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Year 5 - Pathology ICSM1 > Histopathology 8 - Renal disease > Flashcards

Histopathology 8 - Renal disease Flashcards

1
Q

Which part of the nephron is impermeable to water?

A

Distal convuluted tubule

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2
Q

What is a “horse shoe kidney”?

A

Congenital renal fusion

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3
Q

What is the inheritance pattern of adult polycystic kidney disease?

A

Dominant

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4
Q

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

A

Hypertension
Flank pain
Haematuria

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5
Q

What are the genetic associations of PCKD?

A

PDK1 PDK2

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6
Q

What is the most strongly associated aneurysm with PCKD?

A

Berry aneurysm

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7
Q

In which patients are kidney cysts most likely to form?

A

End stage renal failure and on dialysis

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8
Q

How can the causes of acute renal failure be classified?

A

Pre-renal/renal/post-renal

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9
Q

What is the most common cause of acute renal failure?

A

Acute tubular injury

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10
Q

How does acute tubular injury affect glomerular filtration?

A

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

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11
Q

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

A

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

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12
Q

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

A

Drugs (especially NSAIDs)

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13
Q

How does acute glomerulonephritis present?

A

Oligouria

Urine casts containing erthrocytes and leucocytes

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

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14
Q

What is acute crescentic glomerulonephritis?

A

Is a rapidly progressing glomerulonephritis.

Immune mediated inflammation of glomerulonephritis with crescents as main histopathological finding

Includes:
Type 1: Anti-GBM disease
Type2: E.g- PSGN. IgA Nephropathy, SLE, Alports
Type 3: Pauci-immune disease

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15
Q

Which aetiologies might cause immune complex associated crescentic glomerulonephritis?

A

SLE
IgA nephropathy
Post-infectious glomerulonephritis

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16
Q

What is anti-GBM disease?

A

Rare and severe disease caused by Ig directed against the GBM

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17
Q

How can anti-GBM disease affect the lung?

A

Cross-reaction with alveolar basement membrane leading to pulmonary haemorrhage

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18
Q

What are the features of Pauci-immune crescentic glomerulonephritis?

A

Only scanty glomerular Ig deposits

Usually ANCA associated

Vasculitis everywhere

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19
Q

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

A

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

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20
Q

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

A

Breakdown in selectivity of glomerular filtration barrier leading to protein leak

Proteinuria (>3g/day), Protein:creatinine ratio > 300mg/mmol

Hypoalbuminaemia <30g/l

Oedema

Hyperlipidaemia

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21
Q

Recall a pre-renal cause of acute renal failure

A

Failure of perfusion of kidney

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22
Q

Recall 3 renal causes of acute renal failure

A

Acute tubular injury
Acute glomerulonephritis
Thrombotic microangiopathy

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23
Q

How can acute renal failure be caused post-renally?

A

Obstruction

24
Q

How can trauma cause acute renal failure?

A

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

25
Q

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

A

Anti-neutrophil cytoplasm Ig

26
Q

How can immune complexes in the glomerulus be identified?

A

Immunohistochemistry

Electron microscopy

27
Q

Which syndromes are associated with Pauci-immune Crescentic Glomerulonephritis?

A

Wegener’s
Churg Strauss
Microscopic polyangiopathy

28
Q

Which kidney disease is associated with E coli diarrhoea?

A

Thrombotic microangiopathy

29
Q

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

A

Minimal change disease

Focal segmental glomerulosclerosis

30
Q

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

A

Membranous glomerular disease

Phospholipase A2 antibodies

31
Q

Recall 3 systemic diseases that can cause nephrotic syndrome

A

Diabetes mellitus
Amyloidosis
SLE

32
Q

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

A

Effacement of foot processes

33
Q

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

A

Minimal change disease

34
Q

What treatment does minimal change glomerulonephritis usually respond to?

A

Immunosuppression

steroids first line

ciclosporin second line

35
Q

Does focal segmental glomerulonephritis produce the nephrotic or nephritic syndrome?

A

Nephrotic

36
Q

What is the broad pathophysiology of primary membranous glomerulonephritis?

A

Immune complex related

Immune deposits are subepithelial, outside GBM

37
Q

What age group does membranous glomerulonephritis usually affect?

A

Adults

38
Q

What is the most common cause of membranous glomerulonephritis?

A

75% are immune

Antipody against phospholipase A2 receptor

39
Q

Does diabetic nephropathy cause nephrotic or nephritic syndrome?

A

Nephrotic

40
Q

What is amyloidosis?

A

Deposition of extracellular proteinaceous material exhibiting β-sheet structure

41
Q

What is the inheritance pattern of Alport’s syndrome?

A

X-linked dominant

Affects alpha 5 subunit

42
Q

What are the symptoms of Alport’s syndrome?

A

Renal failure in middle age
Deafness
Ocular disease

43
Q

What is the most common form of glomerulonephritis?

A

IgA nephropathy

44
Q

What eGFR is indicative of end-stage renal failure?

A

<15

45
Q

What is the most common cause of chronic renal failure?

A

Diabetes

46
Q

What are anti-GBM antibodies directed against?

A

The C terminal domain of type IV collagen

47
Q

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

A

Hypertensive nephropathy

48
Q

What stain is used to detect amyloidosis?

A

Congo red (–> apple green birefringeance)

49
Q

What socring system is used to score IgA renal disease?

A

Oxford classification

50
Q

What might histopathology show in hypertensive nephropathy?

A

Nephrosclerosis

51
Q

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

A

Diabetes

52
Q

How does SLE affect the kidney?

A

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

Can cause both secondary nephrotic syndrome and rapidly progressing crescenteric glomerulonephritis (Type 2)

53
Q

What are the 3 primary nephrotic syndromes?

What will you see on light and electron microscopy of these?

A

Minimal change disease. Membranous glomerular disease, Focal Segmental Glomerulosclerosis

Light: No changes, thickening of basement membrane, focal and segmental glomerular consolidation and scarring, hyalinosis

Electron: Subepithelial deposits (“Spikey” appearance) in membranous, Loss of podocyte foot processes in all.

54
Q

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

A

Eosinophils and granulomas

55
Q

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

A

ADAMT313 deficiency (eg scleroderma and anti-phospholipid syndrome)

56
Q

Describe each stage of diabetic nephropathy

A

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

57
Q

How is IgA nephropathy graded?

A

Oxford classification (MEST-C)

Year 5 - Pathology ICSM1 (85 decks)

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