Path HY Flashcards
nephrOtic syndromes
- podocyte effacment
- hyperlipidemia
- frothy urine
- proteinuria > 3.5 g/day
- edema
name the nephrotic syndromes
- minimal change disease
- FSGS
- amyloidosis
- diabetic nephropathy
- MPGN
- membranous nephropathy
minimal change disease
- flat podocytes (cytokines)
- Hodgkin Lymphoma
- SELECTIVE proteinuria (albumin only)
- Tx: steroids
FSGS
- unknown cause of flat podocytes
- severe version of minimal change disease
- HIV, sickle cell
- no response to steroids
membranous nephropathy
- immune complexes deposit in BM (PLA2R on podocytes)
- subEPIthelial
- tumor, hepatitis, RA
- spike + dome appearance
- IF: IgG, C3 (granular)
diabetic nephropathy
- glycosylation of BM
- proteinuria
- sclerosis of EA leads to sclerosis of glomeruli
- Kimmelstiel Wilson bodies
- nodular mesangial sclerosis
- Tx: ARB, ACEi
amyloidosis
- extracellular buildup of amyloid paraproteins
- apple green biorefringence
- mesangial sclerosis
membranoproliferative (MPGN)
- thick BM
- hypercellularity of mesangial cells
- TRAM TRACK
Type 1- subendothelial IgG, C3 (hepatitis, lupus)
Type 2- BM C3, hypocomplementemia
type 1 MPGN
- subendothelial deposits
- IgG, C3
- hep b/c, SLE
- tram track
type 2 MPGN
- deposits in BM
- C3 only
- hypocomplementemia
- C3 nephritic factor
nephrItic syndromes
- hematuria
- proteinuria <3.5 g/day
- RBC casts
- oliguria
- decr GFR
- hypertension
name the nephritic syn
- post infectious GN
- IgA nephropathy (Henoch, Berger)
- Lupus Nephritis (4 - DPGN)
- cresentic/RPGN
- MPGN
- Alport
post-infectious GN
- 2/3 weeks after infection
- subENDOthelial deposition (but see subEPIthelial humps)
- HYPOCOMPLEMENTEMIA
- hypercellular glomeruli (neutrophils)
- IF: IgG, C3
- Tx: supportive only
IgA nephropathy
- 2/3 DAYS after infection
- IgA response to trigger (URI)
- mesangioproliferative bc IgA deposits in mesangium
- activates complement, but only weakly, so no hypocomplementemia
- IF: IgA granular
Henoch Schonlein has extra renal involvement (skin, GI, joints)
Berger is renal only
Lupus Nephritis 4/ DPGN
- subENDOthelial deposits
- hypercellular
- thickened capillary loops
- IF: “full house” IgG, IgA, IgM, C3, C1q
- fever, rash, arthritis
RPGN
- cresentic
- macrophages + fibrin
Type 1: antiGBM antibodies, goodpasture (linear IF)
Type 2: hypersensitivity, SLE, post strep GN (granular IF)
Type 3: ANCA positive (pauci immune)
type 1 RPGN
- antiGBM antibodies
- LINEAR IF
- goodpastures
type 2 RPGN
- hypersensitivity
- SLE, post strep
- GRANULAR IF
type 3 RPGN
- ANCA positive
- pauci immune IF
- lymphocyte release
Alport Syn
- genetic type 4 collagen defect
- can’t see, can’t pee, can’t hear a bee (eyes, ears, renal)
- x linked
- lamellation of GBM
thin basement membrane disease
- non progressive hematuria
- benign
- AD
- defect in type 4 collagen (make less)
acute interstitial nephritis
- hypersensitivity rxn (EOS, PMNs)
- trigger: PCN, sulfas, NSAIDS, diuretics
- assoc w: sarcoidosis, sjogren, SLE
- fever, rash, AKI
- WBC casts
- EOS
- can lead to papillary necrosis
chronic interstitial nephritis
- chronic use of NSAIDs, phenacetin, caffeine
- papillary necrosis (slough off, obstruct)
- large calcified scars
papillary necrosis
- classic feature of analgesic nephropathy
- coagulative necrosis of papillae
- sloughing of tissue
- hematuria
- painless
- normal renal fxn
causes: chronic drug use, diabetes, acute pyelonephritis, sickle cell anemia
acute pyelonephritis
- E coli
- ascending infection
- predisposing: DM, urinary reflux
- UTI
- WBC, hematuria, WBC casts
- distended tubules due to pus
chronic pyelonephritis
- parenchymal scarring
- SEVERE DISTORTION of pelvis/calyces
- sclerosed glomeruli
- THYROIDIZATION
myeloma kidney
- paraprotein
- distended tubules with lumenal casts
- can be due to hypercalcemia
cortical necrosis
- acute onset of renal failure
- anuria
- causes: septic shock, obstetric catastrophes
urate nephropathy
- large uric load
- gout
- tumor lysis syndrome
- kidney stones
- yellow blue biorefringence
benign hypertensive arteriolosclerosis
- hyalinized intima
- hyperplasia of media
- onion skin fibrosis
- flea bite kidney
renal cell carcinoma
- fever, wt loss, fatigue
- men > women
- tobacco, HTN, obesity
- PCT cells
- clear cells: glycogen, lipid
- triad: hematuria, flank pain, flank mass
- VHL deletion
- paraneoplastics (renin, PTH, ACTH, EPO)
- left sided varicocele
- retroperitoneal LN spread to lung, bone
- Tx: surgery
Wilm’s tumor/ nephroblastoma
-young kids
-blastema, epithelium, stroma
-WAGR (wilms, aniridia, genital abnorm., retardation)
-Denys Drash
-Beckwith Wiedman (pediatric overgrowth)
-high renin – HTN
-
oncocytoma
- large, TAN
- Nest and cord growth
- cortical
- EOSINOPHILC and GRANULAR cytoplasm
- myxoid stroma
- epithelial in origin
angiomyolipoma
- blood vessels, smooth muscle, and adipose
- EOS
- TUBEROUS SCLEROSIS
urothelial carcinoma
- tobacco, chemo, occupational exposure, phenacetin, radiation
- no casts in urine
- HEMATURIA
- frequent urgent painful urination
- Tx: surgery
urothelial papilloma
- children
- normal urothelium, but on papilla
- high grade
urothelial carcinoma in situ
- flat (no papillae)
- no umbrella layer
- high grade
- shed cells into urine (urine cytology to diagnose)
- eos
- pleiomorphic
squamous
- schisto
- UTI
adenocarcinoma
- glandular
- urachal remnant
- cystitis/extrophy
