Fogo, Ch. 1 - Anatomy & Basic concepts

Question 1

What is the normal adult kidney weight?

Answer 1

150g

Question 2

Describe the renal arterial supply/tree

Answer 2

Renal artery

Anterior/posterior divisions

Inerlobar

Arcuate

Interlobular

Afferent arterioles

Question 3

What supplies the vasa recta?

Answer 3

Efferent arterioles from juxtamedullary glomeruli

Question 4

What is the glomerular hilus? The orifice?

Answer 4

Hilus = Vascular pole

Orifice = Exit of urinary space to proximal tubule

Question 5

What proteins comprise the podocyte slit diaphragm?

Answer 5

NEPH1, NEPH3, podocin

Question 6

What are the layers of the glomerular basement membrane? What is it composed of?

Answer 6

Lamina rara externa, lamina densa, lamina rara interna

Composed of Type IV collagen, laminin 11, entactin.

Question 7

How thick is the glomerular basement membrane?

Endothelial fenestrae?

Answer 7

340-360nm

80nm

Question 8

From what is the mesangium derived?

Answer 8

95% of cells are modified smooth muscle

5% of cells are derived from bone marrow

Question 9

Distinguish between the morphology of the proximal and distal tubules.

Answer 9

Proximal tubules have more apical nuclei and a more prominent brush border than distal tubules (which have basal nuclei).

Question 10

What is the role of the juxtaglomerular apparatus? The macula densa?

Answer 10

JGA: Secretes renin from granular cells to regulate the RAAS axis.

MD: Regulates afferent arteriolar flow

Question 11

What is the lacis?

Answer 11

A collection of mesenchymal cells that surround the macula densa and juxtaglomerular apparatus.

Question 12

In immunofluorescence, when is C4d useful?

Answer 12

In evaluating transplant failure.

Question 13

What LM stain can distinguish granular immune deposits?

Answer 13

Trichrome (bright red-orange)

Question 14

From where is THP secreted? What is its relevance?

Answer 14

From the thick ascending limb and early distal convoluted tubule. An antimicrobial peptide that is the main component of renal casts and can be abnormally located in disease.

Question 15

Recite three locations of abnormal THP accumulation.

Answer 15

Glomerular/proximal: Due to retrograde flow

Interstitial: From wall disruptions due to eg inflammation, ATN, hydrostatic pressure…

Perihilar

Question 16

Recall six patterns of glomerular pathology.

Answer 16

Hypercellularity

Increase in extracellular matrix

Sclerosis

Crescent formation

Peripheral migration

Alterations in podocytes

Question 17

Distinguish between acute and atrophic tubular changes.

Answer 17

Acute: Loss of brush border, sloughing

Atrophic: Decrease in tubule caliber, irregular BM thickening, casts, thyroidization

Question 18

Recall some patterns of injury to the interstitium. How does it appear?

Answer 18

Edema, inflammation, and fibrosis. In all cases, the tubules appear to be more spaced out.

Question 19

Describe a general mechanism of immunologic glomerular disease.

Answer 19

Antibody- or cell-mediated process often with immune complexes lodging in mesangium, subendothelial/subepithelial, attracting leukocytes and causing mesangial proliferation.

Question 20

Recall some mechanisms of interstitial and vascular injury.

Answer 20

Interstitial: Cytokines (PDGF/TGFb) induce fibrosis

Vascular: Thrombosis, wall inflammation, arteriosclerosis