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Pathology > Kidney > Flashcards

Kidney Flashcards

1
Q

What are tge 2 major grps of tubulointerstitial kidney dis?

A
  1. Ischemic/toxic tubular injury
  2. Infalmmatory rxn (tubulointerstitial nephritis)
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2
Q

What is the important clinical chracteristic of acute tubular injury or necrosis?

A

Acute reneal failure

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3
Q

What is the morphological chrcteristic of acute tubular necrosis?

A

Coagulative necrosis or tubular epithelial cells

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4
Q

What is the primary cause of Acute tubular injury?

A

Ischemia/Hypoxia or Nephrotoxicity

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5
Q

What are the diff agents ghat can cause nephrotoxocity?

A

Endogenous agents: hemoglobins, myoglobin, monoclonal light chain, bile/bikirubin

Exogenous: drugs, radioconstrast dyes, heavy metals, organic solvents

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6
Q

What are the main contributors to acute tubular injury?

A

Tubular epithelial cell injury
Altered blood flow in the vessels of your kidney

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7
Q

What is the morphology of ATI?

A

Focal tubular pepithelial necrosis
Tubulorrhexis: repture of basement membranes
Occlusion of tubular lumens by casts

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8
Q

What are the 3 stages of a classic case of ATI?

A

Initiation - rise in BUN, declining GFR
Mainteance: sustained decrease in urine output, hyperkalemia, metabolic acidosis, & other manifesations of uremia
Recovery: steady increase in urine voume, hjypokalemia, normal BUN & creatinine levels

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9
Q

What are groups of inflammatory diseases of tubules & interstitium that manifestest with azotemia?

A

Tubulointersitial nephritis

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10
Q

What body structure is prominently involved?

A

Renal pelvis

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11
Q

What are nonbacterial origins of intersitial nephritis?

A

Drug-induced injury
Metabolic disorders
Physical injury
Viral infections
Immune rxns

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12
Q

How would you describe the clinical onset of acute and chronic tubulointerstitial nephritis?

A

Acute - rapid onset, infection/allergic drug rxn
CHronic - gradual and slow deterioration of renal function

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13
Q

What is the histological feature of acute tubulointerstitial nephritis?

A
  • interstitial edema
  • leukocytic cinfiltraiton
  • tubular injury
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14
Q

What are the histological features of chronic htubuloitnerstitial nephritis?

A

Interstitial FIBROSIS
Mononuclear leukocyte infiltration
Tubular atrophy

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15
Q

What is one of the most common diseases in the kidney that involves the inflammation of the tubules, interstitium, and renal pelvis?

A

Pyelonephritis

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16
Q

In what conditions are pyelonephritis associated with?

A

Lower urinary tract infections (UTI)

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17
Q

What are the 2 forms of pyelonephritis?

A

Acute * chronic pyelonephritis
Acute pyelonephritiss - UTI
Chronic pyelonephritis - obstruction that leads to repeat episodes of acute pyelonephritis

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18
Q

What are the 2 routes by which bacteria can ascend to the kidney?

A

Acending - bacteria from the lower UT —> kidneys (reflex/obstruction

Hematogenous - seeding of kidneys from distant foci of septicemia/infective endocarditis

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19
Q

What is the cause of acute phyelonephritis?

A

Ascending lower bacterial UTI

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20
Q

What is a common cause of recurrent UTI in children?

A

Vesico-ureteral reflux

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21
Q

What is the alternative pathogenesis of acute pyelonephritis?

A

Obstruction of urine outflow

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22
Q

What is the gross morphology of acute pyelonephritis?

A

Normal/swollen
Cortical surfaces - multiple, discrete, yellow-white abscesses

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23
Q

What is the histologic morphology of acute pyelonephritis?

A

Neutrophils within tubular lumen
Suppurative necrosis
Glomeruli are resistant to infection

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24
Q

What are the clincial manifestaions of acute pyelonphritis

A

Flank pain
Systemic signs: fever & body malaise/

Pus cells in urine
WBC casts
Bladder & urethral irritation: dyuria, frequency, urgency

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25
Q

What rae the diff complications of acute pyelonephritis?

A

Renal papillary necrosis
Pyonephrosis
Perinephric abscess

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26
Q

What is the type of pyelonephritis complication where it is an infrequent form if pyelonephritis seen in diabetic px, UT obstruction, analgesic abuse & sickle cell anemia?

A

Renal papillary necrosis

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27
Q

What are the gross & histologic features of renal papillary necrosis?

A

Gross: gray-white to yellow necrosis at the renal pyramids

Histology: coagulative necrosis surrounded by neutrophilic infiltrate

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28
Q

What kind of pyelonephrotic complication is a result of total or complete obstruction along the ureter? What is a characteristic feature of this condition?

A

Pyonephrosis

Suppurative exudate ==> pus fills & accumulates in the renal pelvis, calyces, & ureter

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29
Q

What kind of pyelonephrotic complication is an extension of supurative inflammation through the renal capsule? What is its characteristic feature?

A

Peripnephric abscess

pus in the perinephric tissue

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30
Q

What structures of the kidney are affected by hronic peylonephritis?

A

Renal parenchyma (calcyes, pelvis) & pelvicalcyeal system

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31
Q

What are the 2 forms of chronic pyelonephritis?

A

Chronic reflux pyelonephritis
Chronic obstructive pyelonephritis

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32
Q

What is a more common form of chronic pyelonephritis where there is a superimposition of the UTI on congenital vesicoureteral & intrarenal reflex?

A

Chronic reflux pyelonephritis
- valve does not seal or close completely
- SCARRING of the renal tissue

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33
Q

What is a form of chronic pyelonephritis where there are recurrent episodes of obstruction & infection resutls to renal damage & scarring?

A

Chronic obstructive pyelonephritis

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34
Q

What is the gross morphology of chronic pyelonephritis?

A

Gross: irregularly scarred cortical surfaces
Flattening of renal papillae
Blunting & deformed calcyces

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35
Q

What is the histologic morphology of chronic pyelonephritis?

A

Atrophy of tubules: dilated w/ flattened epithelium
Thyroidization: tubualr lumen is filled wtih pink casts (similar to thryoid colloid)

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36
Q

What is a specific for of pyelonephritis that is associated with infections of Proteus spp & obsutrction?

A

Xanthogranulomatous pyelonephritis

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37
Q

What are the gross & histological features of xanthogranulomatous pyelonephritis?

A

Gross: localized mass-like lesion (simialr to renal tumor)
Histo: foamy macrophages interspered with plasma cells & lymphocytes

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38
Q

What are the clinical manifestations of xanthrogranulomaotus pyelonephritis?

A

Flank pain, pyuria & fever

Mild proteinuria - focal segmental glomerulosclerosis —> ESRD

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39
Q

What are the 2 types of drug-induced tubulointerstitial nephritis?

A

Acute drug-induecd interstitial nephritis
Chronic interstitial nephritis

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40
Q

What is the 2nd most common cause of AKI after pyelonephritis?

A

Drug-induced tubulointerstitial nephritis

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41
Q

What are the 3 ways of which kidneys can be injured by toxins and drugs?

A
  • trigger intersitital immunologic rxn
  • acute tubular injury
  • subclinical but cumulative injury to tubules
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42
Q

What are the adverse rxn of acute drug-induced intersitial neprhitis?

A

Synthetic penicillins, thiazides, & NSAIDS

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43
Q

What are the clinical manifestations of acute drug-induced interstitial nephritis?

A

Fever, rash, & renal abnormalities - most common
Manifestations after drug exposure is not depended on dose

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44
Q

What are signs of clinical course of acute intersitital nephritis?

A

Increase serum creatinine or acute kidney injury w/ oliguria

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45
Q

What is aka analgesic nephropathy where it is caused by excessive chronic intake of NSAIDs, phenacetin-containing analgesics, aspirin, tylenol

A

CHronic intersitial nephritis

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46
Q

What type of HSN rxn is chronic interistial nephritis?

A

Type IV

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47
Q

What are the gross morphological changes of chornic interstial nephritis?

A

Tubulointerstitial nephritis
Renal papillary necrosis (DM & HbS)

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48
Q

What is the clincial course for px suffering from chronic interstitia neprhitis?

A

Drug withdrawal -> improve renal function
Complicated UTI
Transitional papillary carcinoma of the renal pelvis in some cases

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49
Q

What are other tubulointerstitial diseases?

A

Urate nephropathy
Hypercalcemia & nephrocalcinosis
Light-chain case nephropathy
Bile cast nephropathy

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50
Q

What are the 3 forms of urate neprhopathy?

A

Acute uric acid nephropathy
Chronic uric acid nephropathy/Gouty nephropathy
Nephrolithiasis

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51
Q

What happens in acute uric acid nephropathy?

A

Ppt of uric acid crystals in renal tubules —> nephron obstruction -> ARF

52
Q

In what population does acute uric acid nephropathy occur?

A

W/ hematologic malignancies or undergoing chemotherapy

Chemo kills tumor cells —> UA produced from NA breakdown —> INC in collecting tubules

53
Q

What is aka gouty nephropathy? WHat causes it?

A

CHronic UA nephropathy
Hyperuricemia —> deposition of urate crystalsi nt he distal convoluted tubule & CTs

54
Q

What causes nephrocalcinosis?

A

Uncontrolled chronic hypercalcemia —> Ca stones form in the tubulointerstitium of kidneys —> tubular obstruction & loss of function

55
Q

What re the earliest functional deficit in nephrocalcinosis?

A

Inability to contrate urine

Tubular acidosis and salt-losing nephritis

56
Q

What are significant features of light chain cast nephropathy?

A

Bence jones proteinuria
Cast nephropathy

57
Q

What are the histological features of light chain nephropathy?

A

Eosinophilic cast fractured into plate-like fragments (brittle)
Tubules appear atrophic with flattened epithelium
Fibrotic interstitium, sprinkled sparsely with lymphocytes

58
Q

What condition is associated with hepatorenal syndrome where there is a marked elevation of seurm blirubibin leading to bile cast formation?

A

Bile cast nephropathy

59
Q

How can bile cast contribute to kidney injury?

A

Bile & bilirubin toxicity
Tubular obstruction

Reversible injury depends on severity & duration of liver dysf

60
Q

What are the causes of urinary tract obstructions?

A

INC susceptibility to infection & stone formation —> occurs at any level of the urinary tract

61
Q

What are the 2 types of urinatry tract obstructions?

A

Extrinsic lesions - compress the ureter
Intrinsic lesion - in the urinary tract

62
Q

What is hydronephrosis?

A

Distention & dilation of renal pelvis & calcyces —> Progressive atrophy of the kidneys due to obstruction of urine outflow

63
Q

What are some common causes of obsturctive lesion of urinary tract?

A

Pregnancy
Tumors
Inflammation: prostatis, urethritis, ureteritis, retroperitonea fibrosis

64
Q

What is the morphology of acute, sudden, or complete urinatry tract obstruction?

A

Subltle morphological changes
Mild dilation of pelvis
Somes with atrophy of renal parenchyma

65
Q

What are the 4 types of stones that can cause urolithiasis?

A

Ca stones
Mg Ammonium PO4 stones
Uric acid stones
Cystine stones

66
Q

What is the composition of Ca stones and what does it look like in imaging?

A

Ca oxalate + Ca PO4

Majority of kidney stones

Radiopaque

67
Q

What type of urolithiasis stone is associated w/ ammonium-producing bacteria (urease pos)leading to alkaline urine? What is the large calculi produces from thsi stone?

A

Mg ammonium phosphate stones

Forms: Staghorn calculi —> largest calculi

68
Q

What type of urinary stone is common in those with hyperuricemia, seen in gout, & what does it look like in imaging?

A

Uric acid stones

Radiolucent

69
Q

What urinary stone is almost always assoc w/ cystinuria bcos of genetic defects in renal absorption?

A

Cystine stones

70
Q

what are the diff factors that affect stone formation?

A

INC concetration of stone constituents
DEC urine volume
Changes in urinary pH
Presence of bacteria

71
Q

What is the largest stone formed in the kidney?

A

Staghorn calculi

72
Q

What is the gross appearance of staghorn calculi?

A

Hydronephrosis of kidneys & stones are seen as casts of dilated calyces

73
Q

What are the specific conditions required to form staghorn calculi?

A

Urine pH > 7.2 (alkali)
Presence of bacteria in urine (urease pos)

74
Q

What are the substrates of staghorn calculi?

A

Mg NH3 PO4 (Struvite) + Carbonate & CaPO4 (apatite) ppt

75
Q

What are the 5 vascular diseases of the kidneys?

A

Nephrosclerosis
Renal artery stenosis
Thrombotic microangiopathies
Renal infarcts
Others: atherosclerosis, atheroembolic renal diseaes, sickle cell nephropathy

76
Q

What renal vascular disorder is strongly associated with hypertension?

A

Nephrosclerosis

77
Q

What are the 2 process invaded by nephrosclerosis?

A

Medial & intimal thickening
Hyalinization of arteriolar wlal

78
Q

What happens in the medial and intimal thickeing of renal tissue in nephrosclerosis?

A

Thickening of the BV wall
Narrow lumen
Glomerulosclerosis

79
Q

What happens if there is hyalization of the arteriolar wall of nephrosclerosis?

A

INC deposition of basement membrane matrix in the endothlium

80
Q

What is the gross morphology of nephrosclerosis?

A

Cortical scarring & shrinking of the kidney —> GRAIN LEATHER APPEARANCE

81
Q

What is the histologic morphology of nephrosclerosis?

A

Hyaline arteriosclerosis
- lumen narrowing
- microscopic subcapsular scars

82
Q

What are the consequences of vascular narrowing in nephrosclerosis?

A

Tubular atrophy
Interstitial fibrosis
Glomerular alterations
BASICALLY KUMAKAPAL YUNG EPITHELIUM

83
Q

What are the 3 grps of hypertensives that are highly susceptible to formaiton of nephrosclerosis?

A

Balcks & african descent
Persons with underlying dis (ie DM)
Persons with malignant hypertension

84
Q

What causes renal artery stenosis?

A

INC produciton of renin from ischemic kidneys

85
Q

What are the common causes of renal artery stenosis?

A

Narrowing of artery via atheromatous plaque
Fibromuscular dysplasia

86
Q

What is the most common cause of stenosis?

A

Narrowing of artery via theromatous plaque

87
Q

What ist he 2nd most common cause of stenosis?

A

Fibromuscular dyplasia

88
Q

What renal vascular disorder forms due to excessive platelet activation depositing thrombi in capillraires & arteroles?

A

Thrombocytopenia
Microangiopathic hemolytic anemia

89
Q

What leads to the ingestion of food contaminiated with Shiga-like toxin?

A

Clasic HUS

90
Q

What causes the def of TTP?

A

ADAMTS 13 protease

91
Q

What is the gross & histological morphology of thrombotic microangiopathy?

A

Gross:
Acute: patchy or diffuse cortical necrosis & subcapsular etechna

Histo: distended ad occluded glomerular capillaries by thrombi

92
Q

What is a comon site for development of infarcts?

A

Renal infarcts

93
Q

What are often coauses of renal infarcts due to elbolism?

A

Mural thormbosis in the L atrum due to MI
Less freq: Vegetative endocarditis, aortic aneurystems, & aortic atherosclerosis

94
Q

What is the gross & histo morphology of renal infatcts?

A

Gross: White, anemic or pale infarcts that are wedhe-shaped at the apex point towards medula

Histo: coagualtive necrosis

95
Q

What are other vascular renal disorders?

A

Atheroembolic renal disease
Atherosclerosiss
Sicke cell nephropathy

96
Q

What vascular renal dis can lead to HTN in older aging indivisduals?

A

Atherosclerosis

97
Q

What are the diff congenital and cystic disesaes of kidneys?

A

Agenesis of the kidney
Horseshoe kidneys
Cystic disorders of th ekidney

98
Q

What is bilateral and unilateral agenesis?

A

Bilateral: stillborn infants who have limb defects, hypoplastic lunfs

Unilateral: solitary kidney enlarges in compensation to hypertrophy

99
Q

What does a horseshoe kidney look like?

A

Fusion of upper and lower pole of the kidney

100
Q

What are the significance of cystic disorders of the kidney?

A

Heterogenous
Represent diagnost problems
Acute polycystic kidney disease —> major chause of CKD
confused with malignant disorders

101
Q

What are the different benign neoplasms of the kidney?

A

Oncocytoma
Renal papillary adenoma
Angiomyolipoma

102
Q

What is oncocytoma and its histological features?

A

Arises fro intercalated cells of collecting ducts
Large eosinophilic cells —> small round benign appearing nuclei

103
Q

What are the gross & histological morphologies of renal papillary adenoma?

A

Gross: small, discrete nodules arising from the renal tubular epithelium

Histology: Papillomatous structures lined by regular unform small epithelial cells

104
Q

What benign kidney neoplasm consists of BVs, smooth muscles & fat? WHere does it originate?

A

Angiomyolipoma

Perivascular epithelioid cells

105
Q

In what condition is angiomyolipoma seen?

A

Tuberous sclerosis —> mutations in TSC1 or TSC2

106
Q

What are the diff malignant neoplasms of the kidney?

A

Renal cell carcinoma
Urothelial (transitional) renal carcinomas

107
Q

What is the most important risk factor in the development of renal cell carcinoma?

A

Tobacco smoking
This cancer is sporadic

108
Q

What malignant neoplasm of the kidney is common in children?

A

Nephroblastoma or WIlms tumor

109
Q

What is a protein found in renal cell carcinoma that is a product of VHL gene, a tumor suppressor?

A

Von Hippel-Linday protein —> found in chromosome 3p

110
Q

What is the use of VHL protein?

A

Inhibits hypoxia inducible genes involved in angiogenesis —> VEGF, TGF-a, GLUT-1

111
Q

What is the result of loss of VHL?

A

Tumor angiogenesis, tumor cell proliferation, and epithelial cell proliferation

112
Q

What are the diff forms of renal cell carcinoma?

A

Clear cell type
Papillary carcinoma
Chromophobe

113
Q

What is the most common histologic variant of renal cell carcinoma that has tumor cells with clear or granular cytoplasm?

A

Clear cell type

114
Q

What is the cause of clear cell type of renal cell carcinoma?

A

Proximal convoluted tubular
Unilateral and solitary

115
Q

What are the gross & histological morphology of clear cellt type of renal cell carcinoma?

A

Gross: bright yellow-gray to white spherical masses
Histology: tumor cells have round/polygonal shape w/ clear to granular cytoplasm rich in glycogen and lipid

116
Q

What type of renal cell carcinoma arises from the DISTAL convuluted tubule & appears multifocal & bilateral?

A

Papillary carcinoma

117
Q

What is the chromosomal abnormality of papillary carcinoma?

A

Trisomies 7 &17 + loss of Y in male px in the sporadic form

118
Q

What are the gross and histological features of papillary carcinoma?

A

Gross: hemorrhagic w/ necrotic fat surface —> surrounds border fo tumor —> fibrous pseudocapsule

Histo: Cuboidal cells arranged in papillary formaiton within the papillae

119
Q

What type of renal cell carcinom has multiple losses of entire chromosomes? From where does it arise?

A

Chromophobe

Intercalated cells of the collecting ducts

120
Q

What are the gross & histo features of chromophobe?

A

Gross: well-circumstribed solid beige or light brown fat surface

Histo: pale eosinophilic cells often with perinuclear halo

121
Q

What are the clinical features of RCC? Which organ is it prevalent?

A

Paraneoplatic syndrome —> extra-renal manifesations

Prevalent in the lungs & bones

122
Q

What type of malignant neoplasm of the kidney is morphoogically identical to transitional cell carcinoma of the bladder?

A

Urothelial (transitional) renal carcinomas

123
Q

What are the clinical manifestations of urothelial renal carcinoma?

A

Obstructive symptoms of fragmentation of tumor
Noticeable hematuria

124
Q

Where does urothelial renal carcnoma arise from?

A

Intercalated cells of collecting ducts

125
Q

What are the gross & histo features of urothelial renal cacinoma?

A

Gross: exophytic ball0-like masses in the renal pelvis & present as obstructive lesions

Histo: >10 cell layers of neopaltic urothelial cells lining the papillae

Pathology (8 decks)

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