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Renal > Pathology > Flashcards

Pathology Flashcards

1
Q

granular casts ‘muddy brown’

A

acute tubular necrosis

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2
Q

casts in urine indicate that the site of haematuria / pyuria is where?

A

glomerular or tubular in origin
i.e. haematuria due to bladder cancer -> haematuria without casts

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3
Q

fatty casts ‘oval fat bodies’

A

nephrotic syndrome
associated with Maltese cross sign

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4
Q

waxy casts

A

end stage renal disease / chronic kidney disease

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5
Q

hyaline casts

A

non-specific, can be normal function kidney with dehydration, exercise or diuretic therapy

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6
Q

pathophysiology of proteinuria in nephrotic syndrome

A

podocyte damage -> impaired charge barrier -> poteinuria

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7
Q

granular ‘stary sky’ appearance on immunoflourescence

A

post-infective glomerulonephritis due to IgG, IgM and C3 deposition along GBM and mesangium

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8
Q

what type of hypersensitivity reaction is post infective glomerulonephritis

A

type III

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9
Q

what type of hypersensitivity reaction is good pastures syndrome

A

type II

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10
Q

antibodies associated with microscopic polyangitis and eosinophillic granulomatosis with polyangitis

A

MPO
pANCA

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11
Q

antibodies associated with granulomatosis with polyangitis

A

PR3
cANCA

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12
Q

main cause of diffuse proliferative glomerulonephritis

A

SLE

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13
Q

wire loping of capillaries on light microscopy

A

diffuse proliferative glomerulonpehritis

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14
Q

features of Alport syndrome

A

x-linked dominant
type IV collagen mutation

eye problems, glomerulonephritis, SNHL

(cant see, cant pee, cant hear a bee)

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15
Q

basket weave appearance on electron microscopy

A

Alports syndrome
(baskets at the port)

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16
Q

GMB splitting and ‘tram-track’ on H&E and PAS stains

A

membrano-proliferative glomerulonephritis

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17
Q

effacement of podocyte foot processes

A

minimal change disease
focal segmental glomerulosclerosis

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18
Q

spike and dome appearance of subepithelial deposits

A

membranous nephropathy

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19
Q

eosinophillic casts resembling thyroid tissue

A

thyroidization of kidney
occurs in chronic pyeloonephritis

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20
Q

causes of acute interstitial nephritis

A

remember the causes of inflammation to your DRAINS;

D iuretics
Rifampicin
Antibiotics (penicillins, cephalosporins)
I - PPI’s
NSAIDS
Sulpha drugs

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21
Q

symptoms of acute interstitial nephritis

A

haematuria
fever
rash
pyuria
costovertebral angle tenderness

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22
Q

in the recovery phase of acute tubular necrosis, what electrolyte abnormality are you at risk of

A

hypokalaemia

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23
Q

features of renal papillary necrosis

A

sloughing of necrotic renal pappilae = gross haematuria

Associated with;
‘SAD papa with pappilary necrosis’
Sickle cell
Acute pyelonephritis
Analgesics i.e. NSAIDS
Diabetes

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24
Q

mutation in ADPKD

A

mutation in genes encoding polycystin protein;
PKD1 - chromosome 16
PKD2 - chromosome 4

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25
Q

mutation in autosomal recessive polycystic kidney disease

A

PKHD1 encoding fibrocytin

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26
Q

condition that may be associated with renal cell carcinoma

A

Von hippel lindau

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27
Q

mutation associated with clear cell renal carcinoma

A

gene deletion on chromosome 3

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28
Q

most common subtype of renal cell carcinoma

A

clear cell

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29
Q

paraneoplastic syndromes associated with renal cell carcinoma

A

‘PEAR’

PTHrP
Ectopic EPO
ACTH
Renin

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30
Q

polygonal clear cells filled with accumulated lipis and carbohydrates

A

renal cell carcinoma

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31
Q

large eosinophillic cells with abundant mitochondria without perinuclear clearing

A

benign renal oncycytoma

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32
Q

mutations associated with Wilm’s tumour (nephroblastoma)

A

loss of function of tumour suppressor genes WT1 or WT2 on chromosome 11

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33
Q

risk factors associated with urothelial carcinoma of bladder

A

PEE SAC
Smoking
Aromatic amines (i.e. 2-Naphthylamine)
Cyclophosphamide

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34
Q

risk factors associated with squamous cell carcinoma of the bladder

A

4 S’s

Schistosomiasis
chronic Systitis (cystitis)
chronic Stones
Smoking

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35
Q

mechanism of diabetic nephropathy

A

non-enzymatic glycation of tissue proteins -> mesangial expansion, GBM thickening and increased permeability and hyperfiltration
proteinuria

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36
Q

hexagonal crystals on urinalysis

A

cystinuria

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37
Q

testing modality for cystinuria

A

cyanide nitroprusside

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38
Q

features of cystinuria

A

recurrent kidney stones
may have family history - autosomal recessive
genetic mutations on chromsome 2 or 19
hexagonal crystals in urinalysis
cyanide nitroprusside test is positive

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39
Q

proliferation of mesangial cells

A

IgA nephropathy

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40
Q

recurrent UTI’s with urease-positive bacteria (i.e. proteus mirabilis) can increase risk of kidney stones of what composite ?

A

ammonium magnesium phosphate (struvite)

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41
Q

what syndrome may Wilm’s tumour be associated with

A

beckwith-Wiedemann syndrome
WAGR
denys - drash syndrome

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42
Q

renal cell carcinoma (clear cell) arises from which part of the kidney

A

proximal convoluted tubule

43
Q

microscopy - congo red stain shows apple green birefringence under polarised light

A

amyloidosis

44
Q

extracellular deposition of an insoluble fibrillar protein

A

amyloidosis

45
Q

most common causative organism of prostatitis

A

e.coli (gram negative)

46
Q

most common composite of renal stone with cystinuria

A

cystine

47
Q

most common composite of renal stone

A

calcium

48
Q

most common composite of renal stone with gram negative urease bacteria

A

struvite

49
Q

most common composite of renal stone with conditions with high cell turnover i.e. cancer

A

uric acid

50
Q

what type of renal stones are radio-lucent and therefore may not be visible on xray

A

cystine stones
uric acid stones

51
Q

glomerulonephritis caused by igG antibodies and is positive for C3 on microscopy

A

membrano proliferative glomerulonephritis

persistent activation of alternate complement pathway
- GBM splitting and tram track on PAS stains

52
Q

urine Na and osmolality if pre renal

A

Urine Na < 20
Urine osmolality > 500

53
Q

subepithelial ‘humps’ caused by lumpy immune complex deposits

A

post strep glomerulonephritis

  • granular ‘stary sky’ appearance
54
Q

what type of glomerulonephritis is associated with HIV

A

FSGS (focal segmental glomerulosclerosis)
renal failure + proteinuria

55
Q

linear antibody deposits along the basement membrane on immunoflourescence

A

anti-GBM disease (good pastures)
renal failure + pulmonary haemorrhage

56
Q

glomerular injury with normal light microscopy

A

minimal change

57
Q

glomerular injury with small vessel haemorrhage

A

small vessel vasculitis i.e. granulomatosis with polyangitis, microscopic polyangitis, eosinophillic granulomatosis

58
Q

how does minimal change disease cause increased prothrombotic risk

A

can cause renal vein thrombosis due to loss of anti thrombin

59
Q

focal segmental glomerulosclerosis secondary causes

A

HIV, sickle cell, infection, obesity, congenital malformations

60
Q

diffuse capillary and GBM thickening

A

membranous glomerulonephritis

61
Q

kimmel-steil wilson lesions

A

diabetic nephropathy
(eosinophillic glomerulosclerosis)

62
Q

secondary causes of membranous nephropathy

A

drugs (NSAIDS, penicillamine, gold)
infections (hepatits B and C, syphillis)
SLE
tumours

63
Q

is fractional excretion of sodium high or low in pre renal AKI ?

A

< 2% (low) in pre-renal

64
Q

WAGR features

A

wilms tumour
aniridia (partial loss of iris)
genital anomalies
range of developmental delays

65
Q

RENAL TUBULAR MEDHCANISM IN ALKALOSIS CAUSED BY VOMITING

A

increased Na/H exchange in proximal convoluted tubule

66
Q

cause of hypernatraemia with urine high urine osmolality and low urinary Na

A

non-renal water loss i.e. vomiting, burns

67
Q

loss of heparan sulphate proteoglycans

A

nephrotic syndrome

68
Q

Na in serum, urine and urine osmolality found in nephrogenic diabetes insipidous

A

hypernatraemia, low urine Na, low urine osmolality

69
Q

how does NSAIDS cause renal damage

A

afferent arteriolar constriction

70
Q

defect in amino acid reabsorption in proximal convoluted tubule

A

cystinuria –> kdiney stones

71
Q

what type of kidney stones can be caused by a urine infection with urease producing bacteria

A

struvite stones

72
Q

intestinal malabsorption of fat can cause what type of stones

A

calcium oxalate

73
Q

rapid destruction of blood erythrocytes can cause what type of stones

A

urate

74
Q

kidney stones can cause a rise in what urinary substrates

A

calcium
uric acid
oxalate

75
Q

electrolyte effects of mannitol

A

hyponatraemia with high serum osmolality (as mannitol remains in the circulation = high osmolality, it draws water out of cells = hyponatraemia)

76
Q

what electrolyte abnormality would chlorthiazide cause?

A

hypercalcaemia (causes excretion of water and chloride and retains calcium)

77
Q

acetazolamide causes excretion of what substances

A

sodium chloride and bicarbonate

78
Q

what UTI causing bacteria produces urease

A

staph. saprophyticus

79
Q

what UTI causing bacteria ferments lactose and forms pink colonies on McCockney agar

A

E.coli

80
Q

what UTI causing bacteria produces hydrogen sulphide

A

proteus
salmonella

81
Q

action of ADH

A

acts on V2 receptors in the collecting ducts

82
Q

wilms tumour, nephrotic syndrome, dysgenesis of gonads

A

denys drash syndrome
(diffuse mesangial sclerosis)

83
Q

wilms tumour, macroglossia, organomegaly, hemihyperplasia, omphalocele

A

beckwith-wideman syndrome

84
Q

chromosome affected in wilms tumour

A

chromosome 11

85
Q

how to convert glucose mg/dl to mmol/l

A

x by 0.0555

86
Q

hyponatraemia, urine Na low and low urine osmolality

A

psychogenic polydypsia

87
Q

pathophysiology of hepatorenal syndrome

A

vasodilatation of splanchnic arterial vasodilatation causes shunting of blood from the kidneys to the gut
rapid onset of AKI without evidence of renal ischaemia or insult
normal histology of he kidney
no improvement with albumin

88
Q

Mesangial and subendothelial IgM, C3 l, and k light chains

A

membrano-proliferative glomerulonephritis

89
Q

Subepithelial deposition of IgG, C3, and leukocytes

A

post strep glomerulonephritis

90
Q

common mets in wilms tumour

A

lung and liver

91
Q

does nephrogenic diabetes insipidous respond to vasopressin

A

no due to ADH resistance (volume depletion leads to elevated ADH levels but this doesnt increase water due to resistance)

92
Q

complications of polycystic kidney disease

A

cerebral aneurysms
hepatic cysts
cardiac valvular lesions

93
Q

UTI with lack of nitrite on urinalysis and by culture on bile esculin agar

A

enterococcus

94
Q

UTI with lack of nitrite on urinalysis

A

gram positive - staph or enterococcus

95
Q

UTI caused by bacteria with blue green pigment, fruity odour and is drug resistant

A

pseudomonnas

96
Q

UTI caused by bacteria which produces urease and causes struvite stones, motility causes swarming on agar

A

proteus

97
Q

UTI caused by bacteria that produces red pigment

A

serratia marcescens

98
Q

thinning and splittig of glomerular basement membrane

A

alport syndrome

99
Q

renal changes in response to haemorrhage

A

increase renin from juxtaglomerular cells + constriction of afferent and efferent arterioles to retain Na and constrict vessels to increase blood pressure

100
Q

features of siADH

A

euvolaemic hyponatraemia
serum osmolality < 275
urine osmolality > 300
urine Na <> 40
reduced free water clearance

first line treatment - water restriction. consider tolvaptan/domeclocycline

101
Q

antihypertensive that causes metabolic alkalosis with low K

A

thiazide like diuretics

102
Q

where does wilms tumour originate from?

A

metanephric blastema

103
Q

renal disease, loss of deep tendon reflexes, ECG changes, nausea

A

low magnesium

Renal (11 decks)

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