Hefs Lectures - Kidney Flashcards
what do you think if you see a solid tumor/mass in the kidney in someone 60-70 y/o?
RCC
-worry about cancer
Angiomyolipoma
- high risk in PREGNANCY due to hemorrhage
- seen in tuberous sclerosis
- mutations in TSC1/TSC2
- nucleus FLAT and pushed to SIDE
Renal Papillary adenoma
- benign tumor of tubular epithelium
- benign unless >3cm -> malignant
oncocytoma
- benign tumor of collecting ducts
- Mahogany- brown color w/ central scars
renal cell carcinoma
- 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
clear cell RCC
- most common
- tumor of PCT
- vacuole w/ nucleus in CENTER
Papillary carcinoma RCC
- tumor of DCT
- FOAM cells
- Psammoma bodies
Chromophobe type RCC
- pale clear cells
- PERINUCLEAR HALO
Urothelial Carcinomas
- malignant tumor of renal pelvis
- cause -> SMOKING
- Lynch syndrome and analgesic nephropathy
Wilm’s tumor
- blastema (epithelial + mesenchyme)
- children 1-6 y/o
- WAGR, Denys-Drash, BWS
- FISHFLESH-like grey-white to cream yellow
- myxomatous or cartilage filled
pathologic response to glomerular injury - hypercellularity
CRESCENT formation -> thick BM reducing filtration
pathologic response to glomerular injury - Sclerosis
COLLAGEN matrix -> obliterate BV lumen
podocyte injury
- PERMANENT damage
- lead to proteinuria
Nephritic syndrome
- BLOOD in urine (hematuria)
- proteinuria (<3g/day)
Nephrotic syndrome
- PROTEIN in urine (proteinuria) - >3g/day
- see hyperlipidemia & lipids in urine
what do immune complexes look like on IF?
-PATCHY, GRANULAR deposition -> “starry sky”
- can be circulating or local deposits
- local seen in GAS
immune complexes in mesangium?
IgA nephropathy (mild)
sub endothelial immune complexes?
-membranoproliferative glomerulonephritis
subepithelial immune complexes?
-membranous nephropathy (acute glomerulonephritis)
anti-GBM disease
- type 4 collagen in GBM becomes antigenic -> Abs bind to antigens -> LINEAR on IF
- normally due to IgG or C3
- ex. Goodpasture’s syndrome
ANCA
- Abs against NEUTROPHILS -> fast progression of GN
- seen in Wegener’s granulomatosis and Churg-Strauss
EACA
-Abs against the ENDOTHELIUM -> vasculitis and GN
IgA Nephropathy (berger)
- IgA against the MESANGIUM
- most common type of glomerulonephritis
- treat w/ STEROIDS
-crescent formation due to mesangial proliferation
Alport syndrome
- X-linked
- defect in type 4 collagen
- thinning and splitting of GBM -> hematuria
Thin Basement membrane disease
- cause benign familial hematuria**
- THIN GBM -> mild and good prognosis
- alpha 3,4 gene mutations of type 4 collagen
- CANNOT treat w/ steroids
