Fung: Renal Pathology II Flashcards
What can you observe on macroscopic examination in a urine analysis?
color
turbidity
What can you observe on microscopic examination in a urine analysis?
casts
organisms
cells: RBCs, WBCs, epithelial
crystals: oxalate, triphosphate, cystine
What other things does a urine analysis show?
specific gravity protein glucose ketones hemoglobin bile urobilinogen
Reversible clinicopathologic entity characterized by
Acute diminution of renal function
Morphologic evidence of tubular injury
Most common cause of acute renal failure
acute kidney injury
What are some causes of acute kidney injury?
ischemia: shock, hypertension, HUS, DIC, vasculitis
direct toxic injury: drugs, contrast dye, myoglobin, hemoglobin, radiation
acute tubulointerstitial nephritis: hypersensitivity rxn
obstruction
Which portion of the tubules are most susceptible to acute tubular necrosis caused by ischemia? What about acute tubular necrosis caused by toxins?
proximal convoluted tubule & to a lesser extent, the ascending limb of the loop of Henle;
proximal convoluted tubule
Group of renal diseases characterized by histologic and functional alterations predominantly involving the tubules and interstitum
Tubulointerstitial nephritis
What will you see in the early phases of tubulointerstitial nephritis that sets it apart from glomerular disease?
inability to concentrate urine
metabolic acidosis
defects in tubular secretion/absorption
**in the late stages, it is difficult to distinguish
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
Pyelonephritis
Which organisms are most likely to cause pyelonephritis?
E. coli
Proteus
Klebsiella
Enterobacter
What are some symptoms of acute pyelonephritis?
pain at the costovertebral angle fever malaise dysuria frequency/urgency WBC casts
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
chronic pyelonephritis
What causes chronic pyelonephritis in kids? In adults?
vesicoureteral reflux;
in adults, obstruction like BPH or cervical carcinoma
What will you see grossly on the kidneys in chronic pyelonephritis?
scarring of the cortex at the upper and lower lobes (if vesicoureteral reflux)
also blunted calyces
What are two ways that drugs and toxins can cause renal injury?
acute hypersensitivity nephritis
direct toxicity
think analgesics and NSAIDs which can cause nephropathy
What kind of nephropathy would you get with multiple myeloma?
light chain nephropathy
Bence Jones proteins in the urine
Amyloidosis
Light chain deposition disease
What does hypertension do to the kidneys?
renal artery stenosis
also manifests as benign or malignant nephro-arteriolosclerosis
Group of disorders characterized by
Microangiopathic hemolytic anemia
Thrombocytopenia
Renal failure
Thrombotic microangiopathies
What are two forms of thrombotic microangiopathy?
- HUS (Hemolytic uremic syndrome)
2. Thrombotic thrombocytopenic purpura (TTP)
What are some kinds of cysts you might see on the kidney?
simple cysts (normal)
acquired cysts (from dialysis)
polycystic kidney disease cysts
medullary cystic disease cysts
Autosomal dominant disease caused by problems with PKD1 or PKD2
adult polycystic kidney disease
What are 3 extra renal anomalies associated with PCKD?
- polycystic liver disease
- berry aneurysms intracranially
- mitral valve prolapse
Autosomal recessive form Peri/neonatal, infantile, and juvenile disease associated with problems with PKHD1
childhood polycystic kidney disease
What is childhood polycystic kidney disease associated with?
congenital hepatic fibrosis (leading to portal hypertension)
hepatic cysts
