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OS4 > Kidney and Urinary Tract Pathology > Flashcards

Kidney and Urinary Tract Pathology Flashcards

1
Q

WAGR syndrome is associated with ________

A

Deletion of WT1 tumor suppressor gene (located at 11p13)

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2
Q

Which drugs can causes membranous nephropathy?

A

NSAIDs

Penicillamine

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3
Q

Results of hypogammaglobulinemia seen in nephrotic syndrome

A

Increased risk of infection

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4
Q

How does Wilms tumor present?

A

Large, unilateral flank mass with hematuria and HTN (due to renin secretion)

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5
Q

Most common pathogens of pyelonephritis

A

E coli

Enteroccoccus faecalis

Klebsiella

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6
Q

Results of hypoalbubinemia seen in nephrotic syndrome

A

Pitting edema

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7
Q

Alkaline urine with ammonia scent

A

Proteus mirabilis

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8
Q

poststreptococcal glomerulonephritis on H&E

A

hypercellular, inflamed glomeruli

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9
Q

Hamartoma comprised of blood vessels, smooth muscle, and adipose tissue

A

Angiomyolipoma

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10
Q

___________ and ____________ are used prior to initiation of chemotherapy to decrease risk of urate-induced acute tubular necrosis.

A

Hydration; allopurinol

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11
Q

Paraneoplastic syndromes associated with renal cell carcinoma

A

EPO

Renin

PTHrP

ACTH

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12
Q

Risk factors for uric acid stones

A

Hot, arid climates, low urine volume, and acidic pH

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13
Q

Where does the tumor develop in adenocarcinoma that arises from a urachal remnant?

A

Dome of the bladder

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14
Q

Inherited defect leading to bilateral enlarged kidneys with cyst in the renal cortex and medulla

A

Polycystic kidney disease

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15
Q

Histo of chronic pyelonephritis

A

Atrophic tubules containing eosinophilic proteinaceous material resemble thyroid follicles

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16
Q

Denys-Drash syndrome

A
  • Wilms tumor
  • Progressive renal (glomerular) disease
  • Male pseudohermaphroditism
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17
Q

Sterile pyuria suggests urethritis due to ____________ or ___________.

A

Chlamydia or Neisseria gonorrhoeae

*Dominant presenting sign of urethritis is dysuria

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18
Q

Types of acue renal failure

A

Prerenal

Postrenal

Intrarenal

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19
Q

Clinical features of uremia

A

Increased nitrogenous waste products in blood (azotemia) results in nausea, anorexia, pericarditis, platelet dysfunction, encephalopathy with asterixis, and deposition of urea crystals in skin

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20
Q

Nephritic syndrome that arises after group A B-hemolytic streptococcal infection of the skin or pharynx

A

Poststreptococcal glomerulonephritis

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21
Q

Which causes of rapidly progressive glomerulonephritis present with a linear IF pattern

A

Goodpasture syndrome

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22
Q

How does a renal cell carcinoma result in left-sided varicocele?

A

Involvement of the left renal vein by carcinoma blocks drainage of the left spermatic vein leading to varicocele

*Right spermatic vein drains directly into the IVC; hence, right-sided varicocele is not seen

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23
Q

Long term results on medulalry cystic kidney disease

A

Parenchymal fibrosis results in shrunken kidneys and worsening renal failure

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24
Q

Classic presentation of ammonium magnesium phosphate stone

A

Staghorn calculi in renal calyces

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25
Q

Cystine stones are associated with _______.

A

Cystinuria

  • A genetic defect of tubules that results in decreased reabsorption of cysteine
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26
Q

Nephritic syndrome that progresses to renal failure in weeks to months

A

Rapidly progressive glomerulonephritis

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27
Q

Most common cause of nephrotic syndrome in Hispanics and AA

A

Focal segmental glomerulosclerosis

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28
Q

Causes of nephrotoxic acute tubular necrosis

A

Aminoglycosides

Heavy metals

Myoglobinuria

Ethylene glycol (associated with oxalate crystals in urine)

Radioconstrast dye

Urate (tumor lysis syndrome)

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29
Q

Conjoined kidneys usually connected at the lower pole

A

Horseshoe kidney

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30
Q

Autosomal dominant PKD is associate with _________, ________, and _________.

A

Berry aneurysm,hepatic cysts, and mitral vale prolapse

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31
Q

Gross and microscopic of renal cell carcinoma

A

Yellow mass; microscopically, the most common variant exhibits clear cystoplasm

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32
Q

Beckwith-Wiedemann syndrome is associated with ____________.

A

Mutations in WT2 gene cluster (imprinted genes at 11p15.5), particularly IGF-2

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33
Q

How does IgA nephropathy present?

A

Episodic gross or microscopic hematuria with RBC casts, usually following mucosal infections

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34
Q

Cysts often develop witin shrunken end-stage kidneys during dialysis, increasing the risk for ____________.

A

Renal cell carcinoma

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35
Q

How does cystitis present?

A

Dysuria

Urinary frequency

Urgency

Suprapubic pain

*Systemic signs are usually absent

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36
Q

BUN: Cr ratio, FENa, and urine osmolality in prerenal azotemia

A

BUN: Cr ratio> 15

[FENa]<1%

Urine osmolality >500

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37
Q

How does alport syndrome present?

A

Isolated hematuria, sensory hearing loss, and ocular disturbances

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38
Q

EM of membranous nephropathy

A

Subepithelial depositis with “spike and dome” appearance on EM due to immune complex deposition

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39
Q

Beckwith-Wiedemann syndrome

A
  • Wilms tumor
  • Neonatal hypoglycemia
  • Muscular hemihypertrophy
  • Organomegaly (including tongue)
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40
Q

Risk factors of sqaumous cell carcinoma of the bladder

A
  • Chronic cystitis (older women)
  • Shistosoma haematobium infection (Egyptian male)
  • Long-standing nephrolithiasis
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41
Q

EM of poststreptococcal glomerulonephritis

A

Supportive

  • Children rarely progress to renal failure
  • Some adults develop rapidly progressive glomerulonephritis
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42
Q

Treatment for uric acid stones

A

Treatment involves hydration and alkalinization of urine (potassium bicarbonate); allopurinol is also administered in patients with gout.

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43
Q

Selective proteinuria is seen in __________.

A

Minimal change disease

*Loss of albumin, but not immunoglobulin

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44
Q

Injury and necrosis of tubular epithelial cells

A

Acute tubular necrosis (intrarenal azotemia)

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45
Q

Why is hypocalcemia a clinical feature of chronic renal failure?

A

Due to decreased 1-alpha hydroxylation of vitamin D by proximal renal tubule cells and hyperphosphatemia

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46
Q

Most common malignant renal tumor in children

A

Wilms tumor

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47
Q

IgA nephropathy results in immune complex deposition in _________ of glomeruli.

A

Mesangium

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48
Q

Cuase of acute tubular necrosis

A

Necrotic cells plug tubules; obstruction decreases GFR

*Brown, granular casts are aseen in the urine

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49
Q

Goodpasture’s syndrome

A

Antibody against collagen in glomerular and alveolar basement membranes; presents as hematuria and hemoptysis classically in young, adult males

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50
Q

Treatment for a calcium oxalate and/ or calcium phosphate stone

A

HCTZ (calcium-sparing diueretic)

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51
Q

Major way in which uric acid stones differ from other types of stones

A

Radiolucent

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52
Q

Which parts of the kidney are particularly susceptible to ischemic damage?

A

Proximal tubule and medulalry segment of the thick ascending limb

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53
Q

Cuases of renal papillary necrosis

A

Chronic analgesic abuse (long term-phenacetin or aspiring use)

Diabetes mellitus

Sickle cell trait or disease

Severe acute pyelonephritis

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54
Q

Histo of membranous nephropathy

A

Thick glomerular basement membrane

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55
Q

Chronic pyelonephritis

A

Interstitial fibrosis and atrophy of tubules due to multiple bouts of acute pyelonephritis

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56
Q

BUN: Cr ratio, FENa, and urine osmolality in postrenal azotemia

A

Early

  • BUN: Cr ratio> 15
  • [FENa]<1%
  • Urine osmolality >500

Long-standing

  • BUN: Cr ratio<15
  • [FENa]> 2%
  • Urine osmolality<500
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57
Q

Why is renal osteodystrophy a clinical feature of chronic renal failure?

A

Due to secondary hyperparathyroidism, osteomalacia, and osteoporosis

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58
Q

How does urothelial carcinoma?

A

Generally seen in older adults; clasically presents with painless hematuria

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59
Q

Chronic pyelonephritis leads to…

A

Cortical scarring with blunted calyces; Scarring at upper and lower poles is characteristic of vesicoureteral reflux

60
Q

How does acute intersitial nephritis present?

A

Oliguria, fever, and rash days to weeks after starting a drug; eosinophils may be seen in urine

61
Q

How is rapidly progressive glomerulonephritis characterized?

A

Crescents in Bowman space on H&E stain; crescents are comprised of fibrin and macrophages

62
Q

Clinical features of acute tubular necrosis

A
  • oliguria with brown, granular casts
  • Elevated BUN and creatinine
  • Hyperkalemia with metabolic acidosis
63
Q

What increases the risk for pyelonephritis?

A

Vesicoureteral reflux

64
Q

How does autosomal recessive form of polycystic kidney disease present?

A

In infants as worsening renal failure and hypertension; newborns may present with Potter sequence

65
Q

Hallmark of acute renal failure

A

Azotemia (increased BUN and creatinine), often with oliguria

66
Q

Ischemia leading to acute tubular necrosis is often preceded by ____________.

A

Prerenal azotemia

67
Q

Histo of membranoproliferative glomerulonephritis

A

Thick glomerular basement membrane on H&E often with “tram-track” appearance

68
Q

There is an increased risk of angiomyolipoma in ___________.

A

Tuberous sclerosis

69
Q

Cause of postrenal azotemia

A

Due to obstruction o furinary tract downstream from the kidney

70
Q

in nephrotic syndrome, proteinuria must be > ___________g/day.

A

3.5

71
Q

Biopsy of nephritic syndrome

A

Hypercellular, inflamed glomeruli

72
Q

Is acute tubular necrosis reversible?

A

Reversible, but often requires supportive dialysis since electroclyte imbalances can be fatal

*oliguria can persist for 2-3 wks before recovery; tubular cells take time to reenter the cell cycle and regenerate

73
Q

BUN: Cr ratio, FENa, and urine osmolality in intrarenal azotemia

A
  • BUN: Cr ratio<15%
  • [FENa]>2%
  • Urine osmolality <500
74
Q

How does renal cell carcinoma present?

A

Hematuria, palpable mass, and flank pain

*All three symptoms rarely occur together

75
Q

How does renal papillary necrosis present?

A

Gross hematuria and flank pain

76
Q

Flat pathway of urothelial carcinoma development

A
  • Develops as a hig-grade papillary tumor and then invades
  • Associated with early p53 mutations
77
Q

Most common causes of chronic renal failure

A

DM, HTN, and glomerular disease

78
Q

Cause of prerenal azotemia

A

Due to decreased blood flow to kidneys.

79
Q

Results of unilateral kidney agenesis

A

Hypertrophy of the existing kidney; hyperfiltration increases risk of renal failure later in life

80
Q

Most common type of lower urinary tract cancer

A

Urothelial (Transitional cell) carcinoma

81
Q

Causes of rapidly progressive glomerulonephritis

A

Goodpasture syndrome

PSGN or diffuse proliferative glomerulonephritis

Wegener granulomatosis

Microscopic polyangiitis

Churg-strauss syndrome

82
Q

Causes of nephrolithiasis in order of frequency

A

Calcium oxalate and/or calcium phosphate

Ammonium magnesium phosphate

Uric acid

Cystine

83
Q

Malignant kidney tumor comprised of blastema, primitive glomeruli and tubules, and stromal cells

A

Wilms tumor

84
Q

Pathophysiology of nephrotic syndrome causes by DM

A
  • Nonenzymatic glycosylation of the vascular basement membrane resulting in hyalin arteriolosclerosis
  • Glomerular efferent arteriole is more affected than the afferent arteriole, leading to high glomerular filtration pressure
    • Hyperfiltration leads to microalbuminuria
  • Eventual progression to nephrotic syndrome
85
Q

Characteristics of sporadic renal cell carcinomas

A
  • Classically arise in adult males as a single tumor in the upper pole of the kidney
  • Risk factor: cigarette smoke
86
Q

Drug-induced hypersensitivity involving the interstitium and tubules; results in acute renal failure

A

Acute intersitital nephritis

87
Q

Pathogenesis of renal cell carcinoma

A
  • Loss of VHL tumor suppressor gene, which leads to increased IGF-1 and increased HIF transciption factor (increases VEGF and PDGF)
88
Q

Why is a hypercoagulable state seen in nephrotic syndrome?

A

Due to loss of antithrombin III

89
Q

Autosomal recessive PKD is associated with _______ and __________.

A

Congenital hepatic fibrosis (leads to portal hypertension) and hepatic cysts

90
Q

How does nephrolithiasis present?

A

As colicky pain with hematuria and unilateral flank tenderness

91
Q

Which disease result in granular IF patterns?

A

Poststreptococcal glomerulonephritis or diffuse proliferative glomerulonephritis

92
Q

Findings in urine in chronic pyeloenephritis

A

Waxy casts

93
Q

Nephrotic syndrome

A
  • Glomerular disorders characterized by proteinuria resulting in:
    • Hypoalbuminemia
    • Hypogammaglobulinemia
    • Hypercoagulable state
    • Hyperlipidemia and hypercholesterolemia
94
Q

Acute interstial nephritis may progress to ________.

A

Renal papillary necrosis

95
Q

How does poststreptococcal glomerulonephritis present

A

2-3 wks after infection as hematuria (cola-colored urine), oliguria, HTN, and periorbital edema

96
Q

Calcium oxalate and/ calcium phosphate stones can be seen with _________.

A

Chrohn disease

97
Q

Causes of nephrotic syndrome

A

Minimal change disease

Focal segmental glomerulosclerosis

Membranous nephropathy

Membranoproliferative glomerulonephritis

Diabetes mellitus

Systemic amyloidosis

98
Q

Clinical features of chronic renal failure

A

Uremia

Salt and water retention with resultant HTN

Hyperkalemia with metabolic acidosis

Anemia

Hypocalcemia

Renal osteodystrophy

99
Q

Focal segmental glomerulosclerosis may be associated with __________, __________, and __________.

A

HIV; heroin use; sickle cell disease

100
Q

most common type of renal disease in SLE

A

Diffuse proliferative glomerulonephritis

101
Q

Treatment for cystine stones

A

May form staghorn calculi; treatment involves hydration and alkalization of urine

102
Q

EM of focal segmental glomerulosclerosis

A

Effacement of foot processes

103
Q

Causes of UTI

A
  • E. Coli
  • Staph saprophyticus
    • Increased incidence in young, sexually active women
  • Klebsiella
  • Proteus mirabilis
  • Enterococcus faecalis
104
Q

membranoproliferative glomerulonephritis type I (subendothelial) is associated with ______ and _________.

A

HBV; HCV

105
Q

Alport syndrome

A
  • Inherited defect in type IV collagen; most commonly X-linked
  • Results in thinning and splitting of the glomerular basement membrane
106
Q

Electron microscopy of minimal change disease

A

Effacement of foot processes

107
Q

Which causes of rapidly progressive glomerulonephritis have a negative IF?

A

Wegener granulomatosis

Microscopic polyangiitis

Churg-Strauss syndrome

108
Q

Denys-Drash syndrome is associated with ___________.

A

Mutations of WT1

109
Q

Treatment for chronic renal failure

A

Dialysis or renal transplant

110
Q

Damage seen in minimal change disease is mediated by _________.

A

Cytokines from T cells

111
Q

Causes of acute interstitial nephritis

A

NSAIDs

Penicillin

Diuretics

112
Q

WAGR syndrome

A
  • Wilms tumor
  • Aniridia
  • Genital abnormalities
  • Mental and motor Retardation
113
Q

Why is anemia a clinical feature of chronic renal failure?

A

Due to decreased erythropoietin production by renal peritubular interstitial cells

114
Q

Histo of minimial change disease

A

Normal glomeruli on H &E stain; lipid may be seen in proximal tubule cells

115
Q

Membranous nephropathy may be associated with _________, __________, _________, or __________.

A

Hep b or C

solid tumors

SLE

Drugs

116
Q

Minimal change disease is associated with ___________.

A

Hodgkin lymphoma

117
Q

Pathophysiolofy of prerenal azotemia

A
  • Decreased blood flow results in decreased GFR, azotemia, and oliguria
  • Reabsorption of fluid and BUN ensues (serum BUN: Cr ratio>15)
  • Tubular function remains intact
118
Q

___________ slow progression hyperfiltration induced damage.

A

ACE inhibitors

119
Q

Horseshoe kidney is abnormally located in the lower abdomen because it gets caught on the _______________ during its ascent from the pelvis to the abdomen.

A

Inferior mesenteric artery

120
Q

Amyloid deposits in the _______, resulting in nephrotic syndrome.

A

Mesangium

121
Q

Papillary pathway of urothelial carcinoma development

A
  • Develops as a low-grade papillary tumor that progresses to a high-grade papillary tumor and then invades
  • Not associated with early p53 mutations
122
Q

Characteristics of nephrotic syndrome due to DM

A

Sclerosis of the mesangium with formation of Kimmelstiel-Wilson nodules

123
Q

Exstrophy

A

Congenital failure to form the caudal portion of the anterior abdominal and bladder walls

124
Q

Most common cause of nephrotic syndrome in Caucasian adults

A

Membranous nephropathy

125
Q

UTI risk factors

A

Sexual intercouse

Urinary stasis

Catheters

126
Q

Results of hyperlipidemia and hypercholesterolemia seen in nephrotic syndrome

A

May result in fatty casts in urine

127
Q

Pathophysiology of postrenal azotemia

A
  • Decreased outflow results in decreased GFR, azotemia, and oligouria
  • During early stage of obstruction, increased tubular pressure “forces” BUN into the blood; tubular function remains intact
  • With long-standing obstructuion, tubular damage ensures, resulting in decreased reabsorption of BUN, decreased absorption of sodium, and inability to concentrate urine
128
Q

membranoproliferative glomerulonephritis type II (intramembranous) is associated with ______ .

A

C3 nephritic factor

  • Autoantibody that stabilizes C3 convertase, leading to overactivation of complement, inflammation, and low levels of circulating C3
129
Q

Laboratory findings of cystitis

A

Urinalysis

  • Cloudy urine with >10 WBCs/ high power field

Dipstick

  • Positive leukocyte esterase (due to pyuria) and nitrites

Culture

  • Greater than 100,000 colony forming units
130
Q

____________,_________, and _________ distinguish Chrug-Strauss from microscopic polyangiitis.

A

Granulomatous inflammation, eosinophilia, and asthma

131
Q

Nephrtic syndrome

A

Glomerular disorders characterized by glomerular inflammation and bleeding

  • Limited proteinuria (<3.5 g/day)
  • Oliguria and azotemia
  • Salt retention wth periorbital edema and HTN
  • RBC casts and dysmorphic RBCs in urine
132
Q

Most common cause of ammonium magnesium phosphate stone

A

Infection with urease postive organisms (proteus vulgaris or Klebsiella); alkaline urine leads to formation of urine

133
Q

Adenocarcinoma of the bladder arises from..

A
  • Urachal remnant
  • Cystitis glandularis
  • Exstrophy
134
Q

Characteristics of hereditary renal cell carcinomas

A
  • Von Hippel-Lindau
    • Autosomal dominant
    • Inactivation of the VHL gene leading to increased risk for hemangioblastoma of the cerebellum and renal cell carcinoma
135
Q

How does pyelonephritis present?

A

Fever

Flank pain

WBC casts

leukocytosis, in addition to symptoms of cystitis

136
Q

Treatment for ammonium magnesium phosphate stone

A

Surgical removal of stone (due to size) and eradication of pathogen (to prevent recurrence)

137
Q

Causes of nephritic syndrome

A

Poststreptococcal glomerulonephritis

Rapidly progressive glomerulonephritis

IgA nephropathy (berger disease)

Alport syndrome

138
Q

Potter sequence

A

Bilateral agenesis leads to oligohydramnios with lung hypoplasia, flat face with low set ears, and developmental defects of the extremities; incompatible with life

139
Q

Which cause of nephrotic syndrome has an excellent response to steroids?

A

Minimal change disease

140
Q

How does the autosomal dominant form of PKD presnt?

A

In young adults as HTN (due to increased renin), hematuria, and worsening renal failure

141
Q

Cause of chronic pyelonephritis

A

Due to vesicoureteral reflux (children) or obstruction (e.g. BPH or cervical carcinoma)

142
Q

Pathophysiology of nephritic syndrome

A

Immune-complex deposition activates complement; C5a attracts neutrophils, which mediate damage

143
Q

Inherited (autosomal dominant) defect leading to cysts in the medullary collecting ducts

A

Medullary cystic kidney diasease

144
Q

Risk factors for urothelial (transitional cell) carcinoma

A
  • Cigarette smoke (major)
  • Napthylamine
  • Azo dyes
  • Long-term cyclophosphamide or phenacetin use
145
Q

Dysplastic kidney disease

A

non-inherited, congenital malformation of the renal parenchyma characterized by cysts and abdnormal tissue

*Usually unilateral; when bilateral, must be distinguised from inherited polycystic kidney disease

146
Q

Which part of the kidney is most susceptible to nephrotoxic acute tubular necrosis?

A

Proximal tubules

147
Q

Most common cause of nephrotic syndrome in children

A

Minimal change disease

OS4 (4 decks)

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