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2MBChB Renal > Pathology > Flashcards

Pathology Flashcards

1
Q

What is nephritis?

A

Inflammation of the kidney.

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2
Q

What is pyelonephritis?

A

Infective inflammation of the kidney.

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3
Q

What is glomerulonephritis?

A

Non-infective inflammation fo the kidney.

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4
Q

What are the main types of glomerulonephritis?

A

Immune-mediated (in the kidney itself):

  • Immune response direct at something in the glomerulus.
  • Caused by circulating immune complexes getting stuck in the sieve (glomerulus).

Related to vasculitis.

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5
Q

What is Good Pasture’s syndrome?

A

IgG antibodies against the alpha 3 subunit of collagen 4 ( presenting in the glomerulus, basement membrane and alveoli).

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6
Q

What circulating immune complexes are there that can get stuck in the glomerular sieve?

A

Hepatitis viruses.

Bacteria (post-streptococcus).

HIV.

Drugs - gold, penicillamine.

Cancer - any but most often lymphomas.

Vasculitis e.g. GPA, microscopic polyangiitis.

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7
Q

What are the differences between pANCA and cANCA?

A

pANCA = perinuclear.

cANCA = cytoplasmic.

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8
Q

What is nephritic syndrome?

A

Haematuria.

Hypertension.

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9
Q

What is nephrotic syndrome?

A

Heavy proteinuria (includes antibodies, complement and proteins in clotting cascade).

Non-dependent oedema.

Hyperlipidaemia.

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10
Q

How are different glomerulonephritis’ diagnosed?

A

Light microscopy.

Electron microscopy.

Immunofluorescence.

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11
Q

What does crescentic glomerulonephritis mean?

A

Indicates rapidly progressive glomerulonephritis.

This is bad.

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12
Q

What do granulomas in the kidney suggest?

A

GPA.

Sarcoid.

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13
Q

Under light microscopy, what may you see in glomerulonephritis?

A

Hypercellularity (inflammatory cells and reactive proliferations.

Sclerosis (ongoing damage).

May see crescents.

May see vasculitis.

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14
Q

Under electron microscopy, what may you see in glomerulonephritis?

A

Deposits can be seen either subepithelial, mesangial or subendothelial.

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15
Q

Under immunofluorescence, what may you see in glomerulonephritis?

A

Can see what kind of antibody and what distribution.

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16
Q

What does condition shows linear IgG under immunofluorescence?

A

Goodpasture’s.

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17
Q

What are the causes of focal segmental glomerulosclerosis?

A

Obesity.

HIV.

Sickle cell.

IV drug seals.

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18
Q

Is focal segmental glomerulosclerosis nephrotic or nephritic?

A

Nephritic.

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19
Q

What are the causes of membranous glomerulosclerosis?

A

Infection (hepatitis, malaria, syphilis).

Drugs (penicillamine, NSAID, captopril, gold).

Malignancy (lung, colon, melanoma).

Lupus (15% of all GMN in lupus).

Autoimmune (thyroiditis).

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20
Q

Is membranous glomerulosclerosis nephrotic or nephritic?

A

Nephrotic.

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21
Q

What is the appearance of membranous glomerulonephritis?

A

Thick membranes.

Subepithelial immune deposits.

Spikey appearance.

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22
Q

What are the causes of IgA glomerulonephritis?

A

Genetic, acquired defect.

Coeliac.

Post-streptococcal respiratory tract infection.

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23
Q

Is IgA glomerulonephritis nephrotic or nephritic?

A

Nephritic.

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24
Q

What is the appearance of IgA glomerulonephritis?

A

IgA deposition in the mesangium of the glomerulus.

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25
What are the causes of membranoproliferative glomerulonephritis?
Idiopathic. Infection. Lupus. Malignancy.
26
Is membranoproliferative glomerulonephritis nephrotic or nephritic?
Either.
27
What is the appearance of membranoproliferative glomerulonephritis?
Duplication of the basement membrane. Big lobulated hypercellular glomeruli with thick membranes (tram tracks).
28
What is a Bosniak score?
Score to predict cancer in the kidney.
29
What are acquired cysts?
Simple cysts that have an attenuated lining. Show a degenerate type of change. Benign and seen commonly. Often associated with long-term dialysis.
30
What is autosomal recessive polycystic kidney disease?
Polycystic kidney disease. Presents in childhood. Kidney is of normal size and has a smooth surface. Can get cysts in the liver also.
31
What is xanthogranulomatous pyelonephritis?
A specific infection that looks like a cancerous mass but isn't. Creates a mass but is usually associated with infection.
32
What is an oncocytoma?
Benign tumour of the kidney. Small, oval and well circumscribed. Mahogany brown with a central stellate scar. Histology = very pink and granular cytoplasm.
33
What is chromophobe?
Malignant tumour of the kidney.
34
What is the histological appearance of a chromophobe?
Oncocytic but with raisonoid nuclei and perinuclear haloes. ## Footnote *Similar appearance to oncocytoma.*
35
What are papillary carcinomas?
Malignant tumour of the kidney. Generally low-grade.
36
What is a collecting duct carcinoma?
Malignant tumour of the kidney. High-grade appearance with a very desmoplastic stroma. Poor survival.
37
What is clear cell carcinoma?
Malignant tumour of the kidney. ## Footnote *When people say renal cancer they usually mean a clear cell carcinoma.*
38
What are the risk factors of clear cell carcinoma?
Obesity. Genetic influence.
39
What is the presenting complaint of clear cell carcinoma?
Haematuria. Mass. Hypertension - rarely.
40
What is the macroscopic appearance of a clear cell carcinoma?
Often partly cystic and very heterogeneous surface but most striking feature is the bright yellow tumour surface.
41
What are the microscopic features of clear cell carcinoma?
Clear cells - artefacts of processing and relates to hypoxia of the cells.
42
What does renal clear cell carcinoma have a propensity to do?
A propensity for renal vein involvement and can even extend into vena cava and grow up towards the heart.
43
Which genetic mutation is seen in most of the sporadic renal cancers?
VHL. * This gene codes for HIF (**hypoxia inducible* *factor).* * Normally VHL* *ubiquinates* *HIF.* * In low O2 they dissociate and HIF acts as a transcription factor for VEGF, PDGFRB and EPO.*
44
What is the cause of minimal change glomerulonephritis?
Not known.
45
What develops minimal change glomerulonephritis?
Children.
46
Is minimal change glomerulonephritis nephritic or nephrotic?
Nephrotic.
47
What is the appearance of minimal change glomerulonephritis?
Not much to see histologically.
48
What is the prognosis of minimal change glomerulonephritis?
Good. Usually resolves with some steroids.
49
What changes are seen in the kidneys due to diabetes?
Diffuse and nodular glomerulosclerosis. Nodule (called Kimmel Stiel Wilson Lesion). Microvascular disease (arterial sclerosis). Infection e.g. pyelonephritis, papillary necrosis.
50
What gene causes autosomal dominant polycystic kidney disease?
Mutation in nephrin.
51
What is autosomal dominant polycystic kidney disease?
Loads of cysts develop over time in the kidney. Normally present with the condition as an adult or were screened for it as a child due to family history.
52
What are the clinical features of autosomal dominant polycystic kidney disease?
Size of kidney (often present with a mass like lesion). Pain. Haematuria because of cyst rupture. Infarction. Systemic disease - liver cysts, cerebral aneurysms associated with subarachnoid haemorrhage.
53
What are the subtypes of cystitis?
Parasites & mycotic infection. Aseptic. Reactive to catheterisation.
54
What is the pathology of schistosomiasis causing cystitis?
Squamous metaplasia in the bladder.
55
How is aseptic (interstitial) cystitis diagnosed?
Persistent symptoms of dysuria. Persistently negative cultures and urinalysis. Biopsy - non-specific. Variable pathology - some inflammation, congestion, mast cells.
56
What is cystitis cystica?
Infolding of bladder mucosa into cysts. Infection in the bladder and mucosal cysts in the bladder wall.
57
What are the risk factors for urothelial neoplasia?
Smoking. Associated with lung cancer. Beta-naphthyline.
58
What are the risk factors for prostate cancer?
Cadmium batteries. Less hormonal link than benign prostatic hyperplasia.
59
What are the consequences of schistosomiasis?
Difficult to remove all eggs so there is persistent inflammation, squamous metaplasia and eventual squamous cell carcinomas.
60
What can cause persistent inflammation of the bladder?
In-dwelling catheters. Infection. *Leads to scarring, metaplasia and then squamous cell carcinoma.*
61
What happens to the histology of the bladder if there is chronic obstruction downstream?
The bladder muscle has to work harder so becomes trabeculated.
62
What epithelium lines the foreskin and glans of the penis?
Squamous epithelium.
63
What is the epithelium of the urethra?
Squamous at the distal end and then urothelial more proximally.
64
Which HPV types cause genital warts?
HPV 6 and 11.
65
What are the 2 types of penile intraepithelial neoplasia (PEiN)?
Differentiated (non-HPV related). Dedifferentiated (HPV-related). *PEin is the same as carcinoma in situ.*
66
What is the function of the testis?
Make sperm (in the seminiferous tubules).
67
What do the seminiferous tubules contain?
Germ cells. Sertoli cells. Maturing sperms.
68
What cells are found in the interstitium of the testes?
Leydig cells.
69
What is a hydrocoele?
Accumulation of fluid around the testes, between the two layers of the tunica vaginalis and mesothelial lining. Unicystic, smooth and fluid filled.
70
What does a hydrocoele appear like on examination?
Smooth. Softish. Circumscribed. Lucent (transillumination).
71
What is a spermatocoele?
Cystic change within the vas of the epididymis. ## Footnote * Unknown cause and usually asymptomatic.* * May feel a fullness.*
72
What is a varicocoele?
Varicosities of venous plexus that drains the testis. Usually asymptomatic and may present having felt a lump.
73
What will a varicocoele feel like on examination?
Feels like a bag of worms.
74
What is a bell clapper deformity?
The insertion of the tunica vaginalis is high. The testis can rotate and even sit laterally.
75
What are the 2 types of testicular tumours?
Seminomatous. Non-seminomatous. *Both are types of germ cell tumours.*
76
What are the risk factors for seminoma?
Undescended testes. Testicular malignancy will also increase the risk in the contralateral testis
77
What is the histology of a seminoma?
Germ cell tumours. Looks like lots of dots (small and big) in a white background.
78
What is the treatment of for a seminoma?
Extremely responsive to radiotherapy even if relatively advanced.
79
What is a non-seminomatous testis tumour?
Mixed types of seminoma. Seen in males 30s. Far more aggressive than seminoma and can metastasise.
80
What is the treatment for non-seminomatous tumour?
Very chemosensitive. The outcome with mets is reasonable, but it must be treated early.
81
What is a mature teratoma?
Contains 3 germ layers (endoderm, ectoderm and mesoderm). All classified as malignant (in the ovary most are benign).
82
What does the yolk sac form of a teratoma produce?
Alpha feto protein.
83
What does the embryonal form of a teratoma look like?
High grade. Aggressive form. Associated with mets.
84
What does the trophoblast form of a teratoma look like?
Wacky looking cells. Positive for beta HCG and will give a positive pregnancy test.

2MBChB Renal (20 decks)

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