Lecture 55 - CKD Pathology

Question 1

what is the difference between benign and malignant nephrosclerosis

Answer 1

Benign – modest HTN that remains stable; damage to the kidney may occur over time

Malignant (accerlated) - an acute HTN usually on top of benign HTN that leads to vascular damage

Question 2

Benign Nephrosclerosis

Gross Path

Histology

Answer 2

Gross: small contracted kidney

Histo: Hyalinosis, Fibroelastic Hyperplasia (reduplication of the elastic lamina)

Question 3

malignant nephrosclerosis

Gross Path (pathognomonic term)

Histology

Answer 3

Gross: Flea bitten (rupture of renal arterioles, capillaries)

Histology - Onion skinning of arteries; Fibrinoid necrosis of arterioles

Question 4

2 causes of renal artery stenosis:

Answer 4

Atherosclerosis – acquired; due to HLD

Dysplesia: congenital,

Question 5

Clinically associated scenarios associated with Diabetic Glomerulosclerosis:

Answer 5

Non nephrotic proteinuria –> nephrotic syndrome –> CKD

Question 6

Pathogenesis of DM glomerulosclerosis

Answer 6

Increased Serum Glucose –> Non enzymatic glycosylation of vascular basement membrane, which leads to protein leak

Increased ECM produciton of the GBM: Diabetic Nodules

Question 7

DM glomerulosclerosis histology

what is the pathognomonic finding

Answer 7

LM:
Capillary basement membrane thickening

Kimmelstein-Wilson Mesnagial Nodules (Pathog)

EM – Thick basement membrane

Question 8

Clinical findings of adult PKD

Presentation

Associated findings

Answer 8

Bilateral marked enalrgemnt of the kidneys, compression of the parenchyma —> CKD

HTN, Hematuria, Renal failure in young adult

A/w berry aneurysm, mitral valve prolapse, hepatic cysts, splenic, pancreatic, pulm cysts

Question 9

Genetics of PKD
- what genes
what chromosomes
function of these genes

Answer 9

PKD1 - Chr 16
PKD2 - Chr 4 
Autosomal dominant 
High penetrance
Function is within cell/cell matrix interactions

Question 10

Histology of PKD

Answer 10

Early on - large aresa of useless parenchyma

Lateer - -cysts have destroyed parenchyma;

Question 11

Amyloidosis –
common presentation in regards to kidney disease
what is the difference between AL and AA Amyloid
(AL and AA are secondary to what other conditions respectively)

Answer 11

Presentation: heavy proteinuria

AL: IG accumulation; secondary to multiple myeloma

AA: AA protein accumulation from macrophages; secondary to chronic inflammatory conditions

Question 12

Amyloidosis – histological features

Answer 12

H&E: 
Amorophous pink
Congo red Positive
Apple Green Biferingence under polarized light 
EM: Fibrillary Material