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HistoPath > 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

Regulates pH, also Na, K and Ca levels

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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? (2)

A

PDK1 PDK2

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6
Q

What is the most strongly associated aneurysm with PCKD?

A

Berry aneurysm (result in subarachnoid haemorrhage)

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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

  • Tubular epithelial cells are damaged by ischaemia, toxins, drugs
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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 (NSAIDs, ABx, diuretis)

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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

Immune mediated inflammation of glomerulonephritis with crescents as main histopathological finding

Causes:
Anti-GBM disease (Goodpasture’s)
Pauci-immune disease

Get irreversible renal failure

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15
Q

Which aetiologies might cause immune complex associated crescentic glomerulonephritis? (3)

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

Specifically target C-terminal domain of Type IV collagen

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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 (>3.5g/day)
  • Hypoalbuminaemia
  • 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

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24
Q

How can trauma cause acute renal failure?

A

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

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25
Q

Anti-neutrophil cytoplasm Ig in which kidney condition/

A

Pauci-immune acute crescentic glomerulonephritis

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26
Q

How can immune complexes in the glomerulus be identified?

A

Immunohistochemistry
Electron microscopy

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27
Q

Which syndromes are associated with Pauci-immune Crescentic Glomerulonephritis? (3)

A

Wegener’s
Churg Strauss
Microscopic polyangiopathy

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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 glomerulonephritis

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

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 AI

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

Then glomerulonephritis, HTN

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 (ANA) and anti-dsDNA antibodies directed against a broad range of intracellular and extracellular antigens

53
Q

Does SLE cause the nephrotic or nephritic syndrome?

A

Nephrotic

54
Q

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

A

heavy interstitial inflammatory infiltrate with tubular injury: 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)

58
Q

Where is Na actively reabsorbed in kidney?

A

Proximal Convoluted Tubule

59
Q

Increased R of what in Adult (Dominant) Polycystic Kidney Disease

A

Malignancy

60
Q

Which kidney disease shows linear deposition of IgG on the glomerular basement membrane

A

Anti-GBM Disease (Goodpasture’s)

61
Q

First presentation of Diabetic Nephropathy

A

microalbuminuria

62
Q

Which stage of Diabetic Nephropathy do you see Kimmelstiel-Wilson nodules?

A

3

63
Q

Cause of AA amyloidosis

A

serum amyloid protein

NB Patients tend to have a chronic inflammatory condition

64
Q

Cause of AL amyloidosis

A

immunoglobulin light chains

NB 80% have multiple myeloma

65
Q

Hereditary defect in Type IV collagen synthesis resulting in Microscopic haematuria

A

Thin Basement Membrane Disease

66
Q

Aetiology of IgA nephropathy

A

granular deposition of IgA and complement (immune complex) in the mesangium

67
Q

Which other condition can IgA nephropathy be seen in?

A

Henoch-Schonlein Purpura

68
Q

What precedes IgA nephropathy?

A

URTI 1-2 days before (then get frank haematuria)

HistoPath (21 decks)

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