Pathology 3

Question 1

What is chronic kidney disease?

Answer 1

structural or functional abnormalities in kidney lasting 3 months or longer

Question 2

What are the different stages of ckd?

Answer 2

stage 1: kidney damage with normal or relatively high GFR (at least 90)
stage 2: mild reduction in GFR (60-89)
Stage 3: moderate reduction in GFR (30-59)
stage 4: severe reduction in GFR (15-29)
stage 5: established kidney failure (GFR less than 15 or dialysis)

Question 3

What is uremia?

Answer 3

azotemia associated with constellation of clinical signs and symptoms

Question 4

What are causes of established CKD in the US?

Answer 4

diabetes
HTN
cystic kidney diseases and interstitial nephritis
diabetes and HTN account for >60%

Question 5

What are the clinical manifestations of advanced uremia?

Answer 5

accumulation of nitrogenous waste products
severe acidosis
anemia
GI symptoms
HTN and cerebral manifestations
osteodystrophy

Question 6

What are the general clinical manifestations of CKD?

Answer 6

advanced uremia
urine output to virtually nothing
patients survived only weeks before dialysis era

Question 7

What does sclerosis do in glomerular diseases?

Answer 7

reduces glomerular filtration
elevated serum creatinine and BUN
example is hypertensive nephrosclerosis

Question 8

What does tubular damage lead to that means ATI can cause AKI?

Answer 8

arteriolar vasoconstriction - further reduces GFR
cast formation and tubular obstruction blocks urine outflow
back leak of tubular fluid
reduced ultra filtration

Question 9

What are the four different classifications of renal cell carcinoma in order of decreasing frequency?

Answer 9

Clear cell
papillary
Chromophobe renal cell
collecting duct

Question 10

What is seen grossly for clear cell carcinoma?

Answer 10

large spherical expansile mass

bright yellow with areas of hemorrhage and necrosis

Question 11

What is clear cell carcinoma?

Answer 11

sporadic or familial (VHL gene on ch 3)

Question 12

What is seen on LM with clear cell carcinoma?

Answer 12

tumor cells with clear cytoplasm that form solid sheets or trabecular and tubular structures
prominent delicate vasculature

Question 13

What is papillary carcinoma?

Answer 13

frequently multifocal and bilateral

sporadic or familial (activation of MET gene on ch 7 = tyrosine kinase receptor for growth factor)

Question 14

What does one see microscopically in papillary carcinoma?

Answer 14

papillae formation with fibrovascular cores

cells have pink or clear cytoplasm

Question 15

What is seen in chromophobe renal cell carcinoma?

Answer 15

grossly tan brown

combo of clear and pink cells with wrinkled raisinoid nuclei and perinuclear halos

Question 16

What are the different types of renal stones?

Answer 16

calcium oxalate or calcium phosphate - most due to idiopathic hypercalciuria
magnesium ammonium phosphate (struvite) - ppl with alkaline urine from UTIs esp proteus
uric acid - gout and leukemias, acid urine favors uric acid stone formation

Question 17

What are the two forms of urothelial carcinoma of renal pelvis?

Answer 17

papillary/poypoid tumor expanding pelvic/calyceal system, tend to be noninvasive
large invasive centered on pelvic/calyceal system and medulla