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Bloc D - Renal > Pathology > Flashcards

Pathology Flashcards

1
Q

What are the functions of the glomerulis?

A
  1. Filtration of water and small solute
  2. Barrier to proteins (size and charge selective)
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2
Q

Any alteration/loss of the negative charge barrier can cause?

A

albuminuria or selective proteinuria

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3
Q

Any structural anomaly to GBM, endothelial cell or podocyte can cause ?

A

proteinuria or hematuria

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4
Q

What is the mechanism involved in immune glomerular injury?

A
  • In situ immune complex formation 

  • Deposition of preformed circulating immune complexes 

  • Cytotoxic
  • Antibodies
Cell-Mediated
  • Immune Injury
Activation of Alternative Complement Pathway
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5
Q

What are the mechanisms involved in non-immune glomerular injury?

A

Nephron loss created by a vicious circle where the injury creates structural changes, hyperfiltration, increased intraglomerular pressure and sclerosis of nephrons; direct injury to podocytes, hypertension, diabetes, many others 


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6
Q

End-stage kidney injury will result in ?

A
  1. Sclerosis of glomeruli
  2. Tubular atrophy
  3. Interstitial fibrosis
  4. Vascular fibrous obliteration
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7
Q

Define selective and non selective proteinuria

A

Proteinuria that is more than 85% albumin is selective proteinuria. Albumin has a net negative charge, and it is proposed that loss of glomerular membrane negative charges could be important in causing albuminuria. Nonselective proteinuria, being a glomerular leakage of all plasma proteins, would not involve changes in glomerular net charge but rather a generalized defect in permeability.

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8
Q

What is Nephrotic syndrome?

A

Heavy proteinuria, hypoalbuminemia, severe oedema, hyperlipidemia and lipiduria

Urinary sediment: fatty and hyaline casts, lipids, oval fat bodies

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9
Q

What is Nephritic syndrome?

A

Hematuria, proteinuria, RBC in urine that form a cast, renal failure and hypertension

Usualy caused by inflammatory lesions of glomeruli

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10
Q

What is the role of biopsy?

A
  1. Diagnosis
  2. Prognostic
  3. Treatment
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11
Q

What are the characteristics of primary diseases?

A
  • Membranous glomerulopathy

  • Minimal change disease

  • Focal segmental glomerulosclerosis

  • Membranoproliferative glomerulonephritides
  • IgA nephropathy

  • Others
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12
Q

What are the characteristics of secondary renal diseases?

A
  • Diabetes mellitus

  • Amyloidosis

  • Systemic lupus erythematosus
  • Drugs (nonsteroidal anti-inflammatory, penicillamine, )

  • Infections (malaria, syphilis, hepatitis B and C, HIV)

  • Malignant disease- paraneoplastic (carcinoma, lymphoma)
  • Others
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13
Q

What are the nephrotic syndrome diseases?

A
  • Membranous glomerulopathy
  • Minimal change disease
  • Focal segmental glomerulosclerosis (FSGS)
  • Diabetes mellitus
  • Pregnancy
  • Amyloidosis
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14
Q

What are the nephritic syndrome diseases?

A
  • Membranoproliferative glomerulonephritides
  • IgA nephropathy
  • Lupus
  • Infections (malaria, syphilis, hepatitis B and C, HIV)

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15
Q

Membranous glomerulopathy (nephrotic syndrome)?

A

Antibodies that recognize, in own kidney, a similar protein in the membrane of the glomerular epithelial cell, can be secondary to infections, cancer, drugs and autoimmune diseases

Biopsy shows diffuse thickening of glomerular capillary walls

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16
Q

Minimal change disease
 (nephrotic syndrome)?

A

Minimal changes in pathology seen in electron microscopy, good prognosis, children more than adults

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17
Q

Focal segmental glomerulosclerosis (FSGS)
(nephrotic syndrome)?

A

Common diagnosis, injury to podocytes, 50% will develop end-stage disease, can be hereditary

Clinically: non-selective proteinuria with mild hematuria (no RBC casts)

Focal and segmental sclerosis

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18
Q

IgA nephropathy
(nephritic syndrome)?

A

Most common type of glomerular disease in the world and most common cause of recurrent hematuria, affects more children and young adults, 25% progress to end-stage renal disease

Pathology findings is variable but always mesangial cell proliferation

Ex. Henoch-Shonlein Purpura systemic symptoms with skin rash (vasculitis)

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19
Q

Diabetes mellitus
 (nephrotic syndrome)?

A

Frequent cause of proteinuria in adult

Pathology shows diffuse or nodular diabetic glomerulosclerosis, arteriosclerosis, marked thickening of GBM on EM

20
Q

Pregnancy
(nephrotic syndrome)?

A

Proteinuria is often a sign of maternal hypertension and pre-eclampsia, usualy don’t do biopsy

21
Q

Infections (malaria, syphilis, hepatitis B and C, HIV)
 (nephritic syndrome)?

A

More common in children, Coca-Cola urine, good prognosis

Pathology shows diffuse global hypercellularity, leucocytes large granular deposits

22
Q

Clinical manifestation of glomerular disease?

A
  1. Hematuria (nephritic syndrome)
  2. Proteinuria (nephrotic syndrome)
  3. Mixed pattern (nephritic/nephrotic)
  4. Renal failure
23
Q

What are the 2 kinds of Tubulointerstitial disease?

A
  1. Tubulointerstitial nephritis
  2. Acute tubular injury
24
Q

What are the types of Tubulointerstitial nephritis?

A
  1. Acute pyelonephritis
  2. Chronic pyelonephritis
  3. Reflux nephropathy
  4. Drug-induced interstitial nephritis
25
Q

Acute pyelonephritis?

A

Caused by bacterial infection (ex. E Coli), no biopsy

Clinical presentation: chills, sudden onset symptoms, unilateral costo-vertebral angle

Risk factors: women, pregnancy, immunosuppressant, bladder obstruction, diabetes, procedures

Pathology shows acute inflammation

26
Q

Reflux nephropathy?

A

Chronic inflammation and fibrosis, colloid casts (thyroidisation), secondary to glomerulosclerosis FSGS

27
Q

Drug-induced interstitial nephritis?

A

Adverse immune reaction to drug, mostly associated with certains antibiotics and analgesics, Oliguria, azotemia

Symptoms appear 2-40 days after taking drug

Pathology shows , leukocytes, hematuria and no proteinuria

28
Q

Acute tubular injury?

A

Acute tubular necrosis, oliguria, decreased GFR, acidosis, fluid overload

Pathology shows necrosis but no inflammation

29
Q

Rapidly progressive glomerulonephritis (nephritic syndrome)?

A

Associated with nephritic syndrome, (proliferation of parietal cells)

  1. Anti-GBM disease
    ​Young men and older women, aggressive treatment and poor prognosis
  2. Immune-complex mediated
  3. Pauci-immune
    More common, ANCA
30
Q

What are the non-invasive urothelial lesions according to the WHO 2016?

A

Flat

–Reactive atypia

–Dysplasia

–Carcinoma in Situ

Papillary

–Papilloma

–Papillary Neoplasm of Low Malignant Potential (PUNLMP)

–Papillary Carcinoma, Low grade (LGTCC)

–Papillary Carcinoma, High grade (HGTCC)

31
Q

What are the types of non-invasive urothelial cells that are lined by benign urothelial cells?

A
  1. Papilloma
  2. Papillary Neoplasm of Low Malignant Potential (PUNLMP)
32
Q

Pathologic caracteristics of Low grade papillary UCA (LGTCC)?

A

Nuclear crowding, mild loss of polarity, occasional large hyperchromatic nuclei, rare mitosis

33
Q

Pathological findings of High grade papillary UCA (HGTCC)?

A

Loss of polarity, pleomorphism, dyscohesion (red arrow), frequent mitosis at any level

34
Q

Pathological findings of Urothelial carcinoma in-situ (CIS)?

A

Cytologically similar to HGTCC except the lesion is flat

35
Q

Grading of invasive urothelial tumours?

A
  • pT1=lamina propria invasion
  • pT2= muscularis propria invasion CYSTECTOMY
  • pT3=invasion of perivesical adipose tissue
36
Q

Risk of recurrence in Papilloma and PNLUMP?

A

Low and Low

37
Q

Risk of recurrence in LGTCC?

A

nfrequent recurrence (50%) and rare progression (less than 10%)

38
Q

What is the most common symptom of urothelial cancer?

A

painless hematuria

39
Q

Risk factors for kidney cancer?

A

Sporadic (95%)

–Smoking

–Obesity

–Hypertension

–CRF on long-term hemodialysis

–Tuberous sclerosis

Familial (5%)

–Von Hippel-Lindau (VHL) syndrome (germline mutation of the VHL gene on 3p)

40
Q

Types of Renal epithelial tumors?

A

Benign

–Oncocytoma

–Papillary adenoma

–Metanephric adenoma

Malignant (renal cell carcinomas)

–Conventional RCC

–Papillary RCC

–Chromophobe RCC

–Collecting duct RCC

–Medullary carcinoma

–Unclassified RCC

41
Q

Characteristics of Conventional (clear cell) RCC?

A

MOST COMMON

Heterogeneous cut-surface, solid and cystic, hemorrhage and necrosis, golden yellow color

42
Q

Characteristics of Papillary RCC?

A

SECOND MOST COMMON

Well circumscribed, encapsulated, hemorrhage and necrosis, granular cut surface

Type 1 and 2 (2 = agressive)

43
Q

Characteristics of Chromophobe RCC?

A

THIRD MOST COMMON

Solid cut-surface, light brown to tan color, well circumscribed, rare hemorrhage or necrosis, binuclei

44
Q

Characteristics of Oncocytoma?

A

Benign, 5% of renal tumors, solid tumor with brown mahogany color and central scar, composed of bland nests of eosinophilic cells

45
Q

Characteristics of Angiomyolipoma?

A

Benign neoplasm that may be associated with tuberous sclerosis and which is usually recognized on imaging by its adipocytic component

46
Q

Gradinf of renal cancer?

A

pT1 confined to kidney ≤ 7 cm

pT2 confined to kidney > 7 cm

pT3 extrarenal but limited by Gerota’s fascia, fat invasion

pT4 beyond Gerota’s fascia (including ipsilateral adrenal gland invasion)

47
Q

What are the two most important prognostic factors of clear cell RCC?

A
  1. Nuclear grade
  2. Pathologic stage

Bloc D - Renal (7 decks)

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