Kidneys Flashcards
1
Q
renal vein is
A
anterior
2
Q
ureter is
A
posterior
3
Q
electron microscopy fixed in
A
glutaraldehyde
4
Q
light microscopy fixed in
A
formalin
5
Q
fluorescent microscopy fixed in
A
zeus fixative (transport media)
6
Q
visceral epithelial cells of foot processes
A
podocytes
7
Q
interfaces with endothelial cells and podocytes
A
glomerular basement membrane
8
Q
support cells that are contractile and phagoytic/capable of proliferation of matrix and collagen
A
mesangial cells
9
Q
specialized vascular cells that form the walls of glomerular tuft capillaries
A
endothelial cells
10
Q
elevation in BUN and creatinine
A
azotemia
11
Q
decreased GFR causes
A
azotemia
12
Q
kidney hypoperfusion impairs renal function with no parenchymal damage
A
prerenal azotemia
13
Q
obstruction distal to kidney (bladder)
A
post renal azotemia
14
Q
term used to describe clinical manifestations of azotemia in GI, peripheral nerves and cardiac
A
uremia
15
Q
inflammatory glomerular disease causes
A
nephritic syndrome
16
Q
derangement in glomerular capillary walls resulting in increased permeability to plasma proteins
A
nephrotic syndrome
17
Q
4 clinical presentations of nephritic syndrome
A
-hematuria
-mild proteinuria
-decreased GFR
-HTN
18
Q
4 clinical presentations of nephrotic syndrome
A
-massive proteinuria
-hypoalbuminemia
-severe generalize edema
-hyperlipidemia and lipiduria
19
Q
glomerular, interstitial, vascular or tubular injury
A
acute kidney injury
20
Q
GFR in AKI
A
rapidly declining
21
Q
fluid/electrolyte balance in AKI
A
concurrent dysregulation
22
Q
metabolic wastes in AKI are
A
retained
23
Q
oligouria and anuria occur in this disease
A
AKI
24
Q
persistently diminished GFR in this renal disease, as well as persistent albuminuria
A
chronic kidney disease
25
GFR is less than 5% in this renal disease, terminal stage of uremia
End stage renal disease
26
accumulation of homogenous eosinophilic material on H&E
hyalinosis
27
deposition of extracellular collagenous matrix (type IV)
sclerosis
28
diffuse proliferation of glomerular cells associated with leukocytes, typically caused by immune complexes
acute proliferative glomerulonephritis
29
most common infection causing acute proliferative glomerulonephritis
Group A beta hemolytic streptococci
30
granular deposits of IgG and C3 in this disease
APGN
31
what can be seen on EM of APGN
humps on the epithelial side of the basement membrane
32
this form of glomerulonephritis is rapidly progressive
crescentic glomerulonephritis
33
proliferation of bowman capsule epithelial cells and monocyte/macrophage infiltration form
glomerular crescents
34
diffuse thickening of the glomerular capillary wall due to the accumulation of deposits containing IgG along the subepithelial side of the basement membrane
membranous nephropathy
35
75% of membranous nephropathy is
primary
36
diffuse effacement of podocytes detectable only by electron microscopy in glomeruli that appear normal by light microscopy
minimal change disease
37
most frequent cause of nephrotic syndrome in children
minimal change disease
38
characteristic feature of minimal change disease
dramatic response to corticosteroid therapy
39
most common cause of nephrotic syndrome in adults
focal segmental glomerulosclerosis
40
sclerosis of only the capillary tuft portion of the glomerulus
focal segmental glomerulosclerosis
41
IgM and C3 may be present in immunofluorescence in this disease
focal segmental glomerulosclerosis
42
collapsing variant of FSGS
HIV-associated nephropathy
43
immune-mediated complex depositions associated with systemic infection
membranoproliferative glomerulonephritis
44
presence of IgG complex deposits in the subendothelium
type 1 MPGN
45
complement activation without immune complexes with dense intramembranous deposits
type 2 MPGN
46
proliferative glomerulonephritis associated with predominant mesangial IgA deposition
IgA nephropathy/Berger disease
47
most common type of glomerulonephritis worldwide
IgA nephropathy
48
clinical symptoms of berger disease
recurrent hematuria
49
mutations in collagen genes causing renal disease
hereditary nephritis
50
mutation in gene for type IV collagen causing irregular BM thickening
Alport syndrome
51
mutation in gene for type IV collagen causing BM thinning
thin basement membrane lesion
52
3 clinical manifestations of alport syndrome
-chronic renal failure
-nerve deafness
-eye problems
53
clinical manifestation of thin basement membrane lesion
hearing/ocular abnormalities
54
deposition of IgA1-dominant immune complexes in small vessels
Henoch-Schonlein purpura
55
major cause of renal morbidity and mortality
diabetic nephropathy
56
leading cause of renal failure in the US
diabetic nephropathy
57
nodular glomerulosclerosis
Kimmelsteil-Wilson nodules
58
most common acute kidney injury
acute tubular injury/necrosis
59
is acute tubular injury reversible?
yes
60
these are most sensitive to a decrease in renal perfusion that is severe and sustained enough to injure the tubular epithelium
proximal tubules
61
endo/exogenous sources of toxic injury to the epithelium can cause what
acute tubular injury
62
proteinaceous casts can accumulate in the distal tubules causing what
acute tubular injury
63
a severe decrease in renal perfusion can cause what
acute tubular injury
64
tubular epithelium injury can lead to (4)
decreased GFR, tubule obstruction, oliguria, anuria
65
both acute and chronic types of tubulointerstitial nephritis manifest in
azotemia
66
interstitial edema and leukocyte infiltrate seen in this form of tubulointerstitial nephritis
acute
67
mononuclear leukocyte infiltrate, interstitial fibrosis, tubular atrophy seen in this form of tubulointerstitial nephritis
chronic
68
chronic tubulointerstitial nephritis has this effect on the glomerulus
downstream effects
69
bacterial infection associated with a UTI
acute UTI
70
vesicoureteral reflux causing infection
chronic UTI
71
most common origin of pyelonephritis
ascending
72
inflammation of bladder
cystitis
73
inflammation of kidneys and collecting systems
pyelonephritis
74
85% of UTIs are due to
gram negative rods from the GI tract
75
two indications of acute pyelonephritis grossly
papillary necrosis and perinephric micro-abscesses within collecting ducts
76
total or almost complete obstruction especially when high in urinary tract, causing suppurative exudate to be unable to drain, filling renal pelvis, calyces, and ureter with pus
acute pyonephrosis
77
irregular, coarse depressed scars on the cortical surface of the kidney with easy stripping of the capsule indicates
chronic pyelonephritis
78
tubular thyroidization in this form of pyelonephritis
chronic pyelonephritis
79
atrophic or dilated tubules with flattened epithelium containing eosinophilic, waxy casts
tubular thyroidization
80
fibroblasts present with chronic inflammation in this form of pyelonephritis
chronic pyelonephritis
81
rare form of chronic pyelonephritis
xanthogranulomatous pyelonephritis
82
when does xanthogranulomatous pyelonephritis often occur in the presence of
staghorn calculi
83
xanthogranulomatous pyelonephritis is more common in
women
84
foamy lipid laden macrophages/histiocytes replacing parenchyma are found in this form of pyelonephritis
xanthogranulomatous pyelonephritis
85
marker used to identify macrophages used in xanthogranulomatous pyelonephritis
CD68
86
second most common cause of acute kidney injury
tubulointerstitial nephritis induced by drugs and toxins
87
tubulointerstitial nephritis induced by drugs and toxins is common in those who ingest (3)
synthetic penicillin, rifampin, NSAIDs
88
precipitation of uric acid crystals in the renal tubules leading to obstruction of nephrons and development of acute renal failure
urate nephropathology
89
urate nephropathology is common in pts receiving this
chemotherapy
90
what ducts do uric acid crystals usually precipitate in
collecting ducts
91
hyperparathyroidism, multiple myeloma, vit. D intoxication, metastatic cancer, or excess calcium intake may induce the formation of these (2)
calcium stones and nephrocalcinosis
92
nephrotoxic effects developing from overproduction of monoclonal Igs and free light chains causing nephropathy and glomerulopathies
light chain cast nephropathy (myeloma kidney)
93
these are present in multiple myeloma pt urine, indication light chain cast nephropathy
Bence Jones protein
94
nephropathy in patients with chronic liver disease
bile cast nephropathy
95
what creates bile casts in the kidneys
elevated serum bilirubin
96
another name for bile cast nephropathy
cholemic nephrosis
97
medial and intimal thickening and hyalinization of the wall
hyaline arteriosclerosis
98
nephrosclerosis is associated with
hypertension
99
pinpoint petechial hemorrhages on the cortical surface
flea-bitten appearance
100
onion skin appearance of the interlobar arteries/larger arterioles indicate
hyperplastic arteriosclerosis
101
flea bitten appearance and fibrinoid necrosis of the kidney indicate what clinical presentation
malignant hypertension
102
most common cause of renal artery stenosis at the origin
atheromatous plaque
103
second most common cause of renal artery stenosis
fibromuscular dysplasia
104
renal vascular disease responsible for 2-5% of hypertension cases
renal artery stenosis
105
hemolytic-uremic syndrome and thrombocytopenic purpura
thrombotic microangiopathies
106
thrombi in renal capillaries/arterioles occur due to (2)
endothelial injury and platelet aggregation
107
three symptoms of sickle cell nephropathy
hematuria, proteinuria, diminished concentrating ability
108
morphology of sickle cell nephropathy
patchy papillary necrosis
109
most renal infarcts are cause by
embolism
110
a mural thrombosis from this part of the heart can cause an embolism leading to a renal infarct
left atrium
111
type of necrosis seen in renal infarcts
coagulative necrosis
112
this type of renal agenesis is incompatible with life
bilateral
113
adaptive changes in patients with renal agenesis can cause
compensatory hypertrophy
114
renal agenesis also occurs in what trisomy syndrome
trisomy 13/Patau
115
renal hypoplasia is more commonly
unilateral
116
decrease in size and decrease in # of lobes or renal pyramids
renal hypoplasia
117
lie either just above the pelvic brim or sometimes within the pelvis in an abnormal position
ectopic kidney
118
ectopic kidney with kinking or tortuosity of ureters can caused this
predisposition to bacterial infections
119
fusion of the kidneys
horseshoe kidney
120
most common congenital kidney anomaly
horseshoe kidney
121
90% of horseshoe kidneys are fused in the
lower pole
122
40% of pts with PKD have
polycystic liver disease
123
gene implicated in AD PKD
PKD1 gene
124
expanding cysts that destroy renal parenchyma that causes renal failure
PKD
125
renal function is maintained until this decade of life because cysts initially involve only portions of nephrons
4th-5th
126
2 causes of death in 4-10% of patients with PKD
berry aneurysm, subarachnoid hemorrhage
127
autosomal recessive PKD is usually
childhood
128
the PKHD1 gene in autosomal recessive PKD encodes for
fibrocystin
129
regulates the primary cilium of tubular cells
fibrocystin
130
elongated cysts arranged like spokes on a wagon wheel with scant glomeruli indicate what disease
autosomal recessive polycystic kidney disease
131
multiple cysts in collecting ducts in the medulla, however renal function is not typically affected
medullary sponge kidney
132
most common genetic cause of end stage renal disease in childhood and adolescence
nephronophthisis
133
cysts in the medulla in nephronophthisis are at the
corticomedullary junction
134
nephronopthisis causes damage to the cortical tubulointerstitium leading to this, which progresses to renal insufficiency
fibrosis
135
sporadic, varying sized cysts that are uni or bilateral with islands of undifferentiated mesenchyme
multicystic renal dysplasia
136
undifferentiated mesenchyme in multicystic renal dysplasia (2)
cartilage, immature collecting ducts
137
prolonged dialysis can cause cortical and medullary cysts
acquired cystic disease
138
obstruction of tubules by fibrosis or oxalate crystals can cause
acquired cystic disease
139
pts with acquired cystic disease have a 100-fold increased risk of
renal cell carcinoma
140
simple cysts size
1-5 or 10 cm
141
dilation of the renal pelvis and calyces associated with progressive atrophy of the kidney due to obstruction to the outflow of urine
hydronephrosis
142
type of calculus that causes staghorn calculus
struvite
143
four types of calculi
calcium oxalate or mixed w/ calcium phosphate, struvite, uric acid, cystine
144
may be associated with recurrent urinary tract infections and renal failure
staghorn calculus
145
benign neoplasm arising from the renal tubular epithelium
renal papillary adenoma
146
pale yellow-gray discrete well circumscribed cortical lesions indicate
renal papillary adenoma
147
consists of vessels, smooth muscle, and fat originating from perivascular epithelioid cells that are susceptible to spontaneous hemorrhage
angiomyolipoma
148
angiomyolipomas present in 25-50% of pts with
tuberous sclerosis
149
lesions of the cerebral cortex that produce epilepsy and intellectual disability, variety of skin abnormalities, and unusual benign tumors
tuberous sclerosis
150
epithelial neoplasm composed of large eosinophilic cells having small, round, benign-appearing nuclei that have large nucleoli
oncocytoma
151
30% of cases of oncocytoma have
central stellate scar
152
tan or mahogany brown, relatively homogenous and usually well encapsulated with a central scar indicate
oncocytoma
153
solid nests of eosinophilic granular cytoplasm separated by loose stroma indicate
oncocytoma
154
most significant risk factor for renal cell carcinoma
tobacco
155
syndrome that may cause renal cell carcinoma
von Hipple-Lindau syndrome
156
85% of renal cancers in adults
renal cell carcinoma
157
what gender is RCC more common in
males
158
most common variant of RCC
clear cell
159
cells with clear or granular cytoplasm that are nonpapillary and associated with VHL syndrome
clear cell renal cell carcinoma
160
clear cell renal carcinoma tends to invade
the renal vein
161
variant that arises from the distal convoluted tubule with papillary formations microscopically
papillary variant of renal cell carcinoma
162
hemorrhagic and cystic, especially when large, indicate what
papillary variant of renal cell carcinoma
163
three microscopic indications of papillary renal cell carcinoma
foam cells, psammoma bodies, highly vascular stroma
164
sheets of neoplastic cells with marked nuclear pleomorphism and perinuclear halos seen microscopically in this variant of renal cell carcinoma
chromophobe variant of renal cell carcinoma
165
rare variant showing irregular channels lined by highly atypical epithelium with a hobnail pattern
collecting duct variant of renal cell carcinoma
166
irregular, infiltrating tubules with high grade cells often containing mucin seen in this variant
collecting duct renal cell carcinoma
167
marked stromal desmoplasia and inflammatory infiltrate seen in this variant
collecting duct renal cell carcinoma
168
highly aggressive variant with poor prognosis
medullary renal cell carcinoma
169
4 usual sites of metastasis of medullary renal cell carcinoma
lungs, lymph nodes, liver, and adrenal glands
170
medullary renal cell carcinoma usually is seen in young black males with
sickle cell traits
171
variant that arises from the terminal collecting ducts
medullary renal cell carcinoma
172
solid nests of tumor cells deeply infiltrating the renal parenchyma with intratumoral infiltrate of neutrophils are seen in this variant
medullary renal cell carcinoma
173
this carcinoma tends to be small when discovered ue to fragmentation or hematuria
urothelial carcinoma of the renal pelvis
174
friable mass in the pelvis or ureter is seen in this carcinoma
urothelial carcinoma
175
papillary epithelial proliferation in this carcinoma
urothelial carcinoma
176
5-10% of primary renal tumors originate from
urothelium of renal pelvis
177
most common primary renal tumor of childhood
wilms tumor/nephroblastoma
178
three associated syndromes of Wilms tumor
WAGR syndrome, Denys-Drash, Beckwith-Wiedemann syndrome
179
wilms tumor, aniridia, genitourinary anomalies, retardation
WAGR syndrome
180
triphasic pattern of Wilms tumor
blastema, stroma, epithelium
181
abortive tubules and glomerular structures in Wilms tumor
epithelium
182
fibroblastic or myxoid and may contain heterologous elements in Wilms tumor
stroma
183
staging system for RCC
Fuhrman
