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Renal > Pathology > Flashcards

Pathology Flashcards

1
Q

What is glomerulonephritis?

A

Inflammation of the glomerulus

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2
Q

Name the main groups of causes of glomerulonephritis

A
  1. immune mediated; directed at something in the glomerulus or caused by circulating complexes getting stuck in the sieve
  2. related to vasculitis
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3
Q

What is the effect of goodpastures syndrome on the glomerulus

A
  • directly attacks the glomerulus
  • alpha 3 subunit of collagen 4
  • IgG antibodies
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4
Q

Name examples of circulating immune complexes that can cause glomerulonephritis

A
  • infection; hepatitis viruses, bacteria (post strep), HIV
  • drugs; gold, penicillamine
  • cancer; any but often lymphomas
  • most commonly seen cause of glomerulonephritis
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5
Q

What types of vasculitis can have an effect on the glomerulus and how?

A
  • GPA (cANCA)
  • microscopic polyangiitis (pANCA)
  • fundamentally they stop the glomerular sieve from working
  • disrupt the membranes charge, block the membranes
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6
Q

Nephritic is characterised by what features?

A
  • haematuria

- hypertension

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7
Q

Nephrotic is characterised by what features?

A
  • heavy proteinuria
  • non dependent oedema
  • hyperlipidaemia
  • protein loss includes antibodies, complement and proteins in the clotting cascade
  • immunosuppression, renal vein thrombosis
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8
Q

What three methods help to differentiate between nephrotic and nephritic?

A
  • light microscopy
  • electron microscopy
  • immunofluorescence
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9
Q

What features suggests rapidly progressive glomerulonephritis?

A

Crescents

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10
Q

What can be seen on light microscopy for glomerulonephritis?

A
  • usually see hypercellularity; inflammation and reactive proliferations
  • can see sclerosis; on going damage
  • may see crescent
  • possibly be able to see vasculitis
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11
Q

What can be seen on electron microscopy for glomerulonephritis?

A
  • high magnification
  • can look at the basement membrane
  • can see if there is deposits and usually where the deposits are
  • i.e. subepithelial, mesangial, subendothelial
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12
Q

For minimal change glomerulonephritis;

A) cause
B) who gets it 
C) nephritic or nephrotic
D) appearance 
E) prognosis 
F) treatment
A 
A) unknown 
B) children 
C) nephrotic 
D) not much to see hence minimal change 
E) good prognosis 
F) usually resolves with some steroids (patients need screened before immunosuppressing)
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13
Q

For focal segmental glomerulosclerosis;

A) cause
B) who gets it
C) nephritic or nephrotic
D) appearance

A

A) obesity, HIV, sickle cell, IV drug users
B) adults
C) nephritic
D) focal segmental glomerulosclerosis

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14
Q 
For membranous glomerulonephritis; 
A) who gets it 
B) nephritic or nephrotic
C) appearance 
D) prognosis
A

A) adults
B) nephrotic
C) thick membranes, sub-epithelial immune deposits
D) variable, slow indolent progression. Less than 40% eventually develop renal failure

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15
Q

Name causes of membranous glomerulonephritis

A
  • infection; hepatitis, malaria, syphilis
  • drugs; penicillamine, NSAIDs, captopril, gold
  • malignancy; lung, colon and melanoma
  • lupus; 15% of all GMN in lupus
  • autoimmune disease; thyroiditis
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16
Q 
For IgA nephritis;
A) cause
B) who gets it 
C) nephritic or nephrotic
D) appearance 
E) prognosis
A 
A) genetic, acquired defect 
B) post infectious 
C) nephritic 
D) IgA deposition in mesangium 
E) depends on severity
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17
Q 
For membranoproliferative glomerulonephritis; 
A) cause
B) who gets it 
C) nephritic or nephrotic
D) appearance 
E) prognosis
A

A) idiopathic (type 2- infections, lupus, malignancy)
B) adults and children
C) either
D) big lobulated hypercellular glomeruli with thick membranes; tram tracks
E) depends on severity

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18
Q

Name some features of diabetes seen in the kidney

A
  • diffuse and nodular glomerulosclerosis
  • nodules; kimmel stiel and wilson leison
  • microvascular disease; arterial sclerosis
  • infection; pyelonephritis, papillary necrosis
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19
Q

What is a bosniak score used for?

A

To determine malignancy risk in cystic kidney disease

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20
Q

Described acquired cysts

A
  • very common
  • seen very frequently at autopsy
  • often associated with long term dialysis
  • simple cysts; attenuated lining, degenerate type of change
21
Q

What are the two broad categories of polycystic kidney disease?

A
  • autosomal dominant PCKD

- autosomal recessive PCKD

22
Q

What is the cause and pathology of ADPCKD?

A
  • due to a mutation in nephrin
  • lots of cysts that develop over time
  • large kidney size
  • cysts are lined by simple epithelium
  • often secondary changes; haemorrhage, infarction, rupture
23
Q

Describe the signs and symptoms of ADPCKD

A
  • size of kidney; often present with a mass / lesions
  • pain, haematuria because of rupture, infarction etc
  • systemic disease; liver cysts and cerebral aneurysms
  • associated with sub arachnoid haemorrhage
24
Q

What is xanthogranulomatous pyelonephritis?

A

Specific infection. Creates a mass but is usually assoc. with infection

25
Q

Name a benign tumour of the kidneys

A

Oncocytoma

26
Q

Name malignant tumours of the kidney

A
  • chromophobe
  • clear cell
  • papillary and collecting duct
27
Q

Name a kidney tumour seen in paediatrics

A

Wilms tumour

28
Q

Describe the pathological appearance of oncocytoma

A
  • small, oval and well circumscribed
  • mahogany brown with a central stellate scar
  • very pink and granular cytoplasm
29
Q

Describe the pathological appearance of chromophobe tumours

A
  • uncommon
  • difficulty is their similarity to oncocytomas
  • oncocytic but weith raisonoid nuclei and perinuclear haloes
30
Q

Describe collecting duct carcinoma

A
  • least common
  • high grade appearance with a very desmoplastic stroma
  • poor survival
31
Q

Describe papillary tumours

A
  • 2nd most common
  • generally low grade; type 1 and type 2
  • finger like projections
32
Q

What is the most common form of kidney malignancy?

A

Clear cell carcinoma

33
Q

What are the risk factors and presenting complaint of clear cell carcinomas?

A
  • RF; obesity, genetic influence

- PC; haematuria, mass, hypertension rarely

34
Q

Describe the pathological appearance of macro clear cell carcinomas

A
  • often partly cystic and very heterogenous surface

- bright yellow tumour surface

35
Q

Describe the pathological appearance of micro clear cell carcinoma

A
  • clear cell

- actually an artefact of processing and relates to hypoxia of the cells

36
Q

Where does RCC have the potential to spread to?

A
  • renal vein involvement

- can even extend into vena cava and grow up towards the heart

37
Q

Which gene codes for most sporadic renal cancers?

A

VHL

38
Q

Describe cystitis

A
  • very common
  • rarely biopsied
  • some variants and important subtypes;
  • parasites and mycotic infection
  • aseptic
  • reactive to catheters
39
Q

Describe aseptic cystitis

A
  • persistent symptoms of dysuria
  • persistently negative cultures and urinalysis
  • variable pathology; some inflammation, congestion, mast cells
40
Q

What is cystitis cystica?

A
  • a descriptive term

- infolding og bladder mucosa into cysts

41
Q

Describe the features of urothelial neoplasia

A
  • relatively common
  • who; middle aged and elderly
  • no sex predilection
  • smoking is a massive risk factor
  • also beta naphthyline in the dye industry
42
Q

What malignancies can be found in the bladder?

A
  • transitional cell carcinoma
  • adenocarcinoma
  • urachal adenocarcinoma
43
Q

What is the uracus?

A
  • embryological remnant of the alantois
  • between dome of the bladder and the umbilicus
  • usually involutes but can remain patent
  • adenocarcinomas can arise here
44
Q

What is the function of the prostate?

A

Prostatic fluid and fluid from seminal vesicles. Some contractile function during ejaculation

45
Q

Where on the gland does prostate cancer usually affect?

A

The periphery of the gland

46
Q

Describe PSA

A
  • prostate specific antigen
  • glycoprotein enzyme; kallikrein 3
  • liquifies semen in ejaculate and allows sperm to swim
47
Q

Name factors that can affect PSA level

A
  • a large prostate
  • prostatitis
  • doing a PR exam will elevate
  • drugs such as spironolactone
  • high grade cancers do not produce PSA
48
Q

What system is used to grade prostate tumours?

A

Gleason grading system

Renal (7 decks)

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