Monday - Renal Tumors

Question 1

3 things you see in glomeulous in DM

Answer 1

think BM
mesangial prolif
(both due to glycosylation(

nodular sclerosis
called kimelstiel-wilson disease (hyaline masses at the periph, mesangium is somewhat increased)

jimmy kimmel has diabetes

Question 2

first thing you see in the urine of someone who is develping a diabetic nephropathy

Answer 2

microalbuminuria (30-300 mg/day)

Question 3

most common cause of acute renal failure

Answer 3

acute tubular necrosis/injury

Question 4

two main causes of ATN

Answer 4

ischemic - necrosis tends to be patchy

• hemolysis, mismatched blood transfusions, skeletal muscle destruction

nephrotoxic - necrosis tends to knock out large segments of the proximal portion of the nephron

-drugs, heavy metals, solvents, dyes

Question 5

what happens to the intrarenal vessels during acute tubular necrosis

Answer 5

intrarenal vasoconstriction

Question 6

increased sodium and chloride in the distal tubules creates a tubuloflomerular feedback that causes what to the afferent arteriole

Answer 6

vasoconstriction

Question 7

3 “stages” to the clinical course of ATN

Answer 7

initiation (slight decline in urine output and increased BUN)

maintenance (oliguria (40-400ml/day), salt and water overload, increased BUN, hyperkalemia, metabolic acidosis, often requires dialysis)

recovery - steady increase in urine volume (up to 3 L per day), hypokalemia

Question 8

will heavy metals cause:

ATN?
tubulointerstitial nephritis?

Answer 8

ATN - no
tubulointerstitial nephritis - yes

idk why she said this, they CAN actually cause ATN

Question 9

general histiological view if tubulointerstitial nephritis and what are you generally thinking when you see it

Answer 9

just a lot of inflammatory cells between the tubules with no actual inflamation of the tubules. acute phase you see neutrophils OBV

usually thinking related to drug toxicity

Question 10

suppurative inflammation is just another way of saying what

Answer 10

PMNs, neutrophils, pus, acute

Question 11

histo of acute phyelonephritis

Answer 11

tubule endothelium is damaged and there are a bunch of neutrophils in the tubules

also see more interstitial tissue

Question 12

micro changes in morphology of chronic pyelonephritis

Answer 12

focal tubular atrophy with other areas of dilated tubules (may see thyroidization (tubules filled with colloid casts))

fibrosis in the intersitium

Question 13

what are you thinking if you see very irregular scarring of the kidney, especially on the top and bottom?

Answer 13

chronic pyelonephritis

Question 14

what happens to the nephrons that aren’t damaged in tubulointerstitial nephritis

Answer 14

they become hypertrophied and eventually can develop a focal segmental glomerulosclerosis

Question 15

if you see lymphocytes in the kidney what type of hypersensitivity reaction are you thiking about?

Answer 15

type IV

Question 16

when do you see bence jones proteins

Answer 16

IgG light chains (kappa or lambda) in Multiple Myeloma

they are directly toxic to tubules, they combine with tamm-Horsfall protein in the kidney to form massive casts

Question 17

gross and micro appearance of nephrosclerosis

Answer 17

normal to small kidnyes

surface has fine, even granularity

thickening and hyalinization of the walls of arterioles and small arteries (hyaline arteriosclerosis) which narrows the vessel lumen

Question 18

malignant nephrosclerosis

associated with what

more common in who

gross and microscopic changes?

Answer 18

associated with malignant hypertension

more common in men, blacks, younger patients

pathogenesis related to an initial vascular damage to the kidneys

kidney is ischemic, and renin-angiotensin activated

gross: pinpoint petechial hemorrhages on the cortical surface (flea-bitten)
micro: fibrinoid necrosis of arterioles - Eosinophilic material in blood vessel wall (fibrin). minimal or no inglammation

onion skinning of Vessels/hyperlplastic arteriolitis (concentric proliferation of smooth muscle cells)

Question 19

when do you see

onion skinning of Vessels/hyperlplastic arteriolitis

Answer 19

malignant nephrosclerosis

Question 20

when do you see a flea bitten kidney?

Answer 20

malignant nephrosclerosis

Question 21

glomerulus that looks normal but arteriole has a concentric appearance. what are you thinking

Answer 21

malignant nephrosclerosis

Question 22

new onset hypertension in 20 something lady what are you thinking

Answer 22

fibromuscular dysplasia

stenosis of the renal artery because the muscular wall of the artery is hypertrophied

Question 23

why do you get thrombocytopenia in microangiopathic autoimmune hemolytic anemia

Answer 23

apparently you use up all of your platelets by clotting up and shit

Question 24

stuff about thrombotic microangiopathies

Answer 24

endothelial cell injury (not well known) sometimes e.coli 0157 (verocytotoxin or shiga), viruses, drugs, abnormal vW multimers

due to denuted endothelial

Question 25

typical hemolytic uremic syndrome is caused by what

what toxin does it produce

classic triad

Answer 25

E. coli 0157

verocytotoxin (shiga-like toxin)

anemia
thrombocytopenia
acute renal failure

Question 26

classic symptoms of idiopathic thrombotic thrombocytopenic purpura

Answer 26

fever, neurologic symptoms (more common in TTP than HUS), MAHA, thrombocytopenia, renal failure (more common in HUS than TTP)

Question 27

pathogenesis of idiopathic TTP

Answer 27

genetic defect in protease that cleaves von willebrand multimers

Question 28

what urolithiasis stones are radiolucent

Answer 28

uric acid stones

Question 29

angiomyolipoma - benign or malignant? assoc. with what syndrome

Answer 29

benign

associated with tuberous sclerosis (autosomal dominant with CNS and retinal hamartomas, cardiac and pulmonary myxomas, cutaneous lesions, and this renal angiomyolipoma)

Question 30

oncocytoma

gross and micro appearance

Answer 30

Gross: mahogany brown

micro: large, eosinophilic cells with round nuclei, EM shows abundant mitochondria in the cells (hence the name oncocytoma)

Question 31

most common malignant tumor of the kidney. also the genetics and epidemiology

Answer 31

renal cell cacinoma - 3% of all cancers, 85% of renal cancer in adults.

genetics - 98% of them show losses of chromosome 3p in the region of the VHL gene)

elderly
male
tobacco use is most important risk factor

Question 32

von hippel-lindau syndrome

Answer 32

autosomal dominant
hemangioblastomas of the cerebellum and retina
renal cysts and renal carcinoma

VHL gene of chromosome 3p25.3 acts as tumor suppressor gene (encodes protein that is part of the ubiquitin ligase complex

Question 33

big bright yellow tumor in the kidney

Answer 33

renal cell carcinoma

Question 34

three types of renal cell carcinoma

Answer 34

clear cell - most common
papillary - next most - cuboidal cells and foam cells in papillary cores
chromophobe - least common

Question 35

what does papillary mean

Answer 35

the cells have a central vessel and grow around the outside of the central vessel

Question 36

some common paraneoplastic findings in renal cell carcinoma

Answer 36

polycythemia, hypercalcemia, hypertension, feminization or masculinization

Question 37

name a common kidney cancer that presents late

name one that presents early as hematuria

Answer 37

renal cell carcinomas can present really late

urothelial carcinomas of the renal pelvis can present really early as hematuria