Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

YEAR 5: HISTOPATH > Histo: Renal Disease > Flashcards

Histo: Renal Disease Flashcards

1
Q

List the major functions of the kidneys.

A
  • Excretion of metabolic waste products and foreign chemicals
  • Regulation of fluid, electrolytes and acid/base balance
  • Regulation of blood pressure (renin)
  • Regulation of calcium and bone metabolism (1,25-dihydroxy vitamin D)
  • Regulation of haematocrit (EPO)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

List some key anatomical features of the kidneys.

A
  • Retroperitoneal
  • T12-L3
  • Right kidney lies lower
  • Mean length = 11cm
  • Normal weight = 115-170g
  • 1 million nephrons per kidneys - can lose of lot of nephrons without decrease in funciton
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What proportion of cardiac output goes to the kidneys?

A

20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

By what mechanism is blood filtered through the glomerulus?

A
  • High hydrostatic pressure (60 mmHg)
  • Podocytes create a charge-dependent (anionic) and size-dependent barrier
  • Filtration rate = 125 ml/min
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe the role of the following parts of the nephron:

  1. Proximal convoluted tubule
  2. Loop of Henle
  3. Distal convoluted tubule
  4. Collecting duct
A
  1. Proximal convoluted tubule
    • Actively absorbs sodium
    • Carries out hydrogen exchange to allow carbonate resoprtion
    • Co-transport of amino acids, phosphate and glucose
    • Reabsorption of potassium
  2. Loop of Henle
    • Descending limb and thin ascending limb: permeable to water, impermeable to ions and urea
    • Ascending limb: actively resorbs sodium and chloride
    • This creates a counter-current multiplier that is aligned with the vasa recta
  3. Distal convoluted tubule
    • Impermeable to water
    • Regulates pH by active transport of protons and bicarbonate
    • Regulates sodium and potassium by active transport (aldosterone)
    • Regulates calcium (PTH, 1,25-dihydroxy vit D)
  4. Collecting duct
    • Reabsorb water (principal cells, ADH)
    • Regulates pH (intercalated cells, proton excretion)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe how immune complex deposition can lead to renal disease.

A

Complex deposition in the glomerulus results in complement and inflammatory cell activation resulting in damage to the kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

List some signs and symptoms of renal disease.

A
  • Haematuria
  • Proteinuria
  • Uraemia
  • Hypertension
  • Oliguria/anuria
  • Polyuria
  • Oedema
  • Colic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

List some genitourinary malformations of the kidney.

A
  • Agenesis
  • Renal fusion - e.g. horseshoe
  • Ectopic kidney
  • Renal dysplasia
  • PUJ obstruction
  • Posterior urethral valve
  • Vesicoureteric reflux
  • Ureteral duplication

congenital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Outline the presentation of polycystic kidney disease.

A
  • Hypertension
  • Haematuria
  • Flank pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the inheritance pattern of polycystic kidney disease and which genes are implicated?

A

Autosomal dominant (most of the time)

Genes: PKD1 and PKD2

NOTE: PKD is associated with an increased risk of berry aneurysms (and subarachnoid haemorrhage)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

In which group of renal patients do renal cysts often develop?

A

Patients with end-stage renal disease who are on dialysis

Cysts are often:
multiple
bilateral
cortical and medullary

NOTE: cystic disease is associated with increased risk of malignancy (papillary renal cell carcinoma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

List the renal syndromes

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

List some causes of acute renal failure.

A
  • Pre-renal = failure of perfusion (shock, heart failure)
  • Renal = ATN, acute glomerulonephritis, thrombotic microangiopathy
  • Post-renal = obstruction (enlarged prostate, stones)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the most common cause of acute renal failure?

A

Acute tubular injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

List some causes of acute tubular injury.

A

Tubular epithelial cells damaged by:

Ischaemia

Toxins (contrast, haemoglobin, myoglobin, ethylene glycol)

Drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which commonly used class of drugs predisposes to acute tubular injury?

A

NSAIDs - inhibits vasodilatory prostaglandins which predisposes to ATN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How does acute tubular injury lead to reduced GFR?

A
  • Blockage of tubules by casts (dead cells)
  • Leakage from tubules into interstitial space
  • Secondary haemodynamic changes (due to the blockage/leakage)

dramatic decrease, but potentially reversible + no scarring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is acute tubulo-interstitial nephritis?

A

Immune injury to tubules and interstitium

Can be caused by infection (TB) and **drugs **(NSAIDs, antibiotics, diuretics, allopurinol, PPIs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what drugs cause actue tubulo-interstitial nephritis

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Describe the histological appearance of acute tubulo-interstital nephritis.

A

Heavy interstitial infiltration with eosinophil and granulomas

Consider TB and sarcoid, but most common is drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What causes crescents to appear in acute glomerulonephritis?

A

Occurs in severe glomerulonephritis due to proliferation of cells within Bowman’s capsule

22
Q

List some causes of acute crescentic glomerulonephritis.

A
  • Immune complex deposition e..g IgA nephropathy)
  • Anti-GBM disease (Goodpasture’s) - renal emergency
  • Pauci-immune (ANCA)

NOTE: these can rapidly lead to irreversible renal failure –> urgent needs diagnosis + treatment

23
Q

List some causes of immune complex-associated crescentic glomerulonephritis.

A
  • SLE
  • IgA nephropathy
  • Post-infectious glomerulonephritis
24
Q

What techniques can be used to visualise immune complexes in these diseases?

A

Immunohistochemistry

Electron microscopy

25
What are the antibodies directed against in anti-GBM disease?
Against the C-terminal domain of type IV collagen NOTE: these antibodies can cross-react with the alveolar basement membrane leading to pulmonary haemorrhage and haemoptysis
26
Describe the immunohistochemistry picture produced in anti-GBM disease,
Linear deposition of IgG on the glomerular basement membrane | Also can detect antibody on serology
27
What are the main features of pauci-immune crescentic glomerulonephritis?
* Scanty glomerular immunoglobulin depositis * Usually associated with ANCA * Triggers neutrophil activation and glomerular necrosis * Vasculitis elsewhere
28
What is thrombotic microangiopathy?
* Damage to the endothelium in glomeruli, arterioles and arteries resulting in thrombosis * Red cells can be damaged by fibrin causing MAHA or HUS
29
List some causes of thrombotic microangiopathy.
* Diarrhoea-associated: *E. coli* - toxins can target the renal epithelium * Non-diarrhoea associated: defects in complement regulation, deficiency of ADAMTS13, drugs (calcineurin inhibitors - post transplant), radiation, hypertension, scleroderma, antiphospholipid syndrome
30
What are the characteristic features of nephrotic syndrome?
* Proteinuria (\>3,5 g/day or \>300mg/mmol PCR) * Hypoalbuminaemia * Oedema * Hyperlipidaemia
31
List some causes of nephrotic syndrome.
* **Primary glomerular disease (non-immune complex mediated)** * Minimal change disease * Focal segmental glomerulosclerosis * **Primary renal disease (immune complex mediated)** * Membranous glomerulonephritis * **Systemic disease** * SLE * Amyloidosis * Diabetes mellitus
32
What is minimal change disease?
* most common cause of nephrotic syndrome in children * Glomeruli look normal on light microscopy, but electron microscopy shows loss of foot processes * Generally responds well to steroids and immunosuppression
33
Describe the histological appearance of focal segmental glomerulosclerosis.
Some glomeruli are partially scarred, some are intact NOTE: this responds less well to immunosuppression | this is a diagnosis, not descriptive term
34
What is membranous glomerulonephritis?
* Common cause of nephrotic syndrome in adults * Characterised by immune deposits outside the glomerular basement membrane (subepithelial) * Primary disease is autoimmune * It can occur secondary to epithelial malignancy, SLE, drugs and infections | remember to exclude malignancy as a cause
35
Which antibodies are often found in primary membranous glomerulonephritis?
Antibodies against phospholipase A2 type M receptor (PLA2R)
36
Describe the typical progression of diabetic nephropathy.
Typically begins with microalbuminuria Progresses to proteinuria and, eventually, nephrotic syndrome
37
List and describe the stages of diabetic nephropathy.
* Stage 1: thickening of the basement membrane on electron microscopy * Stage 2: increase in mesangial matrix, without nodules * Stage 3: nodular lesions/Kimmelstein-Wilson nodules * Stage 4: advanced glomerulosclerosis
38
What is amyloidosis?
Deposition of extracellular proteinaceous material exhibiting beta-pleated sheet structure
39
What are the two types of amyloidosis?
* AA - derived from serum amyloid protein and associated with chronic inflammatory disease * AL - derived from immunoglobulin light chains usually as a result of multiple myeloma
40
Name two causes of isolated microscopy haematuria.
* Thin basement membrane * IgA nephropathy
41
what is the staining for amyloidosis
congo red normal light - salmon pink polarised light - apple green
42
How can the cause of asymptomatic proteinuria be confirmed?
Renal biopsy (could be caused by several abnormalities)
43
What is thin basement membrane disease and what causes it?
* Basement membrane \<250 nm thickness * Caused by a hereditary defect in type IV collagen synthesis * Microscopic haematuria is the only consequence in most cases Can be caused by Alport syndrome
44
What is Alport syndrome?
* X-linked disease caused by a mutation in the alpha-5 subunit of type IV collagen (some forms affect alpha-3 and alpha-4) * Leads to progressive damage resulting in renal failure in middle-age * Often accompanied by deafness and ocular disease
45
What is IgA nephropathy?
* Most common cause of glomerulonephritis * Caused by mesangial IgA immune complex deposition * 30% will progress to end-stage renal failure NOTE: Henoch-Schonlein purpura is a type of IgA nephropathy
46
List some causes of chronic kidney disease and state which is most common.
* Diabetes mellitus * Glomerulonephritis * Polycystic kidney disease * Pyelonephritis * Hypertension * Renal vascular disease * Unknown Unknown is most common Of the known causes most common is diabetes
46
How is IgA nephropathy scored
Oxford classication MEST-C best prognosis if 0 in all categories
47
What are some diseases associated with chronic kidney disease?
* Ischaemic heart disease * Calcium and phosphate derangement (due to resulting hyperparathyroidism, osteomalacia and osteoporosis)
48
What are consequences of hypertensive nephropathy?
* Shrunken kidneys with granular cortices * Nephrosclerosis on histology (arterial hyalinosis, arterial intimal thickening, ischaemic glomerular changes, segmental and global glomerulosclerosis)
49
What system is used to classify lupus nephritis?
ISI/RPS classification
50
How does SLE affect kidneys
deposition of immune complexes in kidneys (along with in skin, joints, heart, CNS) anti-dsDNA, anti-nuclear antibodies has a very variable effect on kidneys patient can present with - actue renal failure, nephrotic syndrome, isolated urinary abnormality, CKD

YEAR 5: HISTOPATH (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions