Monday - Renal Tumors Flashcards
3 things you see in glomeulous in DM
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
first thing you see in the urine of someone who is develping a diabetic nephropathy
microalbuminuria (30-300 mg/day)
most common cause of acute renal failure
acute tubular necrosis/injury
two main causes of ATN
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
what happens to the intrarenal vessels during acute tubular necrosis
intrarenal vasoconstriction
increased sodium and chloride in the distal tubules creates a tubuloflomerular feedback that causes what to the afferent arteriole
vasoconstriction
3 “stages” to the clinical course of ATN
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
will heavy metals cause:
ATN?
tubulointerstitial nephritis?
ATN - no
tubulointerstitial nephritis - yes
idk why she said this, they CAN actually cause ATN
general histiological view if tubulointerstitial nephritis and what are you generally thinking when you see it
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
suppurative inflammation is just another way of saying what
PMNs, neutrophils, pus, acute
histo of acute phyelonephritis
tubule endothelium is damaged and there are a bunch of neutrophils in the tubules
also see more interstitial tissue
micro changes in morphology of chronic pyelonephritis
focal tubular atrophy with other areas of dilated tubules (may see thyroidization (tubules filled with colloid casts))
fibrosis in the intersitium
what are you thinking if you see very irregular scarring of the kidney, especially on the top and bottom?
chronic pyelonephritis
what happens to the nephrons that aren’t damaged in tubulointerstitial nephritis
they become hypertrophied and eventually can develop a focal segmental glomerulosclerosis
if you see lymphocytes in the kidney what type of hypersensitivity reaction are you thiking about?
type IV
when do you see bence jones proteins
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
gross and micro appearance of nephrosclerosis
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
malignant nephrosclerosis
associated with what
more common in who
gross and microscopic changes?
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)
when do you see
onion skinning of Vessels/hyperlplastic arteriolitis
malignant nephrosclerosis
when do you see a flea bitten kidney?
malignant nephrosclerosis
glomerulus that looks normal but arteriole has a concentric appearance. what are you thinking
malignant nephrosclerosis
new onset hypertension in 20 something lady what are you thinking
fibromuscular dysplasia
stenosis of the renal artery because the muscular wall of the artery is hypertrophied
why do you get thrombocytopenia in microangiopathic autoimmune hemolytic anemia
apparently you use up all of your platelets by clotting up and shit
stuff about thrombotic microangiopathies
endothelial cell injury (not well known) sometimes e.coli 0157 (verocytotoxin or shiga), viruses, drugs, abnormal vW multimers
due to denuted endothelial
typical hemolytic uremic syndrome is caused by what
what toxin does it produce
classic triad
E. coli 0157
verocytotoxin (shiga-like toxin)
anemia
thrombocytopenia
acute renal failure
classic symptoms of idiopathic thrombotic thrombocytopenic purpura
fever, neurologic symptoms (more common in TTP than HUS), MAHA, thrombocytopenia, renal failure (more common in HUS than TTP)
pathogenesis of idiopathic TTP
genetic defect in protease that cleaves von willebrand multimers
what urolithiasis stones are radiolucent
uric acid stones
angiomyolipoma - benign or malignant? assoc. with what syndrome
benign
associated with tuberous sclerosis (autosomal dominant with CNS and retinal hamartomas, cardiac and pulmonary myxomas, cutaneous lesions, and this renal angiomyolipoma)
oncocytoma
gross and micro appearance
Gross: mahogany brown
micro: large, eosinophilic cells with round nuclei, EM shows abundant mitochondria in the cells (hence the name oncocytoma)
most common malignant tumor of the kidney. also the genetics and epidemiology
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
von hippel-lindau syndrome
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
big bright yellow tumor in the kidney
renal cell carcinoma
three types of renal cell carcinoma
clear cell - most common
papillary - next most - cuboidal cells and foam cells in papillary cores
chromophobe - least common
what does papillary mean
the cells have a central vessel and grow around the outside of the central vessel
some common paraneoplastic findings in renal cell carcinoma
polycythemia, hypercalcemia, hypertension, feminization or masculinization
name a common kidney cancer that presents late
name one that presents early as hematuria
renal cell carcinomas can present really late
urothelial carcinomas of the renal pelvis can present really early as hematuria
