Path Pictures Flashcards
hyaline sclerosis due to high BP
arterionephrosclerosis: end stage hypertensive nephropathy
fibrinoid necrosis of arterioles (far end of hyaline sclerosis) leading to necrosis of glomeruli
Malignant HTN
onion skin: proliferation of intimal cells in small arterie
Hyperplastic arteriosclerosis due to malignant HTN
flea-bitten kidney: damgae of small arteries and arterioles
Malignant HTN
proliferative glomerular disease
membranous glomerular disease
membrano-proliferative glomerular disease
crescentic disease
necrotized and organizing glomerulus
glomerulosclerosis: fibrous scar replacing glomerulus
segmental glomerulosclerosis
normal RBC in urine
dysmorphic RBC in urine
nephritic syndrome
oval fat bodies
Nephrotic
MCD: normal looking
MCD: effacement and detachment of foot processes
MCD: effacement of foot processes
FSGS
one segmentally involved glomerulus, 2 uninvolved glomeruli
FSGS
bottom: hyalinosis
left: adhesion of involved segment to Bowman capsule
FSGS
green arrow: hyalinosis
black: small accumulation of hylanosis
Hyalinosis: accumulation of leaked plasma protein and lipids
foot process effacement
FSGS: just like MCD
collapsing FSGS
left: collapsed BM with 2 adhesions
right: EM of collapsing FSGS
thickened BM without increased cells
membranous nephropathy
membranous nephropathy
thick BM with subendothelial depostis separated by spikes of new GBM
Spike and dome
membranous nephropathy
thick BM with subendothelial deposits (blue)
separated by spikes of new GBM
PSGN
diffuse endocapillary proliferation and infiltration by neutrophils
PSGN
dome shaped subepithelial humps (blue)
MPGN
enlarged glomeruli, increased mesangial matrix and cellularity
thickened, split BM: tram track
MPGN with abundant mesangial matrix
MPGN
highlighting increased cellularity
MPGN
silver stain: highlights thickened split BM due to new membrane fromation and deposits in BM
MPGN
depostis in BM
MPGN: Dense Deposit Disease
dense dark material in glomerular BM
Goodpasture’s:
right: linear
left: necrotizing crescentric glomerulonephritis, not specific
rapidly progressive (crescentic) glomerulonephritis
rapidly progressive (crescentic) glomerulonephritis
can be Goodpasture’s or other immune complex (pauci-immune)
type II crescentic glomerulonephritis
Pauci-immune crescentic glomerulonephritis type III
hereditary nephritis Alport syndrome
BASKETWEAVE: thin BM with splintering of lamina densa
hereditary nephritis/Alport
basket weave
segmental transmural necrotizing vasculitis
top arrows: neutrophils
bottom arrow: fibrinoid necrosis of vessel wall
Polyarteritis nodosa
renal arteriogram with infarct
polyarteritis nodosa
white arrow: renal infarct
black arrow: arterial aneurysms
red arrow: hole in kidney: lead to hypotension
polyarteritis nodosa
numbers: multinucleated giant cells
blue haze: necrosis
necrotizing granulomatous inflammation
granulomatosis with polyangiitis
vascular necrosis and thrombosis
granulomatosis with polyangiitis
crescentic glomerulonephrtiis
granulomatosis with polyangiitis
crescentic glomerulonephrtis
granulomatosis with polyangiitis
arrow: thrombosed capillary
thrombotic microangiopathy in glomerulus
thrombosed arteriole
thrombotic microangiopathy
mesangial proliferative
lupus nephritis class II: mild
focal proliferitive
lupus nephritis class III: moderate
diffuse proliferative: lots of excess cells (inflammatory, mesangial, capillary endothelial cells)
lupus nephritis class IV: severe
diffuse proliferative: wireloop lesions, hyaline thrombosis in capillary
Lupus nephritis class IV: severe
diffuse proliferative: gamaged glomerulus, crescent formation, excess cells of various types
lupus nephritis class IV: severe
membranous
lupus nephritis class V: nephrotic
subendothelial and mesangial deposits
lupus nephritis
subendothelial deposits
Lupus nephritis
intimal thickening of interlobar arteries: ONION SKIN
scleroderma: systemic sclerosis
enlarged, pale cortex, congested medulla (esp. at cortico-medullary junction)
acute tubular necrosis
cortical hemorrhages
acute tubular necrosis
normal renal tubules
blebbing of luminal side cell membranes: an early ischemic change
acute tubular necrosis
diffuse edema of tubular cells: vacuolization
acute tubular necrosis (also seen in osmotic diuresis)
loss of brush border and flattening of epithelium (1,2,3)
necrosis and sloughing of epithelial cells (4)
acute tubular necrosis
necrosis and sloughing of tubular cells mixing into casts with proteinaceous material
acute tubular necrosis
muddy brown granular cast
acute tubular necrosis
apoptosis of tubular epithelial cells (less common that coagulative necrosis)
acute tubular necrosis
flattened epithelium and necrosis and sloughing of epithelium
1 and 2: myoglobin from rhabdomyolysis
vacuoliztion
black arrow: calcium oxalate
acute tubular necrosis
Dx: Ethylene glycol
right arrow: cast debris
left: mitosis
recovery phase of acute tubular necrosis
dark red congestion and areas of light tan suppurative inflammation some with necrosis and some with coalescing abscesses (upper right)
Acute pyelonephritis
congestion with mild hemorrhage, heavy infiltration by leukocytes (PMNs)
acute pyelonephritis
diffuse infiltration by leukocytes (PMNs)
acute pyleonephritis
early renal abscesses
severe acute inflammation and necrosis but not much liquefaction
dimples in cortex: liquefaction
acute pyelonephritis
nuclear debris from breakdown of dead cells, especially neutrophils
cracks: later abscesses will have holes in them
renal abscess
acute pyelonephritis
acute papillary necrosis
acute pyelonephritis complication
pyonephrosis and perinephric abscess
acute pyelonephritis complication
healing by scar formation and deformation of calyx
complication of acute pyelonephritis
scarring
chronic pyelonephritis
depressions: due to scarring through entire parenchyma
inflammation, primarily lymphocytes and plasma cells, primarily interstitial
chronic pyelonephritis
thyroidization: fibrosis and tubules distended with insipissated urine
chronic pyelonephritis
edema, lympohcytes, macrophages, neutrophils, EOSINOPHILS
interstitial nephritis
right: variavle tubular damage and edema
left: inflammatory cells
chronic interstitial nephritis and papillary necrosis
analgesic nephropathy
elderly females
longterm combination analgesic use
analgesic nephropathy: papillary necrosis
AD (adult) polycystic kidney disease
AR (infant) polycystic kidney disease
nephronophthisis: meduallary cystic disease
medullary sponge kidney
common and benign
hydronephrosis with marked dilatation of renal caylces secondary to compresion of renal parencyma
urinary tract obstruction
adenoma
oncocytoma
MAHOGANY BROWN, STELLATE scar
modified tubular cells, nuclei big and regular, no mitotic figures
oncocytoma
Oncocytoma
mahogany brown, stellate scar
mitochondria
oncocytoma
solitary, polar, yellow, with cysts, necrosis, hemorrhage
clear cell carcinoma
solitary, polar, yellow with cysts, necrosis, hemorrhage
clear cell carcinoma
solitary, polar, yellow with cysts, necrosis and hemorrhage
clear cell carcinoma
clear cell carcinoma
small nuclei, clear cell, no mitotic figures
tiny nuclei, no nucleoli, no mitotic figures, eosinophilc cytoplasm
clear cell carcinoma
small regular nuclei
low grade clear cell carcinoma
variable irregular nuclei
high grade clear cell carcinoma
papillary carcinoma
renal cystic disease due to dialysis
papillary carcinoma
finger like
papillary carcinoma
big tumor, lots of hemorrhage
chromophobe carcinoma
chromophobe carcinoma
thick walled vessels
Hale’s collidal iron stain
chromophobe carcinoma
central location
renal pelvis carcinoma: urothelial or transitional cell
renal pelvis carcinoma: urothelial/transitional cell
hyperchromatic nuclei extending into lumen and invading submucosa
renal pelvis carcinoma: squamous cell
Wilm’s tumor/nephroblastoma
Wilm’s tumor
Wilm’s tumor
blastema: all of background of image
epithelial: abortive glomeruli or tubules
clear cells lower left: stromal component: fibroblastic cells with young myxoid light blue matrix around them
tumors all over
metastatic renal cell carcinoma
RARE
small cell carcinoma from lung in glomerulus
looks like crescentic glomerulonephritis: know it isn’t because of Hx
metastatic renal cell carcinoma
sickle cell anemia
blue: sickle cells
black: howell jolly
red: target cell
glomeruli largely occluded by sickled RBC
extensive congestionin peritbular capillaries
Sickle cell nephropathy
glomerulomegaly and mesangial expansion
tubular epithelial hemosiderin accumulaiton
interstial fibrosis and vascular sclerosis
Sickle cell nephropathy
renal artery thrombosis in sickle cell: rare to thrombose large vessels in SICKLE cell nephropathy
hyaline eosinophilic; glomerulus and arterial wall
amyloidosis
CONGO RED +
amyloid in glomerulus
often has false negatives
amyloid kidney
CONGO RED under polarized light: APPLE GREEN BIREFRINGENCE
amyloid
immunoperoxidase stain
often has false postitives
bone marrow; plasmacytosis
arrow: perinuclear Hof of plasma cell
Plasma cell dyscrasis
AL amyloid
Bence jones protein
precipitate in urine or in tubules and tubular epithelial cells can coalesce into a syncytium around them
AL amyloid
AB2M amyloid
AB2M amyloid
nodular glomerulosclerosis resembling diabetic nephropathy
deposits along outer part of tubular BM may be seen
Light chain disease
endothelial side depostion: sand on beach
light chain disease
collapsing FSGS
HIV associated nephropathy
prominent microcystic tubular dilation, interstitial inflammation and fibrosis
collapsed glomeruli
HIV associated nephropathy
membranoproliferative glomerulonephrtits; can have pseudo-thrombi in capillaries
cryoglobulinemia
normal glomerulus
diffuse mesangial thickening: early
diabetic nephropathy
hyaline sclerosis of arteriole and small nodular lesion
diabetic nephropathy: late
kimmelstiel wilson lesion and small capsular drop
diabetic nephropathy: later
BM thickening of capsule and glomerular capillaries and nodule
Diabetic Nephropathy
fibrin cap exudative lesions (red): crescentic depostis of condensed leaked plasma protein overlying peripheral capillaries between endothelial cell and BM or BM and epithelial cells
diabetic nephropathy
thickened arteriole with aneurysm and capsular drop
capsular drop: ONLY in diabetic glomerulopathy, deposits of plasma protein and BM in parietal layer of Bowman’s capsule protruding into urinary space
numerour nodular lesions: Kimmelstiel-Wilson nodules
diabetic nephropathy
Nodulat glomerulosclerosis: correlates with renal failure
END STAGE
diabetic nephropathy: looks like hypertensive nephropathy
diffuse fine granularity of cortical surface
