Kidney Pathology Flashcards
Does renal dialysis and transplantation increase survival from renal disease in all groups?
No, only in certain groups
In older populations, conservative management has similar survival rates
What are the differential diagnoses for generalised oedema?
Kidney failure
Heart failure
Liver failure
Respiratory failure with cor pulmonale
What is the significance of glucosuria in kidney disease?
Not unusual to get a little glucosuria in kidney disease
What are the hallmarks of nephrotic syndrome?
Proteinuria
Low albumin
Peripheral oedema
What can renal biopsies be used to diagnose?
Glomerular diseases
Tubular diseases
Interstitial diseases
Vascular diseases
Why should you have someone on hand to check that you have glomeruli in your biopsy sample?
They can be missed
What part of the kidney is required for biopsy?
Cortex
What does a silver stain show?
Collagen
What is the pathological hallmark of minimal change disease?
Effacement of basement membrane of glomerulus, seen only on electron microscope
What is the significance of a recent sore throat prior to presentation with a kidney issue?
Possible post-streptococcal glomerulonephritis
What is active urine sediment?
On urine dipstick
- 3+ protein
- 3+ erythrocytes
What should be done if there is active urine sediment?
In context of acute renal impairment, urgent action required
What are the two patterns of immunofluorescence seen in the glomerulus, and what do they mean?
Granular > IgA nephropathy
Linear > Goodpasture’s syndrome
What does the presence of crescents in the glomeruli imply?
Much more serious degree of nephropathy
What are the possible causes of acute renal failure?
Glomerular lesions - Rapidly progressive/crescentic glomerulonephritis Tubular lesions = acute tubular necrosis - Ischaemic - Toxic Acute tubulo-interstitial nephritis Vascular lesions - Emboli - Thrombotic microangiopathy
What is cANCA staining more specific for?
Granulomatosis with polyangiitis
What is pANCA staining more specific for?
Microscopic polyangiitis
A 20-year-old male presents with haematuria. Renal biopsy shows mesangial hypercellularity and an increase in mesangial matrix with electron dense deposits in the mesangium. Which of the following is likely to predominate in these mesangial deposits on immunofluorescence or immunohistochemical staining of glomeruli?
IgA
A 46-year-old male with leukocytoclastic vasculitis diagnosed on skin biopsy, cough with haemoptysis, pauci-immune crescentic glomerulonephritis and positive serology for pANCA is most likely to have…
Microscopic polyangiitis
When are renal biopsies performed in the context of diabetes?
Proteinuria excessive, usually at least 1 g/day
What finding on renal biopsy is pathognomonic of diabetic nephropathy?
Kimmelsteil-Wilson nodules
Are spontaneous mutations causing autosomal dominant polycystic kidney disease common?
Not common, but not as uncommon as you’d expect
Is kidney failure avoidable in adult polycystic kidney disease?
No, it’s inevitable
Presence of which modifiable risk factor accelerates the progression to kidney failure in adult polycystic kidney disease?
HTN
What is it called when you have normal sized kidneys with cysts?
Multicystic kidney disease
What is the microscopic appearance of glomerulonephritis?
Neutrophil infiltration
Glomeruli and tubules relatively intact
What is the worry with complex renal cysts seen on ultrasound?
Almost always malignant, especially when they light up with contrast on CT
A 52-year-old man is diagnosed with systemic hypertension. Investigations reveal significantly elevated serum creatinine and the presence of a large polycystic kidneys. Compared to the general population, this man is more likely to have or develop what?
Intracranial berry aneurysm
Why aren’t berry aneurysms often not screened for in the context of adult polycystic kidney disease?
What will you do about it, if it’s found?
When may you screen for berry aneurysms in the context of adult polycystic kidney disease?
FHx of ruptured aneurysm
A 72-year-old man presented with a several week history of shortness of breath and fever. He was found to also have hypertension and polycythaemia. Chest x-ray revealed features suggestive of pulmonary metastases. If a biopsy of one of the lung lesions revealed a tumour composed of cells with clear cytoplasm containing glycogen, between which were many thin-walled blood vessels, the primary site is most likely to be in which of the following organs?
Kidney
