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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
Q

What are the causes of membranoproliferative glomerulonephritis?

A

Idiopathic.

Infection.

Lupus.

Malignancy.

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26
Q

Is membranoproliferative glomerulonephritis nephrotic or nephritic?

A

Either.

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27
Q

What is the appearance of membranoproliferative glomerulonephritis?

A

Duplication of the basement membrane.

Big lobulated hypercellular glomeruli with thick membranes (tram tracks).

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28
Q

What is a Bosniak score?

A

Score to predict cancer in the kidney.

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29
Q

What are acquired cysts?

A

Simple cysts that have an attenuated lining.

Show a degenerate type of change.

Benign and seen commonly.

Often associated with long-term dialysis.

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30
Q

What is autosomal recessive polycystic kidney disease?

A

Polycystic kidney disease.

Presents in childhood.

Kidney is of normal size and has a smooth surface.

Can get cysts in the liver also.

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31
Q

What is xanthogranulomatous pyelonephritis?

A

A specific infection that looks like a cancerous mass but isn’t.

Creates a mass but is usually associated with infection.

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32
Q

What is an oncocytoma?

A

Benign tumour of the kidney.

Small, oval and well circumscribed.

Mahogany brown with a central stellate scar.

Histology = very pink and granular cytoplasm.

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33
Q

What is chromophobe?

A

Malignant tumour of the kidney.

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34
Q

What is the histological appearance of a chromophobe?

A

Oncocytic but with raisonoid nuclei and perinuclear haloes.

Similar appearance to oncocytoma.

35
Q

What are papillary carcinomas?

A

Malignant tumour of the kidney.

Generally low-grade.

36
Q

What is a collecting duct carcinoma?

A

Malignant tumour of the kidney.

High-grade appearance with a very desmoplastic stroma.

Poor survival.

37
Q

What is clear cell carcinoma?

A

Malignant tumour of the kidney.

When people say renal cancer they usually mean a clear cell carcinoma.

38
Q

What are the risk factors of clear cell carcinoma?

A

Obesity.

Genetic influence.

39
Q

What is the presenting complaint of clear cell carcinoma?

A

Haematuria.

Mass.

Hypertension - rarely.

40
Q

What is the macroscopic appearance of a clear cell carcinoma?

A

Often partly cystic and very heterogeneous surface but most striking feature is the bright yellow tumour surface.

41
Q

What are the microscopic features of clear cell carcinoma?

A

Clear cells - artefacts of processing and relates to hypoxia of the cells.

42
Q

What does renal clear cell carcinoma have a propensity to do?

A

A propensity for renal vein involvement and can even extend into vena cava and grow up towards the heart.

43
Q

Which genetic mutation is seen in most of the sporadic renal cancers?

A

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
Q

What is the cause of minimal change glomerulonephritis?

A

Not known.

45
Q

What develops minimal change glomerulonephritis?

A

Children.

46
Q

Is minimal change glomerulonephritis nephritic or nephrotic?

A

Nephrotic.

47
Q

What is the appearance of minimal change glomerulonephritis?

A

Not much to see histologically.

48
Q

What is the prognosis of minimal change glomerulonephritis?

A

Good.

Usually resolves with some steroids.

49
Q

What changes are seen in the kidneys due to diabetes?

A

Diffuse and nodular glomerulosclerosis.

Nodule (called Kimmel Stiel Wilson Lesion).

Microvascular disease (arterial sclerosis).

Infection e.g. pyelonephritis, papillary necrosis.

50
Q

What gene causes autosomal dominant polycystic kidney disease?

A

Mutation in nephrin.

51
Q

What is autosomal dominant polycystic kidney disease?

A

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
Q

What are the clinical features of autosomal dominant polycystic kidney disease?

A

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
Q

What are the subtypes of cystitis?

A

Parasites & mycotic infection.

Aseptic.

Reactive to catheterisation.

54
Q

What is the pathology of schistosomiasis causing cystitis?

A

Squamous metaplasia in the bladder.

55
Q

How is aseptic (interstitial) cystitis diagnosed?

A

Persistent symptoms of dysuria.

Persistently negative cultures and urinalysis.

Biopsy - non-specific.

Variable pathology - some inflammation, congestion, mast cells.

56
Q

What is cystitis cystica?

A

Infolding of bladder mucosa into cysts.

Infection in the bladder and mucosal cysts in the bladder wall.

57
Q

What are the risk factors for urothelial neoplasia?

A

Smoking.

Associated with lung cancer.

Beta-naphthyline.

58
Q

What are the risk factors for prostate cancer?

A

Cadmium batteries.
Less hormonal link than benign prostatic hyperplasia.

59
Q

What are the consequences of schistosomiasis?

A

Difficult to remove all eggs so there is persistent inflammation, squamous metaplasia and eventual squamous cell carcinomas.

60
Q

What can cause persistent inflammation of the bladder?

A

In-dwelling catheters.

Infection.

Leads to scarring, metaplasia and then squamous cell carcinoma.

61
Q

What happens to the histology of the bladder if there is chronic obstruction downstream?

A

The bladder muscle has to work harder so becomes trabeculated.

62
Q

What epithelium lines the foreskin and glans of the penis?

A

Squamous epithelium.

63
Q

What is the epithelium of the urethra?

A

Squamous at the distal end and then urothelial more proximally.

64
Q

Which HPV types cause genital warts?

A

HPV 6 and 11.

65
Q

What are the 2 types of penile intraepithelial neoplasia (PEiN)?

A

Differentiated (non-HPV related).

Dedifferentiated (HPV-related).

PEin is the same as carcinoma in situ.

66
Q

What is the function of the testis?

A

Make sperm (in the seminiferous tubules).

67
Q

What do the seminiferous tubules contain?

A

Germ cells.

Sertoli cells.

Maturing sperms.

68
Q

What cells are found in the interstitium of the testes?

A

Leydig cells.

69
Q

What is a hydrocoele?

A

Accumulation of fluid around the testes, between the two layers of the tunica vaginalis and mesothelial lining.

Unicystic, smooth and fluid filled.

70
Q

What does a hydrocoele appear like on examination?

A

Smooth.

Softish.

Circumscribed.

Lucent (transillumination).

71
Q

What is a spermatocoele?

A

Cystic change within the vas of the epididymis.

  • Unknown cause and usually asymptomatic.*
  • May feel a fullness.*
72
Q

What is a varicocoele?

A

Varicosities of venous plexus that drains the testis.

Usually asymptomatic and may present having felt a lump.

73
Q

What will a varicocoele feel like on examination?

A

Feels like a bag of worms.

74
Q

What is a bell clapper deformity?

A

The insertion of the tunica vaginalis is high.

The testis can rotate and even sit laterally.

75
Q

What are the 2 types of testicular tumours?

A

Seminomatous.

Non-seminomatous.

Both are types of germ cell tumours.

76
Q

What are the risk factors for seminoma?

A

Undescended testes.

Testicular malignancy will also increase the risk in the contralateral testis

77
Q

What is the histology of a seminoma?

A

Germ cell tumours.

Looks like lots of dots (small and big) in a white background.

78
Q

What is the treatment of for a seminoma?

A

Extremely responsive to radiotherapy even if relatively advanced.

79
Q

What is a non-seminomatous testis tumour?

A

Mixed types of seminoma.

Seen in males 30s.

Far more aggressive than seminoma and can metastasise.

80
Q

What is the treatment for non-seminomatous tumour?

A

Very chemosensitive.

The outcome with mets is reasonable, but it must be treated early.

81
Q

What is a mature teratoma?

A

Contains 3 germ layers (endoderm, ectoderm and mesoderm).

All classified as malignant (in the ovary most are benign).

82
Q

What does the yolk sac form of a teratoma produce?

A

Alpha feto protein.

83
Q

What does the embryonal form of a teratoma look like?

A

High grade.

Aggressive form.

Associated with mets.

84
Q

What does the trophoblast form of a teratoma look like?

A

Wacky looking cells.

Positive for beta HCG and will give a positive pregnancy test.

2MBChB Renal (20 decks)

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