Pathology

Question 1

Nephritic

Answer 1

Haematuria
Oliguria
Hypertension
Mild proteinuria

Question 2

Nephrotic

Answer 2

Proteinuria
Hypoproteinaemia
Oedema

Question 3

Immune-Mediated glomerular disease

Answer 3

Circulating immune complex deposit in glomerulus, entrap or deposit foreign antigen in BM leading to complement activation.

Question 4

Acute Proliferative GN

Answer 4

Aet: Post Group A haemolytic strep infection

Morph: Glomeruli: enlarged, hypercellular, polymorphs, mesangial/endothelial proliferation

Clinic: low serum complement, high ASO tire

Result: chronic/crescentric GN

Question 5

Crescentic GN

Answer 5

Proliferation of cells in capsular space
Stimulated by fibrin
Petechial hemorrhages

Aet: APGN, Autoimmune, SBE, Anti-BM disease

Morph: Glomeruli: necrosis, tufts collapse

Prog: Poor

Question 6

RPGN

All idiopathic

Answer 6

Type 1 (anti-GBM antibody)
Good pasture Syndrome 

Type 2 (immune complex)
Postonfectious, SLE, henoch-schonlain purpura

Type 3 (pauci-immune)
ANCA, Wegener granulomatosis, polyarteritis nodosa

Question 7

Minimal change nephropathy

Answer 7

Aet: idiopathic

Macro: large pale kidney

Micro: oedema in interstitium

Clinic: common in children

Prog: 75% recover

Question 8

Focal segmental glomerulosclerosis

Causes

Answer 8

Primary FSGS
HIVAN
Heroin 
Drug toxicity 
Familial

Question 9

HIV associated nephropathy

Answer 9

Collapsing variant of FSGS

Focal cystic dilation of tubules segments
->filled with: proteinaceous material, fibrosis, inflam

Large no. of tubuloreticular inclusions in endothelial cells.

Question 10

Chronic GN

Answer 10

Aet: endstage of GNs

Micro: Glomeruli- hyalination, scarring, shrinkage
Tubule- atrophy, intervening hypertrophy
Interstitium- fibrosis, chronic inflam cells

Clinic: Chronic RF - Uraemia

Prog: RF,

Question 11

Systemic diseases with glomerular involvement

Answer 11

SLE
Diabetes 
Amyloidosis 
Good pasture Syndrome 
Bacterial endocarditis 
Henoch-schonlein purpura
Wegener granulomatosis

Question 12

Membranous GN

Answer 12

Aet: idiopathic, infection, neoplasms, autoimmune

Micro: Glomeruli-> uniform BM thickening
Tubules-> contain lipids
Institium-> fibrosis, foamy histicytes

Clinic: common in adults

Question 13

Mesangiocapillary GN

Answer 13

Aet: post infection, autoimmune

Micro: Glomeruli-> very cellular-> lobularity

Question 14

IgA Nephropathy

Answer 14

Glomerular IgA> intense or= staining to IgG/M

Asymptomatic haematuria(40%), gross haematuria(40%), Nephrotic syndrome(10%), renal failure(10%)

Histo: focal/diffuse Mesangioproliferative GN, endocapillary gn, crescentic gn

Question 15

Diabetic Glomerulosclerosis

Kimmelstiel-Wilson kidney

Answer 15

Aet: longstanding diabetes

Macro: large smooth-> small granular kidneys

Micro:
Glomeruli-> nodular proteinaceous lesions, increase mesangial matrix, fibrin cap, hyalinization, shrinkage
Tubules-> atrophy, hypertrophy
B.vessels-> hypertensive e/a aterioles changes

Clinic: Nephrotic

Path: pyelonephritis, papillary necrosis

Question 16

Renal Amyloidosis

Answer 16

Aet: 2nd to chronic infections

Macro: large pale-> small granular & waxy kidney

Micro: Congo red stain
Glomeruli-> eosinophilic nodules in tufts, increase mesangium, lain amyloid 
Tubules-> atrophic 
Interstitium-> amyloid deposits 
B.vessels-> arterioles with amyloid 

Clinic: Nephrotic

Question 17

Hereditary disorders

Answer 17

Alport syndrome
Thin basement membrane disease
Fabry disease

Question 18

Pyelonephritis

Answer 18

Aet: infection (E.coli, strep. Faecalis)

Hematogenous

Factors: Diabetes, infective endocarditis, immunosuppression

Morph:
Acute: enlarged, abscesses, patchy suppurative inflam.
Chronic: small pale granular, coarse scars, fibrosis
Atrophy, dilation, colloidal

Question 19

Hpyertensive Nephrosclerosis

Answer 19

A.arterioles get hyaline arteriolosclerosis
Result: renal failure

Macro: small, finely granular cortical surfaces

Micro: narrow A.A, ischaemic atrocity of tubules, Glomerular sclerosis, interstitial fibrosis

Question 20

Papillary Necrosis

Answer 20

Aet: ischaemia of vesa recta in pre- existing papillary damage

Due to: shock, diabetes, ureteric obstruction, sickle cell anaemia, prolonged analgesic abuse, acute pyelonephritis

Result: acute RF

Macro: ischaemic papillary necrosis due to vascular narrowing, coagulative necrosis

Micro: hyperaemic and has polymorphs