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Basic Human Pathology 2 > Kidney > Flashcards

Kidney Flashcards

1
Q

order the kidney hilum structure from anterior to posterior

A

vein
artery
nerve
ureter

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2
Q

what is the significance of perirenal sinus fat

A

it is important in staging cancer

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3
Q

what is the functional unit of the kidney

A

nephron

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4
Q

what 5 things make up a nephron

A

glomerulus
proximal tuule
thin limb
distal tubule
collecting duct

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5
Q

what forms the walls of glomerular tuft capillaries

A

endothelial cells

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6
Q

what forms fenestrated areas in the glomeruli to let things filter

A

podocytes

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7
Q

what makes up the glomerular basement membrane

A

endothelial cells and podocytes

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8
Q

what do mesangial cells do

A

support cells (contractile, phagocytic, proliferators, and chemical mediators)

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9
Q

which structure is found at the base of a glomerulus

A

vascular pole - where the afferent vessel enters and the efferent vessel leaves

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10
Q

define azotemia

A

elevation in blood urea nitrogen (BUN) and creatine

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11
Q

define uremia

A

clinical condition of having azotemia

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12
Q

what is a nephritic syndrome

A

inflammation of the glomerulus

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13
Q

what four things does nephritic syndrome present with

A

hematuria
decreased GFR
mild/moderate proteinuria
hypertension

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14
Q

what is nephrotic syndrome

A

derangement în glomerular capillary walls which leads to increased permeability to plasma proteins

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15
Q

what four things does nephrotic syndrome present with

A

massive proteinuria
hypoalbuminemia
severe edema
hyperlipidemia and lipiduria

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16
Q

what is acute kidney injury

A

glomerular, interstitial, vascular, or tubular injury

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17
Q

what are two clinical manifestations of acute kidney injury

A

oliguria (little urine) or anuria (no urine)

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18
Q

what classifies kidney disease as chronic

A

persistent diminished GFR for 3 months or more and/or persistent albuminuria

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19
Q

what is the GFR in someone in end stage renal disease (ESRD)

A

less than 5%

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20
Q

what are the two main types of glomerular disease

A

antibody mediated destruction or deposition of circulating antigen/antibody complexes

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21
Q

which type of glomerular injury is most common

A

immune mediated (anti-body immune complex mediated)

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22
Q

what are the four basic pathological responses to glomerular injury

A

hypercellularity
basement membrane thickening
hyalinosis
sclerosis

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23
Q

what happens when there is hypercellularity from glomerulus injury

A

crescent formation

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24
Q

what is hyalinosis

A

accumulation of eosinophilic, protein material on H&E

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25
Q

what is sclerosis

A

deposition of extracellular collagenous matrix

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26
Q

what is segmental sclerosis

A

one area of sclerosis

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27
Q

what is global sclerosis

A

entire glomerulus involvement

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28
Q

what is nodular sclerosis of the kidney

A

multiple areas of sclerosis in the glomerulus

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29
Q

what is the other name for acute proliferative glomerulonephritis

A

postinfectious and infection-associated glomerulonephritis

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30
Q

what is acute proliferative glomerulonephritis

A

diffuse proliferation of glomerular cells associated with leukocytes (immune complexes)

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31
Q

what infection most commonly causes acute proliferative glomerulonephritis

A

streptococcal

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32
Q

who is most likely to get acute proliferative glomerulonephritis

A

children between 6-10 years old due to strep. infections

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33
Q

what are the IF features of acute proliferative glomerulonephritis

A

granular deposits of IgG and C3

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34
Q

what are the EM features of acute proliferative glomerulonephritis

A

humps (aggregates of immune mediated cells) on epithelial side of basement membrane

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35
Q

in which condition would you see humps in the EM

A

acute proliferative glomerulonephritis

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36
Q

what is crescentic glomerulonephritis

A

immune mediated fibrin reaction leads to fibrin build up in the periphery of the glomerulus, leading to a crescent shape

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37
Q

what is membranous nephropathy

A

diffuse thickening of the glomerular capillary wall due to accumulation of IgG deposits along the subepithelial side of the basement membrane

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38
Q

what are the most common causes of membranous nephropathy

A

mostly primary (autoimmune disease)
can also be due to things like drugs or cancer

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39
Q

what are the light microscopy features of membranous nephropathy

A

diffuse thickening of the glomerular capillary wall

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40
Q

what are the EM features of membranous nephropathy

A

electron-dense deposits on the epithelial side of the basement membrane

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41
Q

what is minimal change disease

A

thinning of the podocytes only seen by electron microscopy

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42
Q

what is the most common cause of nephrotic syndrome in children

A

minimal change disease

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43
Q

minimal change disease is a common occurrence with what

A

corticosteroid therapy

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44
Q

what is the most common cause of nephrotic syndrome in adults in the US

A

focal segmental glomerulosclerosis

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45
Q

which portion of the glomerulus is affected by focal segmental glomerulosclerosis

A

capillary tuft of glomerulus

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46
Q

what are two secondary causes of focal segmental glomerulosclerosis

A

HIV and obesity

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47
Q

what does the EM of focal segmental glomerulosclerosis show

A

diffuse effacement (loss) of podocyte foot processes

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48
Q

what is HIV-associated nephropathy

A

collapsing variant of focal segmental glomerulosclerosis
shows collapsing of tuft

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49
Q

what is membranoproliferative glomerulonephritis

A

deposition of immune-mediated complexes
two different types

50
Q

what is seen in type 1 membranoproliferative glomerulonephritis

A

subendothelial IgG complex deposits typically due to infections

51
Q

what is seen in type 2 membranoproliferative glomerulonephritis

A

intramembranous dense deposits due to compliment cascade activation

52
Q

what is another name for IgA nephropathy

A

berger disease

53
Q

what is IgA nephropathy (Berger disease)

A

mesangial thickening with IgA deposition that can be accompanied by IgG, IgM, and C3

54
Q

what is the most common type of glomerulonephritis worldwide

A

IgA nephropathy (Berger disease)

55
Q

what is hereditary nephritis

A

mutations in type 4 collagen genes

56
Q

what are the two main types of hereditary nephritis

A

alport syndrome and thin basement membrane lesion

57
Q

what is Alport syndrome

A

type 4 collagen causes irregular basement membrane thickening

58
Q

what is thin basement membrane lesion

A

type 4 collagen causes thinning of the basement membrane

59
Q

what is henoch-schonlein purpura

A

deposition of IgA or C3 complexes in small vessels

60
Q

what is the leading cause of renal failure in the US

A

diabetic nephropathy

61
Q

what are the two main things seen in the glomerulus of someone with diabetic nephropathy

A

basement membrane thickening and Kimmelsteil Wilson nodules

62
Q

Kimmelsteil-Wilson nodules are seen in which condition

A

diabetic nephropathy

63
Q

what is the most common acute kidney injury

A

acute tubular injury/necrosis

64
Q

what do you see in someone with acute tubular injury/necrosis

A

proteinaceous casts mostly in the proximal tubules

65
Q

what are the three main causes of acute tubular injury/necrosis

A

infections, toxins, and physical factors

66
Q

what is the most common origin of pyelonephritis

A

ascending infection

67
Q

define pyelonephritis

A

inflammation of kidneys and collecting systems

68
Q

what are the two most common gross features of acute pyelonephritis

A

papillary necrosis and micro-abscesses

69
Q

define pyonephrosis

A

acute case where there is a total or almost complete obstruction of renal parenchyma

70
Q

in which condition could you see a blunted calyx/scar

A

a chronic case of pyelonephritis

71
Q

what is the most important microscopic feature of chronic pyelonephritis

A

tubular thyroidization

72
Q

what is xanthogranulomatous pyelonephritis

A

rare form of chronic pyelonephritis that can produce stag horn calculi

73
Q

xanthogranulomatous pyelonephritis mostly affects who

A

women and those with diabetes mellitus

74
Q

what is phenacetin

A

a type of acetaminophen that used to cause lots of cases of tubulointerstitial nephritis

75
Q

what is urate nephropathy

A

uric acid crystals in the renal tubules (collective ducts) which causes obstructions and can lead to acute renal failure

76
Q

what is seen in the medulla of someone with urate neuropathy

A

renal tophi (aggregate of urate crystals)

77
Q

what is nephrocalcinosis

A

excess calcium deposition in the kidney which can lead to stone formation

78
Q

what is seen in light chain cast nephropathy (myeloma kidney)

A

bence jones protein (casts)

79
Q

what is bile cast nephropathy

A

condition seen in patients with chronic liver disease
elevated serum bilirubin leads to bile casts

80
Q

what is another name for bile cast nephropathy

A

cholemic nephrosis

81
Q

what would be seen in someone with nephrosclerosis

A

sclerosis of small renal vessels
leads to medial and intimal thickening, hyalinization, and fine granular cortical surfaces

82
Q

how does malignant hypertension affect the kidneys

A

pinpoint petechial hemorrhages on cortical surface (flea bitten appearance) and fibrinoid necrosis

83
Q

in which condition would you see a flea bitten appearance of the kidneys

A

malignant hypertension

84
Q

what is the second most common cause of renal artery stenosis

A

fibromuscular dysplasia

85
Q

sickle cell nephropathy causes what three clinical manifestations

A

hematuria
diminished concentrating ability
proteinuria

86
Q

renal agenesis is most commonly associated with which genetic condition

A

trisomy 13

87
Q

what is renal hypoplasia

A

kidney is underdeveloped - usually unilateral

88
Q

what is an ectopic kidney

A

kidney in an abnormal position

89
Q

horseshoe kidney most commonly affects which pole

A

lower pole

90
Q

what is the most common congenital kidney anomaly

A

horseshoe kidney

91
Q

autosomal dominant (adult) polycystic kidney disease is caused by a gene mutation in which gene

A

PKD1 gene

92
Q

40% of patients with polycystic kidney disease also have which disease

A

polycystic liver disease

93
Q

which condition is often caused by polycystic disease

A

hypertension

94
Q

autosomal recessive (childhood) polycystic kidney disease is caused by a gene mutation in which gene

A

PKHD1

95
Q

what do the cysts look like in someone with autosomal recessive (childhood) polycystic kidney disease

A

elongated, slit like cysts

96
Q

what is medullary sponge kidney

A

condition where multiple cysts form in the collecting ducts of the medulla

97
Q

what is multicystic renal dysplasia

A

sporadic, varying sized cysts made of undifferentiated mesenchyme like cartilage

98
Q

acquired cystic disease increases your risk of which disease at a 100-fold increase

A

renal cell carcinoma

99
Q

define hydropnephrosis

A

dilation of renal pelvis and calyces with atrophy of the kidney due to obstructed urine outflow

100
Q

what are the four types of calculi

A

calcium oxalate
struvite
uric acid
cystine

101
Q

what is the most common type of calculi

A

calcium oxalate

102
Q

what is a renal papillary adenoma

A

often peripheral and benign tumor arising from the renal tubular epithelium

103
Q

what is an angiomyolipoma

A

benign tumor of the kidney made of vessels, smooth muscle, and fat

104
Q

which tumor can be described as mahogany

A

oncocytoma

105
Q

what is an oncocytoma

A

benign tumor of the kidney that can metastasize and may have a central scar

106
Q

what is the most common type of renal cancer in adults

A

renal cell carcinoma

107
Q

renal cell carcinoma is associated with which condition

A

Von Hippel-Lindau syndrome

108
Q

what are the 5 major variants of renal cell carcinoma

A

clear cell
papillary
chromophobe
collecting duct
medullary

109
Q

what is the other variant of clear cell variant of renal cell carcinoma

A

Xp11 translocation carcinoma

110
Q

which is the most common variant of renal cell carcinoma

A

clear cell

111
Q

what is clear cell carcinoma

A

kidney carcinoma where the cells have a clear cytoplasm and can invade the renal vein
grossly, they appear very yellow-orange

112
Q

what is papillary cell carcinoma of the kidney

A

arises from the distal convoluted tubule
grossly, they are very hemorrhagic and cystic

113
Q

in which condition would you see perinuclear halos and nuclear pleomorphism

A

chromophobe carcinoma

114
Q

in which condition would you see a hobnail pattern

A

collecting duct carcinoma

115
Q

which variant of renal cell carcinoma has the worst prognosis

A

medullary carcinoma

116
Q

what is urothelial carcinoma of the renal pelvis

A

a tumor originating from the pelvic urothelium
grossly, they are very friable

117
Q

what is the most common primary renal tumor of childhood

A

wilms tumor (nephroblastoma)

118
Q

wilms tumor (nephroblastoma) is associated with which three conditions

A

WAGR syndrome
denys-drash syndrome
beckwith-wiedemann syndrome

119
Q

wilms tumors are made of which three things

A

blastema, stroma, and epithelial cells

120
Q

a T1 kidney tumor is how big in size

A

less than or equal to 7 cm

121
Q

renal vein and renal sinus fat involvement stages a kidney tumor at what automatically

A

T3

122
Q

involvement outside of Gerota’s fascia stages a kidney tumor to what

A

T4

Basic Human Pathology 2 (14 decks)

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