Histopathology Flashcards
1
Q
What are the main pathologies affecting the renal tubules and interstitium?
A
Acute tubular necrosis
Tubulointerstitial nephritis
2
Q
What triad is associated with nephrotic syndrome?
A
1) Hypoalbuminaemia
2) Proteinuria (frothy urine)
3) Oedema
Also note hyperlipidaemia and hypercholesterolaemia
3
Q
What are the different types of nephrotic syndromes?
A
1) Minimal change disease
2) Membranous glomerular disease - phospholipase A2
3) Focal segmental glomerulosclerosis
4) Membranoproliferative glomerulonephritis
4
Q
What are the characteristics of nephritic syndrome?
A
P - Proteinuria
H - Haematuria
A - Azootemia (high urea and creatinine)
R - Red cell casts
O - Oliguria
H - Hypertension
5
Q
What are the different types of nephritic syndrome?
A
1) Acute post infectious glomerulonephritis
2) IgA nephropathy (Berger disease)
3) Rapidly progressive (Crescentic) glomerulonephritis
4) Alport’s syndrome (hereditary nephritis)
5) Thin basement membrane disease (benign familial haematuria)
6
Q
What is the main sign/symptom of Ig A nephropathy (Berger disease)?
A
Frank haematuria
7
Q
What are the 3 different types of rapidly progressive glomerulonephritis?
A
T1: Anti-GBM antibody
T2: Immune complex mediated
T3: Pauci immune
8
Q
Antibodies to phospholipase A2 receptor are associated with what form of glomerulonephritis?
A
Membranous glomerular disease
9
Q
What are the most common causes of PID?
A
chlamydia and gonorrhoea
10
Q
What are the symptoms and signs associated with PID?
A
Dyspareunia, adnexal tenderness, cervical excitation
11
Q
How is PID treated?
A
Metronidazole, Ceftriaxone, Doxycyline
12
Q
What are the complications of PID?
A
Fitz-Hugh Curtis syndrome (Violin strings around the liver)
Sub fertility
Ectopic pregnancy
Tubo - ovarian abscess
Peritonitis
13
Q
What is endomestriosis?
A
Endometrium growing outside the uterus
14
Q
What is adenomyosis?
A
Endometrium growing within the myometrium
15
Q
What is the typical sign and symptom of endometrial cancer?
A
Post-menopausal bleeding
16
Q
What are the RF of endometrial cancer?
A
Anything increasing excess oestrogen exposure
17
Q
How do you diagnose vulval cancer?
A
Biopsy
18
Q
What is the main type of ovarian tumour?
A
Epithelial - 70% of ovarian cancers
19
Q
What cancer is associated with psammoma bodies?
A
Serous cystadenoma
20
Q
What cancer is associated with tubular glands and a history of endometriosis?
A
Endometrioid carcinoma
21
Q
What cancer is associated with ‘clear cells’ and a hobnail appearance (bulbous nucleus and nuclear projections into the cytoplasm)?
A
Clear cell carcinoma????
22
Q
What is the most common ovarian cancer in younger women?
A
Dysgerminoma
23
Q
What is a cystic teratoma also known as?
A
Dermoid cyst
24
Q
What is a tumour that has cells that have differentiated into mature tissues called?
A
Teratoma
25
What are the 3 sex cord tumours?
1) Granulosa/ Theca cell tumours
2) Sertoli-Leydig cell tumours
3) Fibromas - these don't release hormones
26
What is Fibroma associated with?
Meig's syndrome
27
How does HPV lead to cervical cancer?
HPV 16 and 18 are high risk. These produce proteins E6 and E7. E6 inactivates p53 and E7 inactivates retinoblatoma (Rb). These are both TSGs - so it inactivates TSGs.
28
During a self examination, a 44 year old detects a mass in her left breast. A biopsy subsequently confirms an invasive ductal carcinoma. A CT scan is performed to stage her mass. On the CT scan, it is noted she has a mass in her left ovary also. Blood results show an elevated level of oestrogen in the blood? Which is most likely?
1) Pathological endometrial hyperplasia
2) Pathological endometrial hypertrophy
3) Physiological endometrial hyperplasia
4) Physiological endometrial hypertrophy
29
What are the 3 inflammatory breast conditions?
Acute mastitis
Duct ectasia
Fat necrosis
30
What are the 2 types of carcinoma in situ?
1) Lobular
2) Ductal
31
What type of carcinoma in situ is more common?
Ductal carcinoma
32
What are the indications of invasive carcinoma?
Peau d'orange, tethering, Paget's disease, nipple retraction, lymphadenopathy, ulceration, bloody nipple discharge
33
What is the most important prognostic factor for invasive breast carcinoma?
Axillary lymph node involvement
34
What is the commonest type of pancreatic neoplasm?
Ductal adenocarcinoma
35
All of the following are causes of chronic pancreatitis except:
Alcohol
Gall stones
Cystic fibrosis
None of the above
None of the above
36
The following are all complications of gall stones except:
Acute cholecystitis
Gall bladder cancer
Haemolytic anaemia
Obstructive jaundice
Haemolytic anaemia
37
What inflammatory process is associated with:
* Neutrophils
* Lymphocytes
* Plasma cells
* Eosinophils
* Mast cells
* Macrophages
* Neutrophils
* Lymphocytes
* Plasma cells
* Eosinophils
* Mast cells
* Macrophages
38
What are the histological features of squamous cell carcinomas?
Keratin producing
Intercellular bridges
39
What are the cytological features of neutrophils and what inflammatory process are they associated with?
They are polymorphs - their nucleus is polylobate.
They are associated with ACUTE INFLAMMATION.
40
What are the cytological features of lymphocytes and what inflammatory process are they associated with?
Single round nucleus that fills the cytoplasm (high nucleus:cytoplasm ratio)
Associated with CHRONIC INFLAMMATION
41
If we see a lot of lymphocytes on microscopy what are 2 pathologies we should keep in mind?
1) Chronic inflammation (this will be polyclonal)
2) Lymphoma (this will be monoclonal)
42
What are the histological features of a lymphoma?
Dense tumour
Monoclonal
Monomorphic
Starry sky appearance for Burkitt's lymphoma (Macrophages scattered throughout housing necrotic debris)
43
What are the cytological features of eosinophils?
Bilobed nucleus
Pink granules
44
What are the cytological features of mast cells?
Big cell
Packed full of dark blue-purple granules
Cannot clearly see nucleus
45
What are the cytological features of macrophages?
Large cell
Lots of cytoplasm
Contains medium sized nucleus
46
What inflammatory processes are associated with macrophages?
Late acute inflammation (clear up)
Chronic inflammation (priming)
Granuloma formulation
47
What is a granuloma?
An organised collection of activated macrophages (epithelioid cells) - very secretory in function.
Also will show fusion giant cells centrally.
48
Where do squamous cell carcinomas originate?
Anywhere in the body where squamoud epithelium is found.
Skin
Oesophagus
Head and neck
Anus
Cervix
Vagina
Exception: the lung (smoking induces metaplasia to squamous epithelium)
49
What are the congo-red stains and congo-red+ fluorescent light/polarised light used for?
Amyloid (RED with just congo-red and Apple green birefringence under polarised light)
50
How could we differentiate a carcinoma and lymphoma?
We can stain with pan- cytokeratin which is an epithelial marker. Brown would be a +ve result. If the result is negative, then it cannot be a carcinoma.
We can stain for CD45 - a lymphoid marker - if this is positive, we know it is a lymphoma.
51
How can we identify the location of a primary from a metastases?
We can stain to identify the cytokeratins the biopsy is positive for. There are many different types of cytokeratin and they are produced by many different cell types.
For example a liver metastases that displayed CK20 +ve but CK7 -ve, would indicate it was from the colon.
52
The characteristic inflammatory cell seen in asthma is?
Eosinophil
53
The defining features of a squamous cell carcinoma are:
a) Keratin production and glands present
b) Mucin production and keratin production
c) Kertain production and intercellular bridges
c) Keratin production and intercellular bridges
54
What is the site of origin of melanoma?
Skin
55
What is the site of origin of lymphoma?
Bone marrow
Lymph nodes
Spleen
Thymus
56
What is the site of origin of transitional cell carcinoma?
Urinary system transitional cells:
Renal pelvis
Pelvis
Ureters
Bladder
Urethra
57
What is this cancer and what are the features seen?
Transitional cell carcinoma
Dysplastic change
Hyperplasia
Everted papillomas (finger like protusions of epithelium)
58
What is this cancer and what are the histological features?
Squamous cell carcinoma
Keratin production (deposits centrally)
Intercellular bridges
59
What is this cancer and what are the histological features?
Lymphoma
Dense
Monomorphic/clonal cells
High proportion of lymphoctyes
60
What are the sites of origin of adenocarcinoma?
Any glandular organs
Breast
Lung
Stomach
Colon
Prostate
61
What are the histological features of adenocarcinoma?
Presence of glands
Nests of cells
Mucin production (stains blue with mucicarmine stain)
62
What is shown by these pictures?
1st picture shows an oesophageal ulcer caused by CMV infecting a HIV patient taken during endoscopy
2nd picture shows the histology of the lesion including big cell with intranuclear inclusion, classical of CMV
3rd picture shows immunohistochemistry for CMV (brown stain is positive)
63
What is shown by these pictures?
Kaposi's sarcoma (HHV-8 and HIV associated)
a) Dermis is expanded by a solid tumour
b) Monomorphic spindled cells + slit like vascular channels
c) Nuclei of tumour cells demonstrating immunoreactivity for HHV-8
64
What do these pictures show?
B cell lymphoma in HIV patient (Also assoc with EBV)
a) Tumour mass
B) Perivascular lymphomatous infiltrate
65
What do these pictures show?
1) Cavitating TB
2) Granuloma with caseous necrosis
66
What do these pictures show?
Sarcoid granuloma: organised collection of activated macrophages
67
What are giant cells?
Large fused-together macrophages
Multinucleate cells
May be present in sarcoid granuloma
68
What cell type is characteristic of granuloma?
Epithelioid macrophages
69
What do these pictures show?
IgG4 related disease
a) Plasma cell rich inflammatory infiltrate
b) Immunohistochemistry for **IgG4 - IgG4 +ve**
70
What are the steps of alcohol-induced liver disease?
1) Steatosis
2) Steatohepatitis
3) Fibrosis
4) Cirrhosis
5) Hepatocellular carcinoma
71
Causes of granulomatous inflammation in the liver include...
Infectious - Mycobacterium tuberculosis
Non-infectious inflammatory disease - Sarcoidosis
Others:
Primary biliary cholangitis
Drug induced disease
Schistomasiasis
Malignancy
72
The different types of liver damage include...
Fatty change/Steatosis
Fatty liver hepatitis/Steatohepatitis
Liver cirrhosis
Hepatocellular carcinoma
73
What type of amyloid is associated with multiple myeloma and B cell lymphoma?
AL amyloid
74
What does GORD stand for?
Gastro-Oesophageal Reflux Disease
75
What are the complications of reflux oesophagitis?
Ulceration
Haemorrhage
Perforation
Stricture
Barrett's oesophagus
76
What are the 2 different types of Barrett's oesophagus?
1) Without goblet cells - gastric metaplasia
2) With goblet cells - intestinal types metaplasia (more likely to lead to dysplasia and cancer)
77
What are the causes of acute gastritis?
Chemical - aspirin/NSAIDs
Alcohol
Corrosives - any physical drugs i.e. tablets taken without enough water
Infection - Helicobacter pylori
78
What happens if a patient has a gastric ulcer that bleeds slowly?
Anaemia
79
What happens if a patient has a gastric ulcer that bleeds rapidly and massively?
Shock - hypovolaemic
80
What happens if a patient has a gastric ulcer that perforates?
Peritonitis - urgent surgical repair needed
81
What is the most common type of malignant gastric cancer?
Adenocarcinomas (\>95%)
82
What cancers are patients with coeliac disease at risk of?
Duodenal MALToma (lymphoma of the mucosal associated lymphoid tissue)
This is within the duodenum and originates in T-cells (Enteropathy Associated T-Cell Lymphoma)
Histologically, we will see T-cells present.
83
Most oesophageal and gastric cancers arise from pre-existing adenomas...
True or False
False
They arise from the **flat dysplasia pathway** (chronic inflammation, metaplasia, low grade dysplasia, high grade dysplasia, cancer)
84
In a patient with coeliac disease, on a **diet containing gluten**, the following is the most likely histological change in the duodenum?
a) Normal villous architecture, no increase in intraepithelial lymphocytes
b) Villous atrophy, no increase in intra-epthelial lymphocytes
c) Villous atrophy, increased intra-epithelial lymphocytes
d) Normal villous architecture, increased intra-epithelial lymphocytes
c) Villous atrophy, increased intra-epithelial lymphocytes (this is what causes damage to the villi)
85
Which of the following is not a cause of chronic gastritis?
a) Auto-immunity
b) Infection
c) Drugs
d) Metabolic disease
d) Metabolic disease - the others are all causes of chronic gastritis
86
Describe the main ducts within the pancreas
Main pancreatic duct (formed from all of the intralobular ducts) joins to the common bile duct to drain into the duodenum at the Ampulla of Vater
87
What does this picture show?
The pancreas
88
What does this picture show?
Islets of langerhans in the pancreas (endocrine component of pancreas)
89
What would you see in the histological sample of acute pancreatitis?
Yellow-white fatty foci (soaps formed from precipitation of calcium ions and necrosed fat)
90
What mutation is most associated with Pancreatic ductal carcinoma?
K-Ras mutation
91
What does this picture show?
An invasive pancreatic ductal carcinoma
92
What is the commonest type of pancreatic neoplasm?
Ductal adenocarcinoma
93
All the following are causes of chronic pancreatitis except...
Alcohol
Gall stones
Cystic Fibrosis - "mucoviscoidosis"
Haemochromatosis
Trick question
Trick question - all the answers are causes of chronic pancreatitis
94
The following are all complications of gall stones except...
a) acute cholecystitis
b) gall bladder cancer
c) haemolytic anaemia
d) obstructive jaundice
c) haemolytic anaemia
95
What demographic are primary malignant bone tumours most common in?
Children and young adults
96
What are RF in older patients that may point towards a bone malignancy?
Previous radiotherapy
Paget's disease
97
What is the histology of an osteochondroma?
Fibrous surface overlying the cortical or trabecular bone
98
What is the commonest malignant tumour in bone?
Metastases (but metastases are uncommon below the elbow and knee)
99
What age group does osteosarcoma most commonly affect?
\<20s (75%)
100
Where are osteosarcomas most commonly found?
Around the knee - lower femur/upper tibia (60%), hip, shoulder
101
How can osteosarcomas and chondrosarcomas be differentiated?
Osteosarcomas are more haemorrhagic, chondrosarcomas are white in colour.
102
What is the most common age group experiencing chondrosarcoma?
30-60s (60%)
103
What is Ewing's sarcoma (PPNET) and who does it usually affect?
A highly malignant small round cell tumour
\<20 years (80%)
104
What is the chromosomal translocation associated with Ewing's sarcoma?
11;22 EWS/Fli1
105
What is the definition of soft tissue tumour (sarcoma)
Mesenchymal proliferations which occur in the extraskeletal, non-epithelial tissues of the body - excluding the meninges and lymphoreticular system
106
What age do soft tissue tumours usually affect?
Older patients 50%\>55 yrs
107
What are the most common pituitary adenoma cells?
Prolactin secreting cells - lactotrophs (20-30%)
108
Out of all the intracranial tumours that come to clinical attention, how many would you expect are pituitary adenomas?
10%
109
What are the clinical features associated with prolactinomas?
Amenorrhoea
Galactorrhoea
Loss of libido
Infertility
110
What are the clinical features of a growth hormone adenoma?
Pre-pubertal children -\> Gigantism
Adults -\> Acromegaly
Diabetes mellitus, congestive cardiac failure, muscle weakness, HTN
111
What are the clinical features of hypopituitarism?
112
What is hypopituitarism associated with ischaemic necrosis of the pituitary after giving birth?
Sheehan's syndrome
113
What are the signs and sx of local mass effects of pituitary tumours?
Bitemporal hemianopia
Headache
Papilloedema (Raised ICP)
Obstructive hydrocephalus
114
What are the causes of non-toxic thyroid goitre?
Iodine deficiency
Low iodine water and soil content (endemic)
Impaired thyroid hormone synthesis
Puberty (especially in females)
Substance interaction (brassica cabbage)
Hereditary enzyme defects
115
What can happen when a thyroid goitre becomes too large?
May lead to mechanical defects i.e. dysphagia and airway obstruction
116
What is the triad of clinical features associated with Grave's disease?
1) Thyrotoxicosis
2) Infiltrative ophthalmopathy with exophthalmos in upto 40%
3) Infiltrative dermopathy (pretibial myxoedema) in a minority of cases
117
What are the different types of thyroid neoplasm?
Adenomas
Carcinomas
118
What are the subtypes of thyroid carcinoma and what proportion of thyroid carcinomas do they make up?
Papillary (75-85%)
Follicular (10-20%)
Medullary (5%)
Anaplastic (\<5%)
119
What are the actions of PTH?
1) Activates osteoclasts
2) Increases renal tubular absorption of calcium
3) Increases conversion of vit D to active form
4) Increases urinary phosphate excretion
5) Increases intestinal calcium absorption
120
How can parathyroid adenoma be distinguished from normal parathyroid tissue histologically?
Normal parathyroid tissue is 50% fat
121
What is secondary hyperparathyroidism caused by?
Caused by any chronic depression of serum Ca2+. The parathyroid glands are then consistently stimulated and produce PTH. They may be enlarged and asymmetrical.
122
What is tertiary hyperparathyroidism?
When your parathyroid glands keep making too much PTH after your calcium levels return to normal. This type usually occurs in people with kidney problems.
123
What is the most common cause of secondary hyperparathyroidism?
Renal failure/ chronic kidney failure
124
What are the causes of hypoparathyroidism?
Surgical ablation
Congenital absence
Autoimmune disease
125
What are the clinical features of hypoparathyroidism?
Neuromuscular irritability - tingling, muscle spasms, tetany
Cardiac arrhythmias
Fits
Cataracts
126
What are the clinical features of hyperaldosteronism?
Hypertension
Hypokalaemia
127
What are the rules of 10 associated with phaeochromocytoma?
10% arise in association with a familial genetic syndrome i.e. MEN2a/2b, von HL, Sturge Weber
10% are bilateral
10% are malignant
10% of the catecholamine secreting tumours arise outside of the adrenals (paragangliomas)
128
What are the features of tumours in multiple endocrine neoplasia syndrome?
Younger age than sporadic tumours
Arise in multiple endocrine organs
Multifocal
Preceded by hyperplasia
Usually more agressive than sporadic tumours
129
What is the most comon type of thyroid cancer?
Papillary thyroid carcinoma
130
What type of thyroid carcinoma arises from the parafollicular or c cells of the thyroid?
Medullary carcinoma
131
What syndrome is caused by an adrenal adenoma that secretes aldosterone?
Conn's syndrome
132
What are the clinical features of SLE?
Skin - malar rash/ discoid lesions
Oral ulcers
Joint pain/swelling
Neurological - psychosis, depression
Serositis - recurrent pleuritic chest pain
Renal - renal failure
Haematological - pancytopenia
Immunological
133
What is libman sacks?
It is a non-infective endocarditis caused by SLE. Clinical presentations include peripheral emboli and stroke.
134
What is the alternative name for scleroderma?
Systemic sclerosis
135
What antibodies are the diffuse form and limited form of scleroderma/systemic scerosis associated with?
Diffuse form - Anti DNA topoisomerase Ab (Scl70)
Limited form - Anti centromere Ab
136
What is the pathological hallmark of sarcoidosis?
Non-caseating granulomatous inflammation
137
What is the hallmark triad for granulomatosis with polyangiitis?
ENT
Lungs
Kidney
138
What is the hallmark triad for eosinophilic granulomatosis with polyangiitis?
Asthma
Eosinophilia
Vasculitis
139
What are some secondary causes of nephrotic syndrome?
Diabetes
Systemic Lupus Erythematosus
Amyloidosis
140
What is the main pathophysiology behind nephrotic syndrome?
Breakdown in the selectivity of filtration barrier i.e. integrity of the glomerular basement membrane
141
How does the pathophysiology of nephrotic and nephritic syndrome differ?
Nephrotic - Damage to the selectivity of the filtration barrier i.e. glomerular basement membrane
Nephritic - However, is due to glomerular inflammation
142
What glomerular renal pathologies are nost likely to occur in children?
1) Minimal change disease
2) Acute post infectious glomerulonephritis (after streptococcal throat infection Group A B-haemolytic strep pyogenes or impetigo)
143
What nephritic syndrome is associated with the deposition of IgA immune complexes in the glomeruli?
a) Acute glomerunephritis
b) Berger disease
c) Rapidly progressive / crescentic glomerulonephritis
d) Alport's syndrome
b) Berger disease (AKA: IgA nephropathy) is associated with the deposition of IgA-C3 complexes in the golmeruli mesangium (visualised using immunofluorescence on biopsy)
144
What is the anti-GBM Ab in goodpasture's disease directed against?
COL4-A3
145
What mutation causes hereditary nephritis (Alport's syndrome) and what is the inheritance pattern?
Mutation in type 4 collagen alpha 5 chain
X-linked inheritance pattern
146
When and how does Alport's syndrome pregress?
Nephritic syndrome (progresses to ESRF) + sensorineural deafness + eye disorders
Presents at 5-20 years
147
What is the mutation associated with Thin Basement Membrane disease and what is the inheritance pattern?
Mutation in Type 4 collagen alpha 4 chain
Autosomal dominant inheritance pattern
148
How does thin basement membrane disease commonly present?
Asymptomatic haematuria
149
What is the definition of vasculitis?
Inflammation of the blood vessels
150
What are urinary calculi made out of?
Most commonly they are calcium oxalate (Weddelite) stones (75% of them)
The next most common substance is Magnesium Ammonium Phosphate (Struvite/Triple stones) stones (15% of them)
Uric acid makes up 5% of the stones
151
What are calcium oxalate urinary calculi often associated with?
Hypercalciuria
152
What are Magnesium Ammonium Phosphate stones also known as?
Triple stones
153
What precedes the formation of Magnesium Ammonium Phosphate stones?
Infection with a urease-producing organism i.e. Proteus spp.
154
What are the complications of urinary calculi?
Small stones -\> Impaction and colic
Large stones -\> Obstruction to urine flow and blood flow, infection, chronic renal failre
155
Define renal cell carcinoma
Malignant epithelial kidney tumour
156
What are the risk factors of renal cell carcinoma?
Smoking
Obesity
Hypertension
Long-term dialysis
Genetic syndromes - von Hippel Lindau
157
How does renal cell carcinoma present?
Half of cases present with painless haematuria - but most are asymptomatic and are picked up on incidental imaging
158
What is this?
Papilary renal cell carcinoma type 1
159
What is Wilm's tumour (nephroblastoma)?
Malignant triphasic kidney tumour of childhood
2nd most common malignancy in children
160
What are the 3 phases of Wilm's tumour?
Triphasic tumour:
1) blastema - small round blue cells
2) Epithelial component
3) Stromal component
161
How does Wilm's tumour usually present?
Abdominal mass in childern 2-5 years old
162
What is the epidemiology of benign prostatic hyperplasia?
Very common - 25% of men are symptomatic by age 80
It is histologically present in 90% of men by age 80!!!
163
What is the aetiology of benign prostatic hyperplasia?
Aetiology is not clear
IT is thought that perhaps increased oestrogen levels in the blood may induce androgen receptors and stimulate hyperplasia (oestrogen levels increase with age)
164
How is benign prostatic hyperplasia treated?
Alpha blockers
5-a reductase inhibitors
Transurethral resection
165
Define prostatic adenocarcinoma
Malignant epithelial prostate tumour
166
What does prostatic adenocarcinoma arise from?
Prostatic Intraepithelial Neoplasia
167
What mutations are associated with prostatic adenocarcinoma?
PTEN, AMACR, GST-pi, p27
168
How does the gleason score and grade work?
Score = x + y = z (z score ranges from 6-10)
X= most common pattern grade from histology sample
Y = worst pattern grade possible i.e. 5
Grade = Most common pattern from the histology sample (grade ranges from 1-5)
169
How does a testicular germ cell tumour present?
Usually as a painless lump
10% of patients present with metastasis signs:
Back pain
Cough
Dyspnoea
170
What testicular tumour is associated with a lace like growth pattern?
Yolk sac tumour
171
What is the maximum size permissible for a papillary adenoma of the kidney?
15mm
172
What is the most common renal cell carcinoma?
Clear cell renal cell carcinoma
173
What is the gleason score used for?
To score and grade prostate histology samples to determine prognosis i.e. for Prostatic cancers
174
What are the major functions of the kidney?
1) Excretion of metabolic waste products and foreign chemicals (including drugs)
2) Regulation of fluid, electrolyte and acid/base balance (HOMEOSTATIC)
3) Regulation of blood pressure (renin)
4) Regulation of calcium and bone metabolism (1,25 dihydroxycholecalciferol)
5) Regulation of haematocrit (erythropoietin)
175
How much blood is filtered through the glomerulus per minute?
125 ml
176
Which parts of the nephron regulate pH?
Distal convoluted tubule and collecting duct
177
What is the thickness of the glomerular basement membrane?
350nm
178
As well as agenesis, renal fusion (horseshoe), ectopic kidney, renal dysplasia and pelvi-ureteric Junction Obstruction what are 3 other genitourinary malformations?
Ureteral duplication
Vesicoureteral Reflux
Posterior urethral valves
179
What is the inheritance pattern of Adult Polycystic Kidney Disease?
Autosomal dominant
180
How does polycystic kidney disease present?
Usually in adulthood
Hypertension
Flank pain
Haematuria
181
What is there a propensity to form in adult polycystic kidney disease?
Berry aneurysms (PKD1,2,3 increase risk)
182
What brain bleed is associated with berry aneurysms?
Subarachnoid haemorrhage
183
What cystic disease gives a 7% risk of developing papillary renal cell carcinoma?
a) Serous cystadenoma
b) Mucinous cystadenoma
c) Clear cell renal carcinoma
d) Acquired cystic disease of the kidney
d) Acquired cystic disease of the kidney
184
Define acute renal failure
Rapid deterioration in renal function - ocurring in hours - days
185
Define tubulo-interstitial nephritis
Immune injury to tubules and interstitium
186
What are some secondary causes of nephrotic syndrome?
Diabetes mellitus
Amyloidosis
Systemic lupus erythematosus
187
What are the 2 different types of primary glomerular nephrotic syndrome?
Immune complex related and non-immune complex related
188
How does diabetic nephropathy progress?
Starts as a microalbuminuria before progression to proteinuria and nephrotic syndrome
189
Define chronic kidney disease
A Progressive, irreversible loss of renal function characteriused by prolonged symptoms and signs of uraemia (fatigue, itching, anorexia, confusion, bleeding)
190
What is the commonest cause of chronic kidney disease in the UK?
Diabetes (19.5%)
191
The basic unit of the kidney function is the
Nephron
192
Anti-GBM disease is caused by Ab directed against...
C-terminal of type 4 collagen
193
An accepted definition of nephrotic syndrome includes proteinuria of more than...
3.5g/24hr
194
Which histological stain us used to detect amyloid...
Congo red
195
IgA renal disease is scored using the...
Oxford classification MEST-C
196
When a cause is identifies, the commonest cause of kidney failure requiring renal replacement therapy is...
Diabetes
197
