HISTO: Renal pathology

Question 1

What is the pressure at the glomerulus?

Answer 1

60mmHg

Question 2

What is the volume of blood filtered by glomeruli per minute?

Answer 2

125ml/min

Question 3

What is the inheritance pattern of adult PCKD?

Answer 3

AD

Question 4

What is an iatrogenic cause of renal cysts?

Answer 4

Dialysis in ESRD

Question 5

Which type of malignancy occurs due to renal cysts?

Answer 5

papillary cell

Question 6

What is the UO criteria in stage 3 AKI?

Answer 6

<0.3ml/kg/hr for 24hrs or anuria for 12hrs

Question 7

What happens to the brush border of epithelial cells in ATN?

Answer 7

Apoptosis and sloughing leading to obstruction

Question 8

Compared to ATN, what is the mechanism in ATIN?

Answer 8

Acute tubulo-interstitial nephritis is usually caused by immune damage (but can also be drugs/infection). Interstitial inflammatory infiltrate of eosinophils and granulomas is seen.

Question 9

What are two characteristic features of acute glomerulonephrotis?

Answer 9

Urine casts

Crescents

Question 10

What are 3 types of crescenteric glomerulonephritis?

Answer 10

Immune complex-associated - SLE/IgA/post strep
Anti-GBM
Pauci-immune

Question 11

Which crescenteric GN is ANCA positive?

Answer 11

Pauci-immune

Question 12

What are Abs directed at in anti-GMB GN?

Answer 12

C terminal of collagen type IV

Question 13

What is an extra renal complication of anti-GBM GN?

Answer 13

Lung injury - abs cross-react with alveolar BM

Question 14

Which cells cause damage in Pauci-immune GN?

Answer 14

Neutrophils

Question 15

What is the pattern of Ig deposits in anti-GBM vs Pauci immune?

Answer 15

Linear vs scanty

Question 16

What can the causes of thrombotic microangiopathies affecting the kidney be divided into?

Answer 16

Diarrhoea assoc
Non-diarrhoea assoc

e.g. MAHA/HUS

Question 17

What proteinuria levels are seen in nephrOtic syndrome?

Answer 17

> 3.5g/day

Question 18

List the 6 main causes of nephrotic syndrome.

Answer 18

Systemic: DM, SLE, amyloidosis

Non-systemic:
MCD*
FSGS*
MGN - this one is immune complex mediated

*primary glomerular diseases

Question 19

Compare MCD and FSGS tx.

Answer 19

FSGS is less likely to respond to steroids than MCD.

Question 20

What is the most common cause of nephrOtic syndrome in adults?

Answer 20

MGN

Question 21

Where do immune complexes deposit in MGN?

Answer 21

Subepithelium (outside BM) - IgG and C3

Question 22

What is the Ab against in MGN?

Answer 22

PLA2R in primary disease
(phospholipase A2 M receptor)

Secondary disease may be due to malignancy/drugs/ infection/SLE

Question 23

What is the progression in disease in diabetic nephropathy?

Answer 23

Microalbuminaemia –> proteinuria –> nephrotic syndrome

Question 24

Which stage is Kimmelstiel-Wilson seen in diabetic glomerulosclerosis?

Answer 24

Stage III

Question 25

Which stage is thichening BM seen in diabetic glomerulosclerosis?

Answer 25

Stage I

Question 26

What are stages II and IV of diabetic glomerulosclerosis?

Answer 26

Stage I - thick BM Stage II - more mesangial matrix Stage III - nodular lesions Stage IV - advanced glomerulosclerosis

Question 27

What is AA amyloid derived from?

Answer 27

SAA - serum amyloid associated protein

Question 28

Name 2 causes of microscopic haematuria.

Answer 28

Thin BM - hereditary defect in type IV collagen | IgA nephropathy

Question 29

What is the thickness of BM in thin BM disease?

Answer 29

<250nm

Question 30

What syndrome is linked to thin BM?

Answer 30

Alport's - deafness, ocular disease, haematuria

Question 31

What is the defect in Alport's?

Answer 31

X linked dominant - mutation in alpha5 subunit

Question 32

What is the most common form of glomerulonephritis? What is it associated with?

Answer 32

IgA nephropathy - associated with HSP

Question 33

Where is IgA deposited in IgA nephropathy?

Answer 33

Mesangial deposition

Question 34

What classification is used for IgA nephropathy?

Answer 34

Oxford (MEST-C)

Question 35

List the top 5 causes of CKD requiring RRT from 1-5.

Answer 35

``` Diabetes Glomerulonephritis PCKD Pyelonephritis Hypertension ```

Question 36

What is the appearance of kidneys in hypertensive nephropathy?

Answer 36

Shrunken with granular cortices + nephrosclerosis, hyalinosis, intimal thickening and ischaemic changes

Question 37

Which classification is used for renal SLE?

Answer 37

ISN/RPS classification

Question 38

Which class of SLE nephropathy shows subendothelial vs subepithelial deposits?

Answer 38

``` Subendothelial = Class 3 Subepithelial = Class 5 ```

Question 39

Which class of SLE nephropathy shows diffuse >50% disease?

Answer 39

Class 4

Question 40

Which class of SLE nephropathy shows a mesangial vs membranous pattern ?

Answer 40

``` Mesangial - class 1 and 2 Membranous - class 5 ```

Question 41

List 4 renal SLE syndromes.

Answer 41

AKI NephrOtic syndrome CKD Isolated urinary abnormality