Pathology Flashcards
……. is a syndrome characterized by a rapid deterioration of renal function (typically within days to a week), resulting in the accumulation of nitrogenous wastes in the blood that would normally be excreted in the urine.
Acute kidney injury
ACUTE KIDNEY INJURY/ACUTE TUBULAR
INJURY is characterized by inc of which substances?
increase in blood urea nitrogen (azotemia) increase in serum creatinine
oliguria(low urine output)
What is the reason for prerenal acute kidney injury?
Inadequate kidney perfusion
Reason of inadequate kidney perfusion?
-More advanced volume depletion
➢ excessive volume loss (renal, gastrointestinal or cutaneous origin)
➢ low fluid intake
➢ low effective circulating volume (cardiorenal syndrome)
ACUTE TUBULAR INJURY-Prerenal causes?
-Hypotension
• Hypovolemia associated with hemorrhage or fluid loss (e.g., burns)
• Sepsis
• Inadequate cardiac output (e.g., myocardial infarct [heart attack])
• Renal vasoconstriction (e.g., caused by NSAIDs or radiocontrast agents)
• Renal artery stenosis
What is the outcome of prerenal acute tubular injury ?
• OUTCOME: INADEQUATE RENAL PERFUSION, DECREASE IN FILTRATION PRESSURE, DECREASE IN GLOMERULAR FILTRATION
RATE
Hypotension associated with Hypovolemia or shock may cause the activation of which nervous system ?
Activation of Sympathetic nervous system, renin-angiotensin-aldosterone system activation, which leads to Vasoconstriction in the renal vasculature—> increased resistance —> dec flow and dec blood pressure
NSAIDs leads to a pathological………. renal arterioles leading to a decrease in GFR
ACE inhibitors leads to a pathological………. renal arterioles leading to a decrease in GFR
Vasoconstriction of afferent
Vasodilation of efferent
……is one of the most common causes of acute kidney injury and the injury results from a combination of prerenal and intrarenal factors.
Sepsis
Which part of the kidney is mainly is mainly involved in pyelonephritis ?
Renal pelvis
In cases of tubulointerstitial nephritis caused by bacterial infection, the renal pelvis is prominently involved: this is known as ……….
Pyelonephritis
Tubulointerstitial nephritis cases that are nonbacterial in origin are known as ………………. (Caused by drugs, metabolic disorders such as hypokalemia, irradiation, viral infections, and immune reactions)
INTERSTITIAL NEPHRITIS
What type of bacteria is Escherichia coli : the most common cause of acute pyelonephritis?
Enteric gram negative bacilli
What is the mode of transportation in in acute pyelonephritis?
*ascending infection (from the lower urinary tract): Most important source
Or
bloodstream
What is acute pyelonephritis pathogenesis?
Adhesion to the urothelial lining by bacterial FIMBRIAE
—> bacterial colonization of the lining—>
Colonies reaching the bladder (opposite to the flow of urine; during urethral instrumentation, including catheterization and cystoscopy)
Why do UTI most commonly affect females even in the absence of instrumentation?
Due to the close proximity of the female urethra to the rectum( colonization by enteric bacteria)
Which clinical manifestation is associated with poor prognosis of acute pyelonephritis?
Papillary necrosis
What are the histological morphology of Acute pyelonephritis?
1)necrosis and abscess formation within the renal –parenchyma-
pus formation (suppuration) in the tubular lumina—> neutrophils in collecting duct—> white blood cells in urine.
(Typically, the glomeruli are not affected.)
PYONEPHROSIS:Filling of the renal pelvis, calyx, and ureter with pus
2) papillary necrosis: due to diabetes, UT obstruction, or sickle cell anemia
—> poor prognosis
If bacteriuria is not treated during pregnancy, ………… will occur.
symptomatic UTI (leading to pyelonephritis)
Why does acute pyelonephritis occur in men with advanced age?
Increasing prostatic hyperplasia BPH —>Urinary outflow obstruction
What are the symptoms of acute pyelonephritis?
-Flanking dull pain in costovertebral area that extends to umbilicus
- chills, fever, nausea, malaise (systemic sympt)
-dysuria, frequency, and urgency (UT sympt)
-unilateral involvement (early stage)
- no renal failure
-papillary necrosis(poor prognosis)
-pyuria(WBC in urine) & nitrates in urine
Asymmetric contractions (Atrophy) of the kidneys is present in ……….
Chronic pyelonephritis
Symmetrical Kidney scarring occurs in …….
Chronic glomerulonephritis vascular necrosis
What is the main histological finding in chronic pyelonephritis?
Fibrosis
What are the histomorphological features of chronic pyelonephritis?
Fibrosis
inflammatory infiltrate of lymphocytes, plasma cells, eosinophils, and occasionally neutrophils, Eosinophilic casts
Dilation or contraction of tubules, with
atrophy of the epithelial lining (PAS positive casts-colloid casts)
thyroidization in tubules
Arteriolosclerosis (Hypertension)
Glomerulosclerosis (causes nephron loss)
What are the clinical features of chronic pyelonephritis?
Kidney Atrophy (The affected kidneys are asymmetrically contracted)
Tubular dysfunction
Polyuria( urinating more than usual)
Nocturia( urinating during sleep)
Azotemia?
Inc blood urea nitrogen
Inc creatinine
Dec GFR
Uremia?
Worsening of kidney function
Occurs due to azotemia
Nephrotic syndrome is characterized by which manifestations?
Proteinuria(increased protein in urine <3.5)
Hypoalbuminemia (dec plasma albumin in blood<3]
Edema
Hyperlipidemia (increased lipids in blood)
Lipiduria (increased lipids in urine)
A person presents with proteinuria (inc. of protein in urine), generalized edema, hypoalbuminemia(dec plasma albumin in blood), hyperlipidemia &lipiduria, which kidney syndrome does this person have?
NephrOtic syndrome
A person presents with hematuria( presence of blood&WBC casts in urine), proteinuria (inc. of protein in urine), azotemia , hypertension, which kidney syndrome does this person have?
Nephritic syndrome
……….. is the only upper respiratory tract infection that needs treatment and causes acute glomerulonephritis?
Rheumatic fever
What are the clinical manifestations of asymptomatic hematuria or (NON-NEPHROTIC PROTEINURIA)?
IgA nephropathy,
Alport syndrome
Which type of kidney injury is characterized by hyperphosphatemia, dyslipidemia, and metabolic acidosis
CHRONIC KIDNEY DISEASE
Which disease is characterized by pain and hematuria without red blood cell casts
Nephrolithiasis
What is nephrolithiasis?
formation of stones in the collecting system
fixed =intrinsic glomerular antigens or
with extrinsic molecules that are planted in the glomerulus occur in which type of glomerular injury mechanism?
antibodies reacting in situ within the glomerulus
Which type of hypersensitive reaction occurs in glomerular injury?
Type 3 hypersensitivity
The complement activation system, which is a pathway of antibody-initiated glomerular injury, is activated via which pathway?
Classical pathway using the C5b-C9 membrane attack complex
planted antigens → which cause granular pattern of deposition, occurs in which type of immune mediated injury?
Glomerulonephritis Caused by Immune Complexes Formed in SITU
Give an example of Anti-Glomerular Basement Membrane Antibody–Mediated GN
Immune mediated injury
(antibodies are directed against fixed antigens causing a linear pattern)?
Goodpasture disease(causes renal injury)
Glomerulonephritis Caused by Immune Complexes Formed in Situ causes (granular/linear) pattern deposition of antigens
Granular immunofluorescence
Anti-Glomerular Basement Membrane Antibody–Mediated glomerulonephritis (e.g. Goodpasture disease) causes (glomerular/linear) pattern deposition of antigens?
Linear immunofluorescence
The ………..is also crucial to the maintenance of glomerular
barrier function
podocyte
Alport syndrome, diabetes mellitus, systemic lupus erythematosus, all of these syndromes may have an affect on which part of the nephron?
GLOMERULUS
what are the two forms of antibody-associated injury ?
(1) injury resulting from deposition of soluble
circulating antigen-antibody complexes in the glomerulus
and
(2) injury by antibodies reacting in situ within
the glomerulus, either with insoluble fixed (intrinsic) glomerular antigens or with molecules planted within the
glomerulus
Mechanisms of Glomerular Injury and Disease: Mediators of Immune Injury are activated by which pathway?
classical pathway
Causes of nephrotic syndrome?
-(Imp) Minimal-change disease (**most common in children)
-*Focal segmental glomerulosclerosis – when the glomerulus becomes scarred.(**most common in Heroin addicts)
-*membranous neuropathy: immune system attacks glomerular basement membrane GBM
-Membranous glomerulonephritis(**most common in adults)
-diabetes milletus.
……. is the initiating event of primary FOCAL SEGMENTAL GLOMERULOSCLEROSIS (FSGS)?
Injury to podocytes
(then hyalinosis which causes sclerosis/hardening of glomeruli)
Which Syndrome is characterised by the derangement(change) In the capillary walls of the glomeruli resulting in —>increased permeability of the glomerular basement membrane to plasma proteins
NephrOtic syndrome
Which syndrome is characterized by the inflammation of glomeruli caused by proliferation of cells within the glomeruli accompanied by an infiltrate of leukocyte, due to antibody-antigen complexes being present in the glomeruli
Nephritic syndrome (i for inflammation)
Since both focal segmental Glomerulosclerosis FSGS and minimal change disease are associated with podocyte injury and nephrOtic syndrome, what is the difference between them?
FSGS is associated with hematuria, hypertension, proteinuria, and can develop End-stage renal disease more than Minimal change disease
Which disease is characterised by subepithelial immunoglobulin-containing deposits along the Glomerular basement membrane resulting in diffuse thickening of the capillary wall?
Membranous neuropathy (dense deposit disease)
Antibodies against the podocyte antigen phospholipase A2 receptor (PLA2R) are frequently present in which disease?
Membranous neuropathy (or dense deposit disease
What is the immunofluorescence microscopy staining of membranous neuropathy?
Granular deposits of immunoglobulins and compliments along the glomerular basement membrane
which nephrotic disease is most common in adults?
Membranous glomerulonephritis
which nephrotic disease is most common in children (2-3 yrs of age)?
minimal change disease
common finding in spontaneous abortion?
polyploidy
what causes acute urinary obstruction?
urethral stones
what causes chronic urinary obstruction?
prostatic hyperplasia
what are the causes of nephritic syndrome?
-an infection – such as HIV or hepatitis.
-lupus erythematous
-postinfectious glomerulonephritis
-crescentic glomerulonephritis
-primary glomerular disease
which layer of the glomerular corpuscle is damaged in nephrotic syndrome?
epithelial layer (it’s where podocytes are found)
patients with deep vein thrombosis and pulmonary embolisms are known to have which glomerular syndrome?
NephrOtic syndrome
Plasmocytes are found in ..,,…
Chronic endometritis
Polymorphonuclear leukocytes are found in ………
Acute endometrisis
What is the most common malignant germ cell tumor?
Dysgermynoma
Schiller-Duval body is a characteristic patern in histopathology of which tumor?
Endodermal sinus tumor
Call – Exner body is an important microscopic finding and E2 and inhibin B are tumor markers for this tumor?
Granulosa cell tumor
What is an eg of mucinous carcinoma characterized by accumulation of intra-abdominal mucin (presence of mucin in the abdominal (peritoneal) cavity.)secretions and the morbidity is secondary to intestinal obstruction.
Pseudomixoma peritonei
What is the most common benign epithelial cell neoplasm?
Serous cystadenoma
What is the most common benign solid tumor of the ovary and may coexist with meigs syndrome (ascites + hydrothorax + benign ovarian tumor)
?
Fibromas
What is an imp marker that can differentiate benign from malignant tumors in Adnexal masses?
CA125
Papillary necrosis is an important finding in ……..?
Acute pyelonephritis and diabetic people
What are the findings in acute pyelonephritis?
WBC casts and papillary necrosis
Hemolytic anemia, thrombocytopenia, and renal failure are seen in …….
Thrombotic microangiopathies TMA (hemolytic Uremic syndrome)
…… loss of chromosomes 1 and Y →distinguish them from other renal neoplasms
Oncocytoma
Occupational exposure to cardimium ….
Renal cell carcinoma
……. Contains features the triad of → painless hematuria,
a palpable abdominal mass, and
dull flank pain is characteristic
Chromophobe-type renal cell carcinoma
…………… is a common cause of
recurrent kidney stones, hypercalcemia, and
hypophosphatemia
hyper PTH
,,,,,,,,,,,,,,,is a
spherical, yellow tumor on gross examination. On cut
section, it is golden yellow in color due to high lipid
content.
presence of areas of hemorrhage, necrosis, and calcifications. it may invade perinephric fat and renal vein.
On histology, this kidney neoplasm may show
cuboidal or polygonal cells with clear cytoplasm. it cause hematuria and hypertension.
Which kidney neoplasms is this?
Hypernephroma (clear cell renal cell carcinoma)
which type of renal carcinoma is associated with von hippel-Lindau disease?
clear cell carcinoma(most common)
mutations of the MET germ line and chrom. 7q are a common finding in which kidney neoplasm?
familial cases of Papillary renal cell carcinoma
which syndrome causes manifestations such as polycythemia,
hypertension, hyperparathyroidism, painless hematuria?
Paraneoplastic syndromes of Renal cell carcinoma
what is the most common bladder tumor?
non-invasive papillary (urolethelial) tumor
which type of neoplasms in the bladder causes intestinal metaplasia?
adenocarcinoma of the bladder
which type of neoplasms in the bladder causes extensive keratinization?
squamous cell carcinoma of the bladder
where is the inflammation occurring in acute tubular injury?
proximal tubules
corpora amylacea is present in which disease?
benign prostatic hyperplasia
what are the clinical symptoms of benign prostatic hyperplasia?
hesitancy
urgency
frequency
nocturia
where in the prostate does BPH occur?
inner transitional zone
an imp complication of vulvitis is ………..?
Bartholin cyst and abscess formation
which disease of the vulva affects postmenopausal woman and prepubertal girls and is characterized by the disappearance of rete pegs and leukoplakia (white plaques)?
Lichen sclerosus
what is an imp histopathological finding of lichen simplex chronicus?
elongated rete ridges
condylomata acuminata is caused by ?
HPV 6 and 11
which disease is characterized by intraepidermal proliferation of atypical epithelial cells that occurs in vulva or nipple of breast?
extramammary paget disease
………..is seen in MPGN type I
………is seen in MPGN type Ii
………….is seen in MPGN type Iii
deposits in subendothelial areas
dense deposit disease
subepithelial and subendothelial
