Fang 1

Question 1

IgA nephropathy (berger disease)

Answer 1

• Most common type of primary glomerulonephritis worldwise
• Affects children and young adults (non-african americans)
• recurrent hematura
  
  • mild hematuria
  • mild proteinuria
• LM: MESANGIAL PROLIFERATION (>3 cells per mesangial region)
• IF: MESANGIAL IgA (scattered granular)
• EM: Mesengial deposits

Question 2

Alport syndrome

Answer 2

• DEFECT in BASEMENT MEMBRANE
  
  • mutation in alpha5 chain gene of collagen Type IV
• X-linked dominant (affects males, females carrier
• Microscopic hematuria
• Proteinuria is a sign of progression
• SENSORINEURAL DEAFNESS (some of the time)
• GBM THICKENING, splitting and LAMINATION
  
  • Basket weave pattern

Question 3

Thin GBM disease

Answer 3

• asymptomatic hematuria
  
  • benign familial (hereditary) hematuria
• LM = normal
• IF = negative
• EM = THIN GBM

Question 4

what are 3 causes of secondary glomerulonephropathies

Answer 4

SLE

Diabetes

amyloidosis

Question 5

SLE (lupus nephritis)

Answer 5

• ONLY GLOMERULAR DISEASE WITH ALL IMMUNOGLOBULIN DEPOSITION
  
  • IgG, IgA, IgM, C3, C4

Question 6

Diabetic nephropathy

Answer 6

NOdular glomerulosclerosis

• Presents as proteinuria, nephrotic syndrome or chronic renal failures

Question 7

Amyloidosis

Answer 7

• Amyloid gets “TRAPPED” in
  
  • glomeruli, blood vessels, tubules
• GROSS = BIG, PALE, WAXY kidney
• Basement membrane becomes too LEAKY to proteins and patients get NEPHROTIC SYNDROME
• APPLE-GREEN BIREFRINGENCE
  
  • When stained with CONGO RED and seen under POLARIZED LIGHT

Question 8

Acute tubular necrosis (ANT)

Answer 8

• Destruction of renal TUBULAR epithelium
  
  • loss of renal function
• TWO TYPES:
  
  • ISCHEMIC –> not enough filtration
  • NEPHROTOXIC –> makes kidney toxic
    
    • drugs (aminoglycosides)
    • heavy metals (mercury)
    • organic solvents (carbon tetrachloride)
    • radiocontrast dyes
    • Myoglobin (rhabdomyloysis in heat stroke)

Question 9

pathologic changes in Acute Tubular necrosis

Answer 9

• Necrotic debris in tubules (pink stuff)
• Dilated tubules with FLATTENED EPITHELIUM (due to pressure)

Question 10

Acute interstitial nephritis

Answer 10

drug induced hypersentivity reaction

• Drugs: Ibuprofen, thiazide, rifampin, penicillins
• 2 WEEKS LATER: FEVER EOSINOPHILIA, RASH, and an ACUTE RENAL FAILURE
  
  • oligouria + increased Creatinine
    *

Question 11

Pyelonephritis

Answer 11

E. COLI

• ASCENDING, by FAR the most common, I.e. REFLUX, OBSTRUCTION
  
  • Come from urethra –> bladder –> ureters –> kidney
• DESCENDING = can come from blood (staph.)
• ACUTE PYELONEPHRITIS = NEUTROPHILS
• CHORNIC PYELONEPHRITIS: lymphocytes and scars

Question 12

ACUTE PYELONEPHRITIS

Answer 12

• Caused by infections of pelvicalyceal system and renal parenchyma
• PRESENT with COSTO-VERTEBRAL ANGLE PAIN
  
  • MUST HAVE FEVER (other signs of infection)
  • pain while peeing
• DIAGNOSIS = PUS (WBC) casts, urine culture
• KEY LESION
  
  • NEUTROPHILIC INFILTRATES and NEUTROPHIL CASTS in tubules

Question 13

Chronic peylonephritis

Answer 13

• Gradual loss of renal function
• RESULT IS SCARRED KIDNEY WITH CHRONIC INFLAMMATION
• ETIOOGY:
  
  • Obstruction, Pregnancy, immunosuppression
• GROSS: PITTING GEOGRAPHIC SCARS
• Micro: THYRODIZATION = ATROPHIC tubules looks like Colloid in the thyroid (lots of big pink spots)
  *