Histopathology 8 - Renal disease

Question 1

Which part of the nephron is impermeable to water?

Answer 1

Distal convuluted tubule

Question 2

What is a “horse shoe kidney”?

Answer 2

Congenital renal fusion

Question 3

What is the inheritance pattern of adult polycystic kidney disease?

Answer 3

Dominant

Question 4

What is the triad of symptoms/signs associated with adult PCKD?

Answer 4

Hypertension
Flank pain
Haematuria

Question 5

What are the genetic associations of PCKD?

Answer 5

PDK1 PDK2

Question 6

What is the most strongly associated aneurysm with PCKD?

Answer 6

Berry aneurysm

Question 7

In which patients are kidney cysts most likely to form?

Answer 7

End stage renal failure and on dialysis

Question 8

How can the causes of acute renal failure be classified?

Answer 8

Pre-renal/renal/post-renal

Question 9

What is the most common cause of acute renal failure?

Answer 9

Acute tubular injury

Question 10

How does acute tubular injury affect glomerular filtration?

Answer 10

Blockage of tubules by casts –> leakage into interstitial space –> secondary haemodynamic changes that affect GFR

Question 11

What is acute tubulo-interstitial nephritis, and what causes it?

Answer 11

Injury to tubules and interstitium that is usually immune but can also be caused by infection/drugs

Question 12

What is the most common cause of acute tubulo-interstitial nephritis?

Answer 12

Drugs (especially NSAIDs)

Question 13

How does acute glomerulonephritis present?

Answer 13

Oligouria

Urine casts containing erthrocytes and leucocytes

Crescents present when it is bad enough to cause acute renal failure

Question 14

What is acute crescentic glomerulonephritis?

Answer 14

Immune mediated inflammation of glomerulonephritis with crescents as main histopathological finding

Includes:
Anti-GBM disease
Pauci-immune disease

Question 15

Which aetiologies might cause immune complex associated crescentic glomerulonephritis?

Answer 15

SLE
IgA nephropathy
Post-infectious glomerulonephritis

Question 16

What is anti-GBM disease?

Answer 16

Rare and severe disease caused by Ig directed against the GBM

Question 17

How can anti-GBM disease affect the lung?

Answer 17

Cross-reaction with alveolar basement membrane leading to pulmonary haemorrhage

Question 18

What are the features of Pauci-immune crescentic glomerulonephritis?

Answer 18

Only scanty glomerular Ig deposits

Usually ANCA associated

Vasculitis everywhere

Question 19

What on earth is thrombotic microangiopathy? (no seriously if someone works this out pls pm me)

Answer 19

Damage to endothelium in glomeruli, arterioles and arteries leading to thrombosis??

Question 20

What is nephrotic syndrome, and what are is its four diagnostic requirements?

Answer 20

Breakdown in selectivity of glomerular filtration barrier leading to protein leak

Proteinuria (>3.5g/day)

Hypoalbuminaemia

Oedema

Hyperlipidaemia

Question 21

Recall a pre-renal cause of acute renal failure

Answer 21

Failure of perfusion of kidney

Question 22

Recall 3 renal causes of acute renal failure

Answer 22

Acute tubular injury
Acute glomerulonephritis
Thrombotic microangiopathy

Question 23

How can acute renal failure be caused post-renally?

Answer 23

Obstruction

Question 24

How can trauma cause acute renal failure?

Answer 24

Release of myoglobin damages tubular epithelial cells, causing acute tubular injury (rhabodmyolysis)

Question 25

Which antibodies are present in pauci-immune acute crescentic glomerulonephritis?

Answer 25

Anti-neutrophil cytoplasm Ig

Question 26

How can immune complexes in the glomerulus be identified?

Answer 26

Immunohistochemistry | Electron microscopy

Question 27

Which syndromes are associated with Pauci-immune Crescentic Glomerulonephritis?

Answer 27

Wegener's Churg Strauss Microscopic polyangiopathy

Question 28

Which kidney disease is associated with E coli diarrhoea?

Answer 28

Thrombotic microangiopathy

Question 29

Recall 2 examples of non-immune complex related, primary nephrotic syndrome

Answer 29

Minimal change disease Focal segmental glomerulosclerosis

Question 30

Recall an example of a primary cause of nephrotic syndrome that is immune mediated?

Answer 30

Membranous glomerulonephritis

Question 31

Recall 3 systemic diseases that can cause nephrotic syndrome

Answer 31

Diabetes mellitus Amyloidosis SLE

Question 32

In minimal change glomerulonephritis, how do glomeruli appear under electron microscopy?

Answer 32

Effacement of foot processes

Question 33

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

Answer 33

Minimal change disease

Question 34

What treatment does minimal change glomerulonephritis usually respond to?

Answer 34

Immunosuppression

Question 35

Does focal segmental glomerulonephritis produce the nephrotic or nephritic syndrome?

Answer 35

Nephrotic

Question 36

What is the broad pathophysiology of primary membranous glomerulonephritis?

Answer 36

Immune complex related Immune deposits are subepithelial, outside GBM

Question 37

What age group does membranous glomerulonephritis usually affect?

Answer 37

Adults

Question 38

What is the most common cause of membranous glomerulonephritis?

Answer 38

75% are immune Antipody against phospholipase A2 receptor

Question 39

Does diabetic nephropathy cause nephrotic or nephritic syndrome?

Answer 39

Nephrotic

Question 40

What is amyloidosis?

Answer 40

Deposition of extracellular proteinaceous material exhibiting β-sheet structure

Question 41

What is the inheritance pattern of Alport's syndrome?

Answer 41

X-linked dominant | Affects alpha 5 subunit

Question 42

What are the symptoms of Alport's syndrome?

Answer 42

Renal failure in middle age Deafness Ocular disease

Question 43

What is the most common form of glomerulonephritis?

Answer 43

IgA nephropathy

Question 44

What eGFR is indicative of end-stage renal failure?

Answer 44

<15

Question 45

What is the most common cause of chronic renal failure?

Answer 45

Diabetes

Question 46

What are anti-GBM antibodies directed against?

Answer 46

The C terminal domain of type IV collagen

Question 47

What kidney disease is characterised by shrunken kidneys with granular cortices?

Answer 47

Hypertensive nephropathy

Question 48

What stain is used to detect amyloidosis?

Answer 48

Congo red (--> apple green birefringeance)

Question 49

What socring system is used to score IgA renal disease?

Answer 49

Oxford classification

Question 50

What might histopathology show in hypertensive nephropathy?

Answer 50

Nephrosclerosis

Question 51

What is the commonest cause of kidney failure requiring renal replacement therapy?

Answer 51

Diabetes

Question 52

How does SLE affect the kidney?

Answer 52

Anti-nuclear anti-dsDNA Ig directed against a broad range of intracellular and extracellular antigens

Question 53

Does SLE cause the nephrotic or nephritic syndrome?

Answer 53

Nephrotic

Question 54

What would be the histological appearance of acute tubulo-interstitial nephritis?

Answer 54

Eosinophils and granulomas

Question 55

What is the usual cause of non-diarrhoea-associated thrombotic microangiopathy?

Answer 55

ADAMT313 deficiency (eg scleroderma and anti-phospholipid syndrome)

Question 56

Describe each stage of diabetic nephropathy

Answer 56

Stage 1: Basement Membrane thickening Stage 2: Mesangial matrix expansion Stage 3: Nodular lesions (Kimmelstiel-Wilson) Stage 4: Advanced glomerulosclerosis

Question 57

How is IgA nephropathy graded?

Answer 57

Oxford classification (MEST-C)