Histopathology 10: Renal Disease

Question 1

List the triad of symptoms that define Nephrotic syndrome?

Answer 1

• Proteinuria (>3g/24h)
• Hypoalbuminaemia
• Oedema

Question 2

What is the most common cause of nephrotic syndrome in children ?

Answer 2

Minimal change disease

Question 3

Electron microscopy shows loss of podocyte foot processes With no signs of immune deposits on immunofluorescence. This suggests ………. a cause of Nephrotic syndrome.

Answer 3

Minimal change disease

Question 4

Microscopy shows ‘Spikey” subepithelial deposits and diffuse glomerular membrane thickening. This is most likely ………… a cause of Nephrotic syndrome with a poor prognosis.

Answer 4

Membranous glomerular disease

Question 5

Light microscopy shows focal and segmental glomerular consolidation and scarring. The Afro-Caribbean lady is most likely suffering with ……… a cause of Nephrotic syndrome.

Answer 5

Focal segmental glomerulosclerosis (FSGS)

Question 6

What causes Apple green birefringence with Congo red stain ?

Answer 6

Amyloidosis

Question 7

Does multiple myeloma cause AL or AA amyloidosis ?

Answer 7

AL

Question 8

List 2 causes of AA amyloidosis?

Answer 8

Arthritis
TB

(Cause by chronic inflammation)

Question 9

A mnemonic for the characteristic features of Nephritic syndrome is PHAROH. List the characteristic features?

Answer 9

Proteinuria (less than Nephrotic syndrome)
Haematuria 
Azootemia (high urea and creatinine) 
Red cell casts
Oliguria 
Hypertension

Question 10

List 3 causers of Nephrotic syndrome ?

Answer 10

Minimal change disease
Membranous glomerular disease
Focal segmental glomerulosclerosis (FSGS)

Question 11

Post streptococcal glomerulonephitis usually occurs 1-3 weeks post throat infection with ………………. or after Impetigo. The bloods show increased ……. and decreased …….. . Immunoflouresence shows …………………………. in the ……….. and this is a cause of nephritic syndrome.

Answer 11

group A alpha haemolytic streptococcus (S.pyogenes)
ASOT (antistreptolysin O titre) 
C3
Granular deposits of IgG and C3 
Basement membrane

Question 12

Which cause of Nephritic syndrome characteristically occurs 1-2 days after a URTI with frank haematuria?

Answer 12

IgA nephropathy

Question 13

Which cause of Nephritic syndrome is most aggressive and presents with particularly pronounced renal failure and oliguria?

Answer 13

Rapidly progressive Glomerulonephritis

Question 14

What is the characteristic feature of all types of rapidly progressive glomerulonephritis?

Answer 14

Crescents in the glomeruli

Question 15

A patient has pulmonary haemorrhage and haematuria. ImmunoFluorescence shows IgG deposition in the GBM. This is most likely ……………….

Answer 15

Goodpasture’s syndrome

Question 16

Which HLA type is associated with Goodpasteures syndrome ?

Answer 16

HLA-DRB1

Question 17

The main pathogenesis of Goodpasteures syndrome is ………

Answer 17

Anti-GMB antibodies

Question 18

SLE causes Rapidly progressive glomerulonephritis. Immunoflourescence shows ……… deposition on the GMB.

Answer 18

Granular IgG immune complex

Question 19

List 2 Pauci-immune causes of Rapidly progressive glomerulonephritis?

Answer 19

Granulomatosis with polyangitis (Wegener’s granulomatosis)

Microscopic polyangitis

Question 20

Match these

Granulomatosis with polyangitis
Microscopic Polyangitis.

p-ANCA
c-ANCA
ANA
AMA

Answer 20

Granulomatosis with polyangitis c-ANCA

Microscopic Polyangitis. p-ANCA

Question 21

Immunoflourescence shows scanty immune complex deposition. This suggests a ………… cause off rapidly progressive glomerulonephritis

Answer 21

Pauci-immune (granulomatosis with polyangitis, Microscopic polyangitis)

Question 22

List the triad of characteristic features of Alport syndrome?

Answer 22

Nephritic syndrome
Sensorineural deafness
Eye disorders (cataracts, lens dislocation)

Question 23

Benign familial haematuria is caused by ………… and shows asymptomatic haematuria which has ………….. inheritance.

Answer 23

Thinning of GBM

Autosomal dominant

Question 24

List 3 diseases that cause asymptomatic haematuria ?

Answer 24

Alport syndrome
IgA nephropathy
Benign familial haematuria (thin basement membrane syndrome)

Question 25

List 3 causes of ATN ?

Answer 25

Hypovolaemia
Drugs (NSAIDs)
Contrast for radiological imaging
heavy metals

Question 26

What is the most common cause of acute pyelonephritis ?

Answer 26

E.coli

Question 27

Which 2 scans are used to investigate VUR in children ?

Answer 27

MCUG (micturition cystourogram)- identifies the reflux

DMSA - identifies renal scarring

Question 28

How does acute interstitial nephritis present?

Answer 28

Fever, skin rash, haematuria, anaemia, proteinuria caused by a hypersensitivity reaction after exposure to a drug such as NSAIDs or antibiotics

Question 29

List the triad for HUS ?

Answer 29

MAHA
Thrombocytopaenia (after renal thrombosis)
renal failure

Question 30

List pentad for TTP

Answer 30

MAHA
Thrombocytopaenia (after widespread thrombosis)
renal failure
Fever
Neurological signs

Question 31

List 2 causes of secondary Nephrotic syndrome ?

Answer 31

• Amyloidosis

- Diabetes

Question 32

Match the type of RPGN with the immunofluorescence

Type

Type 1 (Goodpastures)
Type 2 (Immune complex e.g SLE)
Type 3 (Pauci-immune)

Immunoflourescence

Linear
Scanty
Granular

Answer 32

Type 1 (Goodpastures)- Linear
Type 2 (Immune complex e.g SLE)- Granular
Type 3 (Pauci-immune)- Scanty

Question 33

List 5 causes of nephritic syndrome ?

Answer 33

Post strep infection
IgA nephropathy
RPGN
Alport's syndrome
Benign familial haematuria

Question 34

What causes chronic interstitial nephritis ?

Answer 34

Long term analgesic consumption e.g NSAIDS or paracetamol

Question 35

List 3 pre-renal causes of renal failure ?

Answer 35

• Hypovolaemia
• Sepsis
• Renal artery stenosis

Question 36

List 3 renal causes of renal failure

Answer 36

• ATN
• Acute glomerulonephritis
• Thrombotic microangiopathy

Question 37

List 3 post-renal causes of renal failure

Answer 37

• stones
• tumours
• prostatic hyperplasia

Question 38

What GFR defines end stage renal failure (stage 5)

Answer 38

GFR <15

Question 39

Which autosomal dominant disease is associated with renal failure and berry aneurysms ?

Answer 39

APCKD (adult polycystic kidney disease)

Question 40

List 5 causes of type 2 (immune complex) RPGN ?

Answer 40

SLE
Henoch–Schlönein purpura
post-streptococcal
Alport’s syndrome
IgA nephropathy