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L5 - Renal Pathology Flashcards

1
Q

What are the primary functions of the kidney?

A

The kidney filters blood, excretes waste products, regulates water and salt balance, maintains acid–base balance, and functions as an endocrine organ.

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2
Q

How much blood does the kidney filter daily and what is the approximate urine output?

A

Approximately 1700 litres of blood are filtered daily, producing around 1 litre of urine.

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3
Q

What anatomical structure is essential for blood filtration in the kidney?

A

The glomerulus, an anastomosing network of capillaries, is central to the filtration process.

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4
Q

Why is the glomerular barrier function critical?

A

It allows water and small solutes to pass while preventing the loss of large protein molecules.

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5
Q

What defines nephrotic syndrome clinically?

A

Nephrotic syndrome is characterised by heavy proteinuria (>3.5g/day), hypoalbuminaemia, severe oedema, hyperlipidaemia, and lipiduria.

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6
Q

How does minimal change disease (MCD) present histologically?

A

MCD shows normal light microscopy with diffuse podocyte foot process fusion on electron microscopy.

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7
Q

What are the key features of membranous glomerulopathy?

A

It is marked by subepithelial electron-dense deposits along the basement membrane, with an antigen–antibody mediated pathogenesis.

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8
Q

What distinguishes focal segmental glomerulosclerosis (FSGS) from other causes of nephrotic syndrome?

A

FSGS involves segmental scarring of some glomeruli and is often associated with conditions like HIV, obesity, or hypertension.

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9
Q

What is the renal impact of diabetic glomerulopathy?

A

It leads to thickening of the basement membrane and increased mesangial matrix due to hyperglycaemia and advanced glycation end-products.

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10
Q

How is amyloidosis identified in the kidney?

A

Amyloidosis is demonstrated by the deposition of amorphous eosinophilic material that shows apple-green birefringence under polarised light after Congo red staining.

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11
Q

What are common features of lupus nephritis in systemic lupus erythematosus (SLE)?

A

SLE shows a range of histological patterns with immune complex deposition, and is associated with a positive ANA and anti-dsDNA on immunofluorescence.

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12
Q

How can chronic glomerular diseases progress to renal failure?

A

Ongoing damage from proteinuria, inflammatory processes, and scarring ultimately lead to chronic renal insufficiency.

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13
Q

What are typical clinical manifestations of acute nephritic syndrome?

A

Haematuria, mild to moderate proteinuria, and hypertension are characteristic.

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14
Q

How is chronic renal failure identified clinically?

A

Chronic renal failure may be asymptomatic initially but is later recognised by reduced glomerular filtration rate and accumulation of metabolic waste.

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15
Q

What role do electron microscopy and immunofluorescence play in renal pathology?

A

They provide detailed insights into glomerular ultrastructure and immune complex deposition, essential for diagnosing specific glomerulopathies.

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16
Q

Why is precise diagnosis of glomerular disease critical for patient management?

A

Accurate diagnosis directs appropriate therapy, which can improve prognosis and prevent progression to end-stage renal disease.

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17
Q

How does the composition of the glomerular basement membrane contribute to its selectivity?

A

Its network of collagen, laminin, and proteoglycans forms a charge- and size-selective barrier essential for filtration.

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18
Q

What ultrastructural change is diagnostic for minimal change disease?

A

Diffuse effacement of podocyte foot processes seen on electron microscopy.

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19
Q

How do immunofluorescence patterns help distinguish membranous glomerulopathy?

A

Granular immunoglobulin deposits along the capillary wall indicate immune complex deposition.

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20
Q

What role does podocyte injury play in the development of proteinuria?

A

Damage disrupts the slit diaphragm, leading to leakage of protein into the urine.

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21
Q

How does focal segmental glomerulosclerosis (FSGS) contribute to chronic kidney disease?

A

Progressive scarring in parts of some glomeruli reduces overall filtration capacity, leading to renal insufficiency.

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22
Q

What are the key electron microscopic features in diabetic glomerulopathy?

A

A thickened basement membrane, mesangial expansion, and sometimes nodular glomerulosclerosis.

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23
Q

How does amyloidosis present differently from other glomerular diseases on electron microscopy?

A

Amyloid deposits appear as non-branching fibrils approximately 7.5–10 nm in diameter.

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24
Q

What clinical criteria help define acute nephritic syndrome?

A

Haematuria, hypertension, and moderate proteinuria are the hallmarks of acute nephritic syndrome.

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25
What is the primary functional unit of the kidney?
The nephron
26
What three layers make up the glomerular filtration barrier?
Fenestrated endothelium, glomerular basement membrane, podocytes
27
Which part of the nephron is responsible for the majority of sodium reabsorption?
Proximal convoluted tubule
28
What is the main function of the proximal tubule?
Reabsorption of water, electrolytes, and nutrients; secretion of waste products
29
What is the role of the loop of Henle in urine concentration?
Establishes a concentration gradient to facilitate water reabsorption in the collecting duct
30
What hormone regulates water reabsorption in the collecting duct?
Antidiuretic hormone (ADH)
31
Which ion is most important in regulating extracellular fluid volume?
Sodium (Na⁺)
32
What is the role of the juxtaglomerular apparatus?
Regulates blood pressure via renin secretion
33
How does the kidney contribute to acid–base homeostasis?
Excretes hydrogen ions and reabsorbs bicarbonate to maintain pH balance
34
What is the role of aldosterone in renal physiology?
Increases sodium reabsorption and potassium excretion in the distal tubule
35
What are the histological features of acute tubular injury?
Tubular epithelial necrosis, loss of brush border, and granular casts
36
How does hypertension contribute to kidney disease?
Causes endothelial damage, leading to glomerulosclerosis and nephron loss
37
What are the common causes of acute kidney injury?
Ischaemia, nephrotoxins, sepsis
38
What distinguishes nephritic syndrome from nephrotic syndrome?
Nephritic syndrome presents with haematuria, hypertension, and mild proteinuria, whereas nephrotic syndrome is characterised by heavy proteinuria, hypoalbuminaemia, and oedema
39
What is the most common cause of nephrotic syndrome in adults?
Focal segmental glomerulosclerosis (FSGS)
40
What immune mechanism underlies membranous nephropathy?
Immune complex deposition along the basement membrane
41
What is the characteristic finding in post-infectious glomerulonephritis?
Subepithelial humps of immune complexes
42
Which type of hypersensitivity reaction is involved in anti-GBM disease?
Type II hypersensitivity reaction
43
How does IgA nephropathy typically present?
Episodic haematuria, often following an upper respiratory infection
44
What is the characteristic light microscopic finding in rapidly progressive glomerulonephritis (RPGN)?
Crescents composed of fibrin and macrophages within Bowman’s space
45
How is Alport syndrome diagnosed?
Genetic testing for mutations in COL4A5 and characteristic lamellated basement membranes on electron microscopy
46
What are the characteristic features of thrombotic microangiopathies affecting the kidney?
Endothelial injury, thrombosis, and microangiopathic haemolytic anaemia
47
What are the primary causes of haemolytic uraemic syndrome?
Shiga toxin-producing Escherichia coli (STEC) infection, complement dysregulation
48
How does sickle cell disease affect renal function?
Medullary infarction, haematuria, proteinuria, and papillary necrosis
49
Which glomerular disease is most commonly associated with HIV infection?
Collapsing focal segmental glomerulosclerosis (FSGS)
50
What renal changes are seen in multiple myeloma?
Cast nephropathy due to light chain deposition
51
How do NSAIDs contribute to kidney injury?
Acute interstitial nephritis, renal papillary necrosis
52
What is the renal impact of lithium therapy?
Nephrogenic diabetes insipidus, chronic tubulointerstitial nephropathy
53
Which systemic disease is most commonly associated with crescentic glomerulonephritis?
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis
54
What is the pathophysiology of hypertensive nephrosclerosis?
Hyaline arteriolosclerosis, glomerular ischaemia, interstitial fibrosis
55
How does chronic kidney disease (CKD) affect bone metabolism?
Hyperphosphataemia, decreased vitamin D activation, secondary hyperparathyroidism
56
What is the most common cause of end-stage renal disease?
Diabetes mellitus
57
What laboratory findings indicate acute kidney injury?
Elevated serum creatinine, blood urea nitrogen (BUN), and metabolic acidosis
58
How does the kidney compensate for decreased perfusion in prerenal AKI?
Activation of the renin-angiotensin-aldosterone system to increase blood pressure and sodium retention
59
What is the significance of muddy brown casts in urine microscopy?
Granular casts composed of necrotic tubular epithelial cells
60
How does chronic kidney disease lead to secondary hyperparathyroidism?
Phosphate retention stimulates parathyroid hormone (PTH) secretion, leading to bone resorption
61
What are the main clinical features of uraemia?
Fatigue, anorexia, nausea, pruritus, pericarditis
62
Which imaging modality is most useful for diagnosing renal artery stenosis?
Doppler ultrasound, magnetic resonance angiography (MRA)
63
What is the most common cause of drug-induced acute interstitial nephritis?
NSAIDs, antibiotics (e.g., beta-lactams), proton pump inhibitors
64
How does myoglobinuria cause acute kidney injury?
Myoglobin is toxic to renal tubules, causing acute tubular necrosis
65
What is the pathogenesis of contrast-induced nephropathy?
Vasoconstriction and oxidative stress from contrast media exposure
66
What are the primary indications for kidney biopsy?
Unexplained proteinuria, haematuria, or renal dysfunction
67
Which metabolic derangements are common in chronic kidney disease?
Hyperkalaemia, metabolic acidosis, hypocalcaemia, hyperphosphataemia
68
What is the role of erythropoietin in renal disease?
Stimulates red blood cell production in response to hypoxia
69
How does nephrotic syndrome contribute to hypercoagulability?
Urinary loss of antithrombin III and increased fibrinogen levels promote clot formation
70
What is the pathogenesis of lupus nephritis?
Immune complex deposition and complement activation
71
Which autoantibody is most specific for lupus nephritis?
Anti-dsDNA
72
What are the histological classes of lupus nephritis?
Class I (minimal), II (mesangial), III (focal proliferative), IV (diffuse proliferative), V (membranous), VI (advanced sclerosis)
73
What is the key finding in pauci-immune glomerulonephritis?
Pauci-immune crescentic glomerulonephritis shows no immune deposits on immunofluorescence
74
How does the kidney contribute to systemic hypertension?
Increases blood volume by regulating sodium and water retention
75
What are the most common causes of papillary necrosis?
Diabetes mellitus, sickle cell disease, analgesic nephropathy
76
What is the typical presentation of renal cell carcinoma?
Flank pain, haematuria, and an abdominal mass
77
Which paraneoplastic syndromes are associated with renal cell carcinoma?
Paraneoplastic erythrocytosis, hypercalcaemia, hypertension
78
What are the histological subtypes of renal cell carcinoma?
Clear cell carcinoma, papillary carcinoma, chromophobe carcinoma
79
Which genetic syndrome is associated with multiple renal cysts?
Von Hippel–Lindau syndrome
80
What is the most common cause of autosomal dominant polycystic kidney disease?
PKD1 or PKD2 gene mutation leading to cyst formation
81
How does medullary sponge kidney differ from polycystic kidney disease?
Medullary sponge kidney is non-hereditary and characterised by cystic dilation of collecting ducts
82
What is the typical presentation of nephrocalcinosis?
Nephrolithiasis and nephrocalcinosis
83
Which renal disease is most commonly associated with hyperuricaemia?
Gouty nephropathy, urate nephrolithiasis
84
What are the key histological features of chronic pyelonephritis?
Tubular atrophy, thyroidisation of tubules, interstitial fibrosis
85
How does vesicoureteral reflux contribute to renal pathology?
Chronic reflux leads to scarring and atrophy of renal parenchyma
86
What is the most common bacterial cause of acute pyelonephritis?
Escherichia coli
87
What are the characteristic findings in xanthogranulomatous pyelonephritis?
Foamy macrophages, giant cells, chronic inflammation
88
What is the most common cause of obstructive uropathy in older men?
Benign prostatic hyperplasia (BPH)
89
How does urinary tract obstruction lead to renal dysfunction?
Hydronephrosis, decreased glomerular filtration rate (GFR)
90
What is the characteristic finding in renal papillary necrosis?
Coagulative necrosis of renal papillae
91
What is the role of the renin-angiotensin-aldosterone system in kidney disease?
Regulates blood pressure and fluid balance through renin and aldosterone
92
How do ACE inhibitors affect renal function?
Dilate efferent arterioles, decreasing glomerular pressure
93
Which renal condition is commonly associated with sarcoidosis?
Granulomatous interstitial nephritis
94
What is the role of podocyte injury in nephrotic syndrome?
Disruption of podocyte slit diaphragm leads to increased permeability to proteins
95
How does C3 glomerulopathy differ from immune complex-mediated glomerulonephritis?
C3 glomerulopathy results from alternative complement pathway dysregulation
96
What is the typical presentation of fibromuscular dysplasia in the kidney?
Young woman with hypertension, renal artery stenosis
97
How does the kidney regulate phosphate balance?
Regulates phosphate excretion and vitamin D metabolism
98
What is the role of FGF23 in phosphate homeostasis?
Inhibits phosphate reabsorption and vitamin D activation
99
How does renal osteodystrophy develop in CKD?
Osteitis fibrosa cystica, adynamic bone disease
100
What are the characteristic findings in thin basement membrane disease?
Uniformly thin glomerular basement membrane
101
What is the genetic inheritance pattern of Alport syndrome?
X-linked dominant inheritance
102
Which renal pathology is associated with ANCA-positive vasculitis?
ANCA-associated vasculitis (e.g., granulomatosis with polyangiitis)
103
How does chronic kidney disease contribute to cardiovascular disease?
Increases cardiovascular risk via hypertension, dyslipidaemia, and vascular calcification
104
What is the pathophysiology of renal anaemia?
Deficient erythropoietin production, leading to normocytic anaemia
105
Which electrolyte disturbances are common in end-stage renal disease?
Hyperkalaemia, hyperphosphataemia, metabolic acidosis, hypocalcaemia
106
What are the histological findings in acute tubulointerstitial nephritis?
Interstitial oedema, eosinophilic infiltrate, tubulitis
107
How does Fanconi syndrome affect renal tubular function?
Proximal tubular dysfunction, leading to loss of glucose, amino acids, phosphate, and bicarbonate
108
What is the typical presentation of Bartter syndrome?
Hypokalaemia, metabolic alkalosis, polyuria, failure to thrive
109
Which genetic mutation is associated with Gitelman syndrome?
SLC12A3 gene mutation affecting thiazide-sensitive sodium chloride cotransporter
110
What are the renal complications of obstructive sleep apnoea?
Hypertension, proteinuria, nocturia
111
How does hyperaldosteronism affect renal function?
Hypernatraemia, hypokalaemia, metabolic alkalosis
112
What are the renal manifestations of tuberous sclerosis?
Renal angiomyolipomas, cysts, and increased risk of renal cell carcinoma
113
What is the main difference between nephrogenic diabetes insipidus and central diabetes insipidus?
Nephrogenic DI results from renal insensitivity to ADH; central DI results from lack of ADH production
114
What is the effect of volume depletion on renal autoregulation?
Increases renal vascular resistance to maintain perfusion
115
What are the primary causes of renal infarction?
Thromboembolism, trauma, vasculitis, atherosclerosis
116
How does sickle cell trait differ from sickle cell disease in renal pathology?
Milder renal involvement compared to sickle cell disease, with a lower risk of infarction
117
What is the role of endothelin in kidney disease?
Vasoconstriction and fibrosis in renal vasculature
118
Which renal pathology is associated with monoclonal gammopathy of renal significance (MGRS)?
Monoclonal light chain deposition causes glomerular or tubulointerstitial damage
119
What are the two main structural regions of the kidney?
Cortex and medulla
120
What part of the kidney contains the glomeruli?
The cortex
121
What is the main role of the glomerulus in renal physiology?
Filtration of blood to form a protein-free filtrate
122
How does the structure of podocyte foot processes contribute to glomerular filtration?
They create narrow filtration slits that maintain selective permeability
123
What happens when podocyte foot processes are fused?
Proteinuria due to increased glomerular permeability
124
What are the three layers that make up the glomerular filtration barrier?
Fenestrated endothelium, glomerular basement membrane, podocyte foot processes
125
Which staining technique highlights immune complex deposits in membranous nephropathy?
Immunofluorescence staining for IgG highlights granular deposits along the capillary walls
126
What is seen on electron microscopy in minimal change disease?
Effacement (fusion) of podocyte foot processes
127
Which two systemic diseases are most associated with secondary membranous glomerulopathy?
Malignancies and chronic infections (e.g., hepatitis B or C)
128
What type of deposits are seen in diabetic glomerulopathy?
Thickening of the glomerular basement membrane and increased mesangial matrix
129
What is the characteristic histological feature of diabetic glomerulosclerosis?
Nodular mesangial expansion (Kimmelstiel–Wilson nodules)
130
Which special stain is used to detect amyloid deposits in the kidney?
Congo red stain
131
What histological appearance confirms amyloid deposits under polarized light?
Apple-green birefringence under polarized light
132
What structural feature is seen in amyloid deposits under electron microscopy?
Non-branching fibrils measuring 7.5–10 nm in diameter
133
What autoantibodies are typically positive in lupus nephritis?
Anti-nuclear antibody (ANA) and anti-double-stranded DNA (anti-dsDNA)
134
What is the meaning of "full house" positivity in immunofluorescence for lupus nephritis?
Positivity for multiple immunoglobulins and complement components (IgG, IgA, IgM, C3, C1q)
135
How does lupus nephritis class IV differ histologically from class II?
Class IV shows widespread glomerular proliferation and immune complex deposition compared to mild mesangial involvement in class II
136
What are the two main causes of nephrotic syndrome in children discussed in the document?
Minimal change disease and focal segmental glomerulosclerosis (FSGS)
137
What histological stain can reveal "spike and dome" appearance in membranous nephropathy?
Silver stain (Jones stain)
138
How does glomerular capillary fenestration aid filtration?
Allows easy passage of water and small solutes while restricting proteins

Clinical Pathology in Action (19 decks)

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