Pathology

Question 1

Name 2 Nephritic syndromes

Answer 1

Post-streptococcal glomerulonephritis (PSGN) and IgA Nephropathy (Berger’s Disease)

Question 2

Causes and risks of PSGN

Answer 2

2-4 weeks post strep infection, mostly in children. Infection leads to development of circulating immune complexes. (Type III hypersensitivity rxn) Deposited subendothelial and mesangial locations leads to inflammation of glomerulus.

Question 3

SXS of PSGN

Answer 3

MILD proteinuria 
Hematuria
RBC casts
Azotemia
HTN
Edema/periorbital edema 
Coke colored urine

Question 4

Tx of PSGN

Answer 4

Supportive care, generally resolves in 1 month

Question 5

Cause of IgA Nephropathy

Answer 5

Mesangial deposition of IgA, IgA loses its galactose and the body can no longer recognize it. IgG attacks them, forming immune complexes that get trapped in kidney, secondary to GI or upper respiratory infection.

Question 6

SXS of IgA Nephropathy

Answer 6

Episodic hematuria often within days of GI infx or upper respiratory infx

Question 7

Name 3 Nephrotic syndromes

Answer 7

Membranous glomerulopathy
Focal Segmental Glomerulosclerosis (FSGS)
Diabetic Glomerulonephropathy

Question 8

Causes of Membranous Glomerulopathy

Answer 8

Primary (75%): Idiopathic

Secondary: Lupus, NSAIDs, gold, penicillamine, hep B, hep C, syphilis, solid tumors

Question 9

Tx of Membranous Glomerulopathy

Answer 9

Steroids + tx of underlying disease

Question 10

Causes of Focal Segmental Glomerulosclerosis

Answer 10

Primary: Idiopathic

Secondary: Heroin drug use, HIV, interferon tx, congenital malformations, sickle cell disease

Question 11

Tx of FSGS

Answer 11

Steroids, ACE inhibitors

Question 12

Causes of Diabetic Glomerulonephropathy

Answer 12

Excess glucose causes the basement membrane of the efferent arterioles to thicken, creating an obstruction and increased pressure which leads to the expansion of the mesangial cells

Question 13

Tx of Diabetic Glomerulonephropathy

Answer 13

(Slows disease progression, does not cure)
HTN: ACE/ARBs
Tx of hyperglycemia

Question 14

2 types of Acute Tubular Necrosis (ATN)

Answer 14

Ischemic (hypovolemia, shock, renal artery stenosis, embolism in renal artery) causes skip lesions in tubules.

Toxic (PCT only, due to drugs, toxins, CCL4, radiocontrast)

Question 15

Causes of acute/chronic Tubulointerstitial Nephritis

Answer 15

Acute: Acute bacterial pyelonephritis, acute interstitial nephritis (hypersensitivity reaction to drugs)

Chronic: Lead nephropathy, analgesic nephropathy, chronic urinary tract obstruction

Question 16

Causes of Pyelonephritis (acute, recurrent, chronic)

Answer 16

(Common) Inflammation affecting the tubules, interstitium, and renal pelvis. Ascending infx most common.

85-90% caused by gram negative bacilli (most commonly E.coli)

Causes:
Urinary tract obstruction/stasis (organisms multiply)
Vesicoureteral reflux
Intrarenal reflux

Question 17

SXS of pyelonephritis

Answer 17

Fever, flank pain, N/V, chills
Unilateral 
Abdominal pain 
Myalgia 
Fatigue 
N & V 
Weakness

Question 18

Causes of Acute Interstitial Nephritis

Answer 18

Due to drug/infx agent acting as a hapten, binding to cytoplasm or EC membrane binding sites with secondary immune mediated injury.
Ibuprofen/NSAIDs, acetaminophen, penicillins, cephalosporins, cimetidine, thiazide diuretics, cyclosporine

Question 19

Causes of Nephrolithiasis

Answer 19

Habits, hereditary errors of metabolism cause excessive production and excretion of stone-forming substances (their urinary concentration exceeds their solubility), urine pH/vol, bacteria

Question 20

Causes of Nephrosclerosis

Answer 20

Sclerosis of renal arterioles, causes local parenchymal ischemia

Causes: HTN or DM

Question 21

Causes of Renal Artery Stenosis

Answer 21

From atherosclerotic plaque or fibromuscular dysplasia (Intractable HTN from renin release)

Causes: HTN

Question 22

Describe Autosomal Dominant Polycystic Kidney Disease (ADPKD)

Answer 22

Mutation in PKD1 or PKD2. Fluid filled cysts in kidneys due to PKD1 or PKD2 not inhibiting cell proliferation.
Major cause of chronic kidney disease.

Question 23

Name 2 malignant renal neoplasms

Answer 23

Renal Cell Carcinoma 
Wilms Tumor (Nephroblastoma)

Question 24

Describe Hydronephrosis

Answer 24

Dilation of renal pelvis and calyces from retained urine.

Back pressure causes renal atrophy, compresses renal vasculature, decreased ability to concentrate urine, and damage to glomeruli.

Leads to scarring and atrophy of papillae
Inability to concentrate urine, salt wasting, HTN, if complete: anuria (incompatible with survival)

Question 25

Describe Vesicoureteral Reflux (VUR)

Answer 25

Malposition of incompetent closure of UVJ allows for urine to reflux from the bladder. Congenital or acquired (scarring in adults causing obstruction)