Hefs Lectures - Kidney

Question 1

what do you think if you see a solid tumor/mass in the kidney in someone 60-70 y/o?

Answer 1

RCC

-worry about cancer

Question 2

Angiomyolipoma

Answer 2

• high risk in PREGNANCY due to hemorrhage
• seen in tuberous sclerosis
• mutations in TSC1/TSC2
• nucleus FLAT and pushed to SIDE

Question 3

Renal Papillary adenoma

Answer 3

• benign tumor of tubular epithelium

- benign unless >3cm -> malignant

Question 4

oncocytoma

Answer 4

• benign tumor of collecting ducts

- Mahogany- brown color w/ central scars

Question 5

renal cell carcinoma

Answer 5

• adults 60-70 y/o
• tobacco #1 cause
• Von-Hippel-Lindau -> loss of VHL
• Hereditary papillary carcinoma -> MET mutation
• SOLID mass
• Paraneoplastic syndrome
• metastatize to renal vein -> PE

Question 6

clear cell RCC

Answer 6

• most common
• tumor of PCT
• vacuole w/ nucleus in CENTER

Question 7

Papillary carcinoma RCC

Answer 7

• tumor of DCT
• FOAM cells
• Psammoma bodies

Question 8

Chromophobe type RCC

Answer 8

• pale clear cells

- PERINUCLEAR HALO

Question 9

Urothelial Carcinomas

Answer 9

• malignant tumor of renal pelvis
• cause -> SMOKING
• Lynch syndrome and analgesic nephropathy

Question 10

Wilm’s tumor

Answer 10

• blastema (epithelial + mesenchyme)
• children 1-6 y/o
• WAGR, Denys-Drash, BWS
• FISHFLESH-like grey-white to cream yellow
• myxomatous or cartilage filled

Question 11

pathologic response to glomerular injury - hypercellularity

Answer 11

CRESCENT formation -> thick BM reducing filtration

Question 12

pathologic response to glomerular injury - Sclerosis

Answer 12

COLLAGEN matrix -> obliterate BV lumen

Question 13

podocyte injury

Answer 13

• PERMANENT damage

- lead to proteinuria

Question 14

Nephritic syndrome

Answer 14

• BLOOD in urine (hematuria)

- proteinuria (<3g/day)

Question 15

Nephrotic syndrome

Answer 15

• PROTEIN in urine (proteinuria) - >3g/day

- see hyperlipidemia & lipids in urine

Question 16

what do immune complexes look like on IF?

Answer 16

-PATCHY, GRANULAR deposition -> “starry sky”

• can be circulating or local deposits
• local seen in GAS

Question 17

immune complexes in mesangium?

Answer 17

IgA nephropathy (mild)

Question 18

sub endothelial immune complexes?

Answer 18

-membranoproliferative glomerulonephritis

Question 19

subepithelial immune complexes?

Answer 19

-membranous nephropathy (acute glomerulonephritis)

Question 20

anti-GBM disease

Answer 20

• type 4 collagen in GBM becomes antigenic -> Abs bind to antigens -> LINEAR on IF
• normally due to IgG or C3
• ex. Goodpasture’s syndrome

Question 21

ANCA

Answer 21

• Abs against NEUTROPHILS -> fast progression of GN

- seen in Wegener’s granulomatosis and Churg-Strauss

Question 22

EACA

Answer 22

-Abs against the ENDOTHELIUM -> vasculitis and GN

Question 23

IgA Nephropathy (berger)

Answer 23

• IgA against the MESANGIUM
• most common type of glomerulonephritis
• treat w/ STEROIDS

-crescent formation due to mesangial proliferation

Question 24

Alport syndrome

Answer 24

• X-linked
• defect in type 4 collagen
• thinning and splitting of GBM -> hematuria

Question 25

Thin Basement membrane disease

Answer 25

• cause benign familial hematuria**
• THIN GBM -> mild and good prognosis
• alpha 3,4 gene mutations of type 4 collagen
• CANNOT treat w/ steroids