearance of membranous GN under a electron microscope

A

Irregular small dense subepithelial deposits w/ basement membrane spikes

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29
Q

Is membranous GN nephrotic or nephritic

A

Nephrotic

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30
Q

In who is membranous GN more common

A

Adults

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31
Q

What is the cause of minimal change NP

A

Idiopathic

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32
Q

What is the appearance of the kidneys w/ minimal change nephropathy

A

Initially large & pale
Later reduced in size

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33
Q

What is the complement [ ] in membranous GN

A

Low complement concentration

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34
Q

What is the complement [ ] of minimal change NP

A

Normal [ ]

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35
Q

Is minimal change NP nephrotic or nephritic

A

Nephrotic

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36
Q

What is the microscopic appearance of minimal change NP

A

Fusion of foot process

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37
Q

In who is minimal change NP more common

A

Children

38
Q

What is the prognosis of minimal change NP

A

Good response to steroid & 75% recovery

39
Q

What is the 2 types of focal segmental glomerulosclerosis

A
  1. Primary FSGS that is idiopathic
  2. HIVAN
40
Q

What is the 4 things that occur in HIVAN

A
  1. Focal cystic dilation of tubule segments
  2. Filled with/ proteinaceous material
  3. Inflammation
  4. Fibrosis
41
Q

What is the 2 causes of mesangiocapillary GN

A
  1. Post-infectious
  2. Autoimmune
42
Q

What is the appearance of the glomeruli in membranoproliferative GN

A

Very cellular & increase in BM material forming a second membrane to grow around
Mesangial processes grow into & appears split

43
Q

What is the 2 types of deposits in membranoproliferative

A

Type 1 deposits in subendothelial
Type 2 laminar intramembraneous deposits

44
Q

What is chronic GN

A

End stage of most forms of GN

45
Q

What is the clinical feature of chronic GN

A

Uraemia

46
Q

What is the prognosis of chronic GN

A

Renal failure

47
Q

What is the 3 microscopic appearance of chronic GN

A
  1. > 90% sclerotic glomeruli
  2. Severe interstitial fibrosis
  3. Tubular atrophy
48
Q

What is 8 systemic disease w/ glomerular involvement

A
  1. SLE
  2. DM
  3. Amyloidosis
  4. Goodpasture syndrome
  5. Microscopic polyarteritis/-angitis
  6. Bacterial endocarditis
  7. Granulomatous is w/ polyangitis
  8. Henoch-Schonlein purpura
49
Q

What is the cause of diabetic glomerulosclerosis

A

Long-standing uncontrolled DM

50
Q

What is 2 associated pathologies of diabetic glomerulosclerosis

A

Pyelonephritis
Papillary necrosis

51
Q

What is the macroscopic appearance of diabetic glomerulosclerosis

A

Early large & smooth
Later small granular

52
Q

What accumulates in tubule epithelial cells of diabetic glomerulosclerosis

A

Glycogen

53
Q

What occurs when/ the afferent & efferent glomerular arterioles in diabetic glomerulosclerosis

A

Arteriolar hyalinosis

54
Q

What is the 5 appearance of the glomeruli in diabetic glomerulosclerosis

A
  1. Modular proteinaceous lesions
  2. Diffuse increase in mesangial matrix
  3. Fibrin capsule
  4. Hyalinization
  5. Shrinkage
55
Q

What is 8 renal disease that cause hypertension

A
  1. Polycystic disease
  2. Glomerulonephritis
  3. Diabetic glomerulonephritis
  4. Renal artery stenosis
  5. Autoimmune disease (SLE)
  6. Vasculitis
  7. Renal neoplasm
  8. Pyelonephritis
56
Q

What is pyelonephritis

A

Non-specific bacterial real infection that can be chronic or acute

57
Q

What is the 3 organisms than ca cause pyelonephritis

A
  1. E. Coli
  2. Proteus
  3. Strep. Faecalis
58
Q

What is the 2 routes of entry w/ pyelonephritis

A
  1. Hematogenous: DM, IE, immunsupression
  2. Ureteric/ascending: cystitis, vesicles-ureteric reflux or obstruction
59
Q

What is the morphology of acute pyleonephritis & the appearance of the tubules & glomeruli

A

Enlarged kidneys w/ cortical abscesses & yellow streak towards medulla
Tubules filled w/ neutrophils
Glomeruli spared

60
Q

What is the 4 complications of acute pyelonephritis

A
  1. Acute renal failure
  2. Perinephric abscess
  3. Pyoephrosis
  4. Papillary necrosis
61
Q

What is the morphology of chronic pyleonephritis & the appearance of the calyces, cortex, vascular tubules & glomeruli

A

Small pale granular & unequal in size kidneys
Calyces scars & blunting
Cortex thinning
Vascular prominent
Tubules atrophied, dilated & contai colloid
Glomeruli sclerosed
Vessels intimal fibrosis & endarteritis obliterans

62
Q

What is the microscopic involvement of chronic pyelonephritis

A

Patchy & interstitium is fibrosed

63
Q

What is the 2 complications of chronic pyelonephritis

A

Chronic renal failure
Hypertensions

64
Q

What is the 3 ways in which drugs act on the kidney

A

Haptens causing interstitial chronic inflammation or fibrosis
Inhibit vasodilation producing papillary necrosis
Toxin produce acute tubular necrosis

65
Q

What is the mechanisms of metabolic induced kidney inflammation

A
  1. Hypersecretion of uric acid, calcium, cystine & protein of myeloma
  2. Substances precipitate in interstitium
  3. Resulting in inflammatory granulomatous reaction w/ fibrosis & scarring
66
Q

What is a consequence of metabolic inflammation in the kidneys

A

Calculi/stone formation

67
Q

What is the 6 pre-disposing factors of calculi

A
  1. Foreign body
  2. Urinary stasis
  3. Infection
  4. Metabolic abnormalities (urate, calcium or cystine)
  5. Ammonia producing infection that increase pH
  6. Idiopathic deficiency in tubular production of a protein
68
Q

What is the 4 causes of obstruction

A
  1. Calculi
  2. Extrinsic or intrinsic tumour
  3. Pregnancy
  4. Prostatic hyperplasia
69
Q

What does obstructions result in

A
  1. Pyelonephritis
  2. Hydronephrosis
70
Q

What is the appearance of chronic pyelonephritis

A

Thyroidisation

71
Q

What is the appearance of acute pyelonephritis

A

Neutrophils w/i the tubule

72
Q

What is hydronephrosis

A

Renal pelvis & calyces systems are dilated & reduction of real parenchyma

73
Q

What is the appearance of the papillae, cortex, tubules & interstitium in hydronephrosis

A

Papillae flattened
Cortex thinned
Tubules dilated & atropic
Interstitium fibrosed

74
Q

What is the 2 causes of acute tubular necrosis

A
  1. Toxins
  2. Ischaemia (progressive that affects the vasa recta)
75
Q

What is the end result of acute tubular necrosis

A

Acute renal failure

76
Q

What is the macroscopic appearance of the kidneys in acute tubular necrosis

A

Large & pale

77
Q

What is the microscopic appearance in acute tubular necrosis regarding the interstitium, tubules & BM

A

Interstitium oedema
Tubules patchy necrosis of the lining cells in ischaemia & patchy distal necrosis in long segments in toxins & attempted regeneration after 2 days
BM intact

78
Q

What is a granular casts

A

Proteins that is found in distal tubules & collecting ducts in acute tubular necrosis

79
Q

What is the cause of papillary necrosis

A

Ischemia of vasa recta in presence of pre-existing papillary damage &
Shock
Acute pyelonephritis
Diabtes Mellitus
Prolonged analgesic abuse
Ureteric obstruction
Sickle cell anaemia

80
Q

What is the end result of papillary necrosis

A

Acute renal failure

81
Q

What is the macroscopic appearance of papillary necrosis

A

Sharply demarcated pale ischamic papillary necrosis due to vascular narrowing
Bilateral & 2/3 of papillae is coagulative necrosis

82
Q

What is the microscopic appearance of papillary necrosis

A

Borders of necrosis are hyper anemic & infiltrated by polymorphs

83
Q

What is hyaline arteriosclerosis & where does it occur in hypertensive nephrosclerosis

A

Narrowing of afferent arteriole by insulation of plasma proteins & lipids

84
Q

What is the end result of hypertensive nephrosclerosis

A

Chronic renal failure

85
Q

What is the macroscopic appearance of benign hypertensive nephrosclerosis

A

Small kidneys w/ finely granular cortical surfaces & narrowed vortices & prominent arcuate vessels

86
Q

What is the macroscopic appearance of malignant hypertensive nephrosclerosis

A

Pinpoint petechial haemorrhage on capsular surface (flea-bitten appearance)

87
Q

What is the microscopic appearance of benign hypertensive nephrosclerosis

A

Narrowed afferent arteriole w/ hyalinised walls
Ischaemic atrophy of tubules & glomerular sclerosis w/ interstitial fibrosis
Larger arteries shows republication of elastic lamina, intimal fibrosis & medial hypertrophy

88
Q

With what is malignant nephrosclerosis associated with

A

Accelerated hypertensions

89
Q

What 3 things does accelerated hypertension end in

A
  1. Cerebral haemorrhage
  2. Cardiac failure
  3. Renal failure
90
Q

What 2 things does accelerated hypertensions cause

A
  1. Endothelial damage
  2. Platelet thrombi
91
Q

What is the microscopic appearance of malignant hypertensive nephrosclerosis

A

Interlobular arteries intima proliferate w/ concentric collagen fibers onion skin
Arterioles have fibrinoid necrosis
Glomeruli have thrombosis in capillary loops & crescent formation

Case 10: Urinary System (8 decks)

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