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Renal > Pathology I > Flashcards

Pathology I Flashcards

1
Q

What is nephritis?

A

Inflammation of the kidney = infective (pyelonephritis) or non-infective (glomerulonephritis)

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2
Q

What is glomerulonephritis?

A

Inflammation of the glomerulus

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3
Q

What are the main causes of glomerulonephritis?

A

Immune mediated = directed at something in the glomerulus, circulating complex deposition
Related to vasculitis

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4
Q

What are some features of direct attack by the immune system causing glomerulonephritis?

A

Rare = Goodpasture’s syndrome (alpha subunit of collagen 4, IgG antibodies)

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5
Q

What are some causes of glomerulonephritis caused by circulating immune complexes?

A

Hepatitis, post-strep infection, HIV, gold, penicillamine, cancer (often lymphoma)

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6
Q

What vasculitis cause glomerulonephritis?

A

GPA = cANCA

Microscopic polyangiitis = pANCA

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7
Q

What does glomerulonephritis prevent?

A

Stop glomerular sieve working = disrupt membrane charge, block membranes

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8
Q

How is glomerulonephritis classified?

A

Nephrotic or nephritic syndrome

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9
Q

What are the features of nephritic syndrome?

A

Haematuria, hypertension

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10
Q

What are the features of nephrotic syndrome?

A

Heavy proteinuria, non-dependent oedema, hyperlipidaemia, immunosuppression, renal vein thrombosis

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11
Q

What proteins are lost in nephrotic syndrome?

A

Antibodies, complement, proteins in clotting cascade

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12
Q

How is glomerulonephritis investigated?

A

Using light microscopy, electron microscopy and immunofluorescence

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13
Q

Can the types of glomerulonephritis cause both nephrotic and nephritic syndromes depending on the person they occur in?

A

Yes = all can cause a nephritic or nephrotic syndrome but have a tendency to cause one or the other

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14
Q

What do crescents on histology mean in glomerulonephritis?

A

Poor prognostic sign = indicates rapid progression

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15
Q

What are some causes of granulomas in glomerulonephritis?

A

GPA and sarcoid

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16
Q

What does light microscopy of glomerulonephritis show?

A

Usually hypercellular = inflammatory cells and reactive proliferation
Can see sclerosis (on-going damage) or crescents
May be able to see vasculitis

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17
Q

What is the benefit of using electron microscopy in glomerulonephritis?

A

High magnification = can look at basement membrane

Can see if there are deposits and where they are

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18
Q

What does immunofluorescence show?

A

What kind of antibody is present and where it is distributed

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19
Q

What does immunofluorescence of Goodpasture’s show?

A

Linear IgG

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20
Q

What are some features of minimal change glomerulonephritis?

A

Nephrotic syndrome of unknown cause = occurs in children, good prognosis, usually resolves with steroids

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21
Q

What are some features of focal segmental glomerulosclerosis?

A

Nephrotic syndrome of adults = causes include obesity, HIV, sickle cell and IV drug use

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22
Q

What are some causes of membranous glomerulonephritis?

A

Hepatitis, malaria, syphilis, NSAIDs, penicillamine, gold, captopril, lung/colon cancer, melanoma, SLE, thyroiditis

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23
Q

How common is membranous glomerulonephritis in patients with SLE?

A

Accounts for 15% of all glomerulonephritis in lupus patients

24
Q

What is membranous glomerulonephritis?

A

Nephrotic syndrome of adults = thick membrane and sub-epithelial deposits

25
Q

What is the prognosis of membranous glomerulonephritis?

A

Variable = slow indolent progression, <40% eventually develop renal failure

26
Q

What is IgA glomerulonephritis?

A

Post-infectious nephritic syndrome = may be genetic or due to acquired defect (coeliac), prognosis depends on severity

27
Q

How does IgA glomerulonephritis appear?

A

IgA deposition in mesangium

28
Q

What causes membranoproliferative glomerulonephritis?

A

Idiopathic = type 2 hypersensitivity (infection, SLE, cancer), affects adults and children, either nephrotic or nephritic syndrome, prognosis depends on severity

29
Q

What is the appearance of membranoproliferative glomerulonephritis?

A

Big lobulated hypercellular glomeruli with thick membranes = train track appearance

30
Q

What conditions can diabetes cause in the kidneys?

A

Diffuse and nodular glomerulosclerosis
Nodules = Kimmel Stiel Wilson lesions
Arterial sclerosis

31
Q

What infections can diabetes cause in the kidneys?

A

Pyelonephritis, papillary necrosis

32
Q

Why is it difficult to tell cystic disease from cancer?

A

Many early cancers are cystic or partly cystic so is difficult to differentiate = use Bosniak score to predict cancer

33
Q

What are some features of acquired cysts?

A

Very common = seen frequently at autopsy
Often associated with long term dialysis
Simple cysts = attenuated lining, degenerative change

34
Q

What causes autosomal dominant polycystic kidney disease (ADPCKD)?

A

Uncommon = due to mutation in nephrin

Often secondary changes = haemorrhage, infarction, rupture

35
Q

What occurs in autosomal dominant polycystic kidney disease?

A

Lots of cysts develop over time = kidney becomes huge

Cysts are lined by simple epithelium

36
Q

How does autosomal dominant polycystic kidney disease present?

A

Mass like lesion or pain/haematuria due to secondary changes

37
Q

What are the systemic manifestations of autosomal dominant polycystic kidney disease?

A

Liver cysts and cerebral aneurysms = associated with sub-arachnoid haemorrhages

38
Q

What are the features of autosomal recessive polycystic kidney disease?

A

Several subtypes = all occur in childhood
Kidney of normal size and has smooth surface
Causes liver cysts

39
Q

What is the only benign tumour of the kidney?

A

Oncocytoma

40
Q

What are the malignant tumours of the kidney?

A

Chromophobe, clear cell, papillary, collecting duct

41
Q

What tumour of the kidney occurs in the paediatric age group?

A

Wilm’s tumour

42
Q

How do oncocytomas appear?

A

Small, oval and well circumscribed
Mahogany brown with central stellate scar
Very pink with granular cytoplasm on histology

43
Q

What are some features of papillary malignancy?

A

Second most common, low grade (type 1 and 2), finger like projections

44
Q

What are chromophobe malignancies difficult to distinguish from?

A

Papillary malignancies = same histology but chromophobe has raisonoid nuclei and perinuclear haloes

45
Q

Are chromophobe malignancies common?

A

No

46
Q

What are some features of collecting duct carcinomas?

A

Least common, high grade appearance with very desmoplastic stroma, poor survival

47
Q

What malignancy do most people mean when they speak of renal cancers?

A

Clear cell carcinomas

48
Q

What are the risk factors for clear cell carcinomas?

A

Strong link to obesity, genetic influence

49
Q

What is the presenting complaint of clear cell carcinomas?

A

Haematuria, mass, rarely hypertension

50
Q

What is the macroscopic appearance of clear cell carcinoma?

A

Often partly cystic and very heterogenous surface = most striking feature is bright yellow tumour surface

51
Q

What is the microscopic appearance of clear cell carcinomas?

A

Clear cells = artefact of processing and relate to cell hypoxia

52
Q

How is clear cell carcinoma staged?

A

Size and then invasion of other structures

53
Q

What structures do clear cell carcinomas tend to invade?

A

Propensity of renal vein involvement

Can even extend into vena cava and grow up towards heart

54
Q

What is VHL associated with?

A

Responsible for most sporadic renal cancers = codes for hypoxia inducible factor (HIF)

55
Q

How do VHL and HIF interact normally?

A

VHL ubiquinates HIF = in low 02 they dissociate and HIF acts as a transcription factor for VGEF, PDGFRB and EPO

56
Q

What pathologies make up VHL syndrome?

A 
Renal cell carcinoma
Cerebellar haemangioblastoma
Pancreatic serous cystadenoma
Tumours of the endolymphatic sac
Epididymal serous cystadenomas
57
Q

What is xanthogranulomatous pyelonephritis?

A

Specific infection that creates a mass in the kidneys

Renal (36 decks)

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