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Block 9 Week 5 Meg > Fung: Renal Pathology II > Flashcards

Fung: Renal Pathology II Flashcards

1
Q

What can you observe on macroscopic examination in a urine analysis?

A

color

turbidity

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2
Q

What can you observe on microscopic examination in a urine analysis?

A

casts
organisms
cells: RBCs, WBCs, epithelial
crystals: oxalate, triphosphate, cystine

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3
Q

What other things does a urine analysis show?

A 
specific gravity
protein
glucose
ketones
hemoglobin
bile
urobilinogen
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4
Q

Reversible clinicopathologic entity characterized by
Acute diminution of renal function
Morphologic evidence of tubular injury
Most common cause of acute renal failure

A

acute kidney injury

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5
Q

What are some causes of acute kidney injury?

A

ischemia: shock, hypertension, HUS, DIC, vasculitis

direct toxic injury: drugs, contrast dye, myoglobin, hemoglobin, radiation

acute tubulointerstitial nephritis: hypersensitivity rxn

obstruction

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6
Q

Which portion of the tubules are most susceptible to acute tubular necrosis caused by ischemia? What about acute tubular necrosis caused by toxins?

A

proximal convoluted tubule & to a lesser extent, the ascending limb of the loop of Henle;

proximal convoluted tubule

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7
Q

Group of renal diseases characterized by histologic and functional alterations predominantly involving the tubules and interstitum

A

Tubulointerstitial nephritis

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8
Q

What will you see in the early phases of tubulointerstitial nephritis that sets it apart from glomerular disease?

A

inability to concentrate urine
metabolic acidosis
defects in tubular secretion/absorption

**in the late stages, it is difficult to distinguish

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9
Q

Common disorder affecting the tubules, interstitium and renal pelvis
Acute or chronic complication of cystitis
Infecting organisms most commonly derived from patient’s fecal flora

A

Pyelonephritis

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10
Q

Which organisms are most likely to cause pyelonephritis?

A

E. coli
Proteus
Klebsiella
Enterobacter

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11
Q

What are some symptoms of acute pyelonephritis?

A 
pain at the costovertebral angle
fever
malaise
dysuria
frequency/urgency
WBC casts
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12
Q

Interstitial fibrosis and atrophy of the tubules due to multiple bouts of acute pyelonephritis
Due to vesicoureteral reflux in children or an obstruction in adults

A

chronic pyelonephritis

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13
Q

What causes chronic pyelonephritis in kids? In adults?

A

vesicoureteral reflux;

in adults, obstruction like BPH or cervical carcinoma

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14
Q

What will you see grossly on the kidneys in chronic pyelonephritis?

A

scarring of the cortex at the upper and lower lobes (if vesicoureteral reflux)
also blunted calyces

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15
Q

What are two ways that drugs and toxins can cause renal injury?

A

acute hypersensitivity nephritis
direct toxicity

think analgesics and NSAIDs which can cause nephropathy

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16
Q

What kind of nephropathy would you get with multiple myeloma?

A

light chain nephropathy
Bence Jones proteins in the urine
Amyloidosis
Light chain deposition disease

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17
Q

What does hypertension do to the kidneys?

A

renal artery stenosis

also manifests as benign or malignant nephro-arteriolosclerosis

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18
Q

Group of disorders characterized by
Microangiopathic hemolytic anemia
Thrombocytopenia
Renal failure

A

Thrombotic microangiopathies

19
Q

What are two forms of thrombotic microangiopathy?

A
  1. HUS (Hemolytic uremic syndrome)

2. Thrombotic thrombocytopenic purpura (TTP)

20
Q

What are some kinds of cysts you might see on the kidney?

A

simple cysts (normal)
acquired cysts (from dialysis)
polycystic kidney disease cysts
medullary cystic disease cysts

21
Q

Autosomal dominant disease caused by problems with PKD1 or PKD2

A

adult polycystic kidney disease

22
Q

What are 3 extra renal anomalies associated with PCKD?

A
  1. polycystic liver disease
  2. berry aneurysms intracranially
  3. mitral valve prolapse
23
Q

Autosomal recessive form Peri/neonatal, infantile, and juvenile disease associated with problems with PKHD1

A

childhood polycystic kidney disease

24
Q

What is childhood polycystic kidney disease associated with?

A

congenital hepatic fibrosis (leading to portal hypertension)

hepatic cysts

25
Q

Inherited defect leading to cysts in the medullary collecting ducts; fibrosis of the parenchyma leads to shrunken kidneys and worsening renal failure

A

medullary cystic kidney disease

**adult-onset (autosomal dominant)

26
Q

What are the four types of kidney stones?

A
  1. Calcium oxolate (70%)
  2. Struvite - magnesium ammonium phosphate (AMP - 15%)
  3. Uric acid (5-10%)
  4. Cystine (1-2%)
27
Q

Stones caused by hypercalciuria

A

Calcium oxolate

28
Q

Stones caused post UTI by Proteus

A

Strivute or ammonium magnesium phosphate

**Proteus takes urea and converts it to ammonium –> alkalinizes urine

29
Q

Stones caused by gout or idiopathic or leukemia

A

uric acid

**in leukemia, you get hyperuricemia b/c of increased nuclear turnover

30
Q

Stones caused by genetic defects in renal absorption of cysteine; presents in children

A

Cystine stones

31
Q

Staghorn caliculi seen in these two types of nephrolithiasis

A

ammonium magnesium phosphate

cystine (in kids)

32
Q

3 benign neoplasms of the kidney

A

papillary adenoma
angiomyolipoma
oncytoma

33
Q

3 malignant neoplasms of the kidney

A

renal cell carcinoma
urothelial cell carcinoma
Wilms tumor

34
Q

Benign tumor composed of blood vessels, smooth muscle and mature adipose tissue
Associated with tuberous sclerosis

A

Angiomyolipoma

35
Q

Renal cell carcinoma can be sporadic or hereditary. Who gets sporadic renal cell carcinomas? Where do they present? What is a major risk factor for these carcinomas?

A

adults males (60yo)
present as a single tumor in the upper pole of the kidney
major risk factor is smoking

36
Q

What are 3 hereditary forms of renal cell carcinoma?

A

Von Hippel-Lindau - autosomal dominant, associated with inactivation of VHL gene, which is a tumor suppressor gene
Hereditary clear cell carcinoma - most common type
Hereditary papillary carcinoma

37
Q

What do renal cell tumors look like on gross exam?

A

a yellow mass

38
Q

What are the symptoms of a renal cell carcinoma?

A

hematuria **most common
palpable mass
flank pain

may have fever, weight loss, and paraneoplastic syndromes (too much EPO, renin, or PTH)

39
Q

Malignant tumor arising from the urothelial lining of the renal pelvis, ureter, bladder, or urethra
Usually arises in the bladder

A

urothelial carcinoma

40
Q

What is the major risk factor for urothelial carcinoma?

A

smoking!

also azo dyes, long-term cyclophosphamide or phenacetin use

41
Q

How do urothelial carcinomas present?

A

usu painless hematuria

42
Q

What are the two ways in which urothelial tumors can arise?

A

flat - they develop as a high-grade flat tumor and then invade
papillary - they develop as low-grade papillary tumors then progress to high-grade then invade

43
Q

Malignant kidney tumor comprised of blastema, primitive glomeruli and tubules, and stromal cells
Most common malignant renal tumor in children

A

Wilms tumor

44
Q

How will Wilms tumor present?

A

large, unilateral flank mass with hematuria and hypertension (due to renin secretion)

Block 9 Week 5 Meg (5 decks)

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