Kidneys Flashcards
Nephritic Syndrome
OHHA
oliguria
hematuria
HPN
azotemia
Nephrotic Syndrome
EPHAL
edema
proteinuria - >3.5 g/d
hyperlipidemia
hypoalbuminemia
MCC of nephritic syndrome in CHILDREN
GAHBS (M12, 4 and 1)
increased ASO
decreased C3
Poststreptococcal Glomerulonephritis (PSAGN)
LM: enlarged hypercellular glomeruli
EM: subepithelial humps on GBM
IF: granular deposits of IGG, C3
Syndrome of progressive loss of renal function
CRESCENTS - proliferation of PARIETAL epithelial cells + leukocytes infiltrating the glomerulus
Crescentic (Rapidly Progressive) Glomerulonephritis
Antibodies against the non-collagenous domain of a3 chain of COLLAGEN TYPE IV – necrotizing hemorrhagic interstitial pneumonitis and RPGN
MALE, ACTIVE SMOKERS
HEMOPTYSIS and RENAL FAILURE
RPGN Type I (GOODPASTURE SYNDROME)
IF: linear IgG and C3 deposits along the GBM
Type III RPGN
Pauci-immune (presence of ANCA)
Granulomatosis with Polyangiitis (ANCA-associated vasculitis)
Glomerular diseases presenting as Nephrotic Syndrome
Minimal Change Disease
FSGS
Membranous nephropathy
MPGN type I
Dense deposit disease (MPGN type II)
Signature finding in nephrotic syndrome
Diffuse effacement of foot processes
MCC in CHILDREM
(-) azotemia
STEROID RESPONSIVE
normal glomerulus on LM
“lipoid nephrosis”
podocyte effacement
Minimal Change Disease (MCD)
ASSOCIATIONS:
Respiratory infections
prophylactic immunizations
NSAIDs
2nd MCC in ADULTS
(-) azotemia
STEROID RESISTANT
Membranous Nephropathy (MGN)
uniform diffuse thickening of the capillary wall
ASSOCIATIONS:
SLE
Infections
EM: SPIKE AND DOME appearance
effacement of foot processes
MCC in ADULTS
(+) azotemia
Focal Segmental Glomerulosclerosis (FSGS)
ASSOCIATIONS:
HIV
Sickle Cell Anemia
Heroin
EM: DIFFUSE EFFACEMENT of foot processes
Nephritic/Nephrotic syndrome
50% of patients progress to ESRD
(+) immune complex deposition
activation of classical and alternative
MPGN TYPE I
LM: DOUBLE CONTOUR TRAM TRACK APPEARANCE
EM: subendothelial electron dense deposits
IF: granular C3 deposits WITH IgG
Nephritic/Nephrotic syndrome
50% of patients progress to ESRD
(-) immune complex deposition
activation of classical and alternative
DENSE DEPOSIT DISEASE (TYPE II)
EM: ribbon like
IF: granular or linear C3 W/O IgG
MC type of glomerulonephritis worldwide
GIT or GUT infection – gross hematuria
IgA Nephropathy (BERGER DISEASE)
post infectious hematuria
Systemic IgA deposition
MC in children 3-8 y/o
PURPURIC SKIN LESION
Henoch Schonlein Purpura (HSP)
kidneys, intestines, joints
MCC of ESRD
Diabetes
KIMMELSTIEL-WILSON NODULES
LARGE END STAGE KIDNEYS
Amyloidosis
DM
HIV
PCKD
Defective assembly of type IV collagen
AR
90% –> ESRD (males)
EYES - lens dislocation, posterior cataracts, corneal dystrophy
ALPORT SYNDROME
Defective assembly of type IV collagen
AR
90% –> ESRD (males)
EYES - lens dislocation, posterior cataracts, corneal dystrophy
EARS - nerve deafness
KIDNEYS - hematuria
ALPORT SYNDROME
EM: early - THIN GBM
late - “BASKET WEAVE” APPEARANCE
Hallmarks of Interstitial Nephritis
(-) nephritic or nephrotic syndrome
(+) defects in tubular function
2nd MCC of AKI
Tubulointerstitial Nephritis Caused by Drugs and Toxins
Acute Drug Induced Interstitial Nephritis
2-40 days after drug exposure
fever, eosinophilia, rash
RENAL ABNORMALITIES - hematuria, mild proteinuria, leukocyturia
withdrawal of offending drugs causes recovery BUT slow
TYPE I or IV Hypersensitivity
MCC of Renal Artery Stenosis
stenosis – renal ischemia – increased RAAS activity – SECONDARY HPN
Atherosclerosis
fibromuscular dysplasia - 2nd MC
Morphology of Renal Artery Stenosis
Diffuse ischemic atrophy w/ MILD arteriolosclerosis in IPSILATERAL kidney
SEVERE arteriolosclerosis in CONTRALATERAL kidney
MC malignant tumor of the kidney
Renal Cell Carcinoma
2nd MC malignant tumor of the kidney
Wilms tumor
3rd MC malignant tumor of the kidney
Urothelial carcinomas
Most important risk factor in Renal Cell Carcinoma
SMOKING
Triad of RCC
painless hematuria
flank pain
palpable mass
Invasion and Metastasis of Renal Cell Carcinoma
tendency to INVADE RENAL VEIN
tendency to metastasize WIDELY before being symptomatic
LUNGS and BONES - MC sites
Paraneoplastic Syndromes associated with RCC
Polycythemia
Hypercalcemia
HPN
Hepatic dysfunction
Cushing syndrome
Eosinophilia
Leukemoid reaction
Amyloidosis
MC type of RCC
PROXIMAL tubule cells
HISTOLOGY:
clear or granular cytoplasm - contains glycogen and lipids
Clear Cell RCC
ASSOCIATIONS:
Von Hippel Lindau - renal cysts, bilateral RCC
DISTAL tubule cells
Hereditary leiomyomatosis and Renal Cell Cancer Syndrome
Hereditary papillary carcinoma (MET)
HISTOLOGY:
papillary formations
PSAMMOMA BODIES
Papillary Cell RCC
INTERCALATED cells of CD
Associated with Birt-Hogg Dube syndrome
HISTOLOGY:
sheets of pale eosinophilic cells with perinuclear halo
Chromophobe Cell RCC
Final common pathway of progressive nephron loss resulting from any type of kidney disease
CHRONIC KIDNEY DISEASE
Morphology:
symmetrically contracted kidneys
red-brown and diffusely granular surfaces
scarring of glomeruli, interstitial fibrosis
(+) lymphocytic infiltrates
MC bladder neoplasms
MALES
advancing age
SMOKING!
PAINLESS HEMATURIA
Urothelial Neoplasms
