Pathology of Kidney 1

Question 1

What is the most common cause of haematuria?

Answer 1

Infection

Question 2

What does a kidney do?

Answer 2

• Fluid and electrolyte balance
• Reabsorption of solutes
• Excretion e.g of conjugated xenobiotics
• Endocrine
  Renin + Erythropoietin

Question 3

How can renal artery stenosis be diagnosed?

Answer 3

Ultrasound

Question 4

What is potter’s syndrome?

Answer 4

It describes the typical physical appearance caused by pressure in utero due to oligohydramnios, classically due to bilateral renal agenesis.
- Also pulmonary hypoplasia + extremity defects

Question 5

What is polycystic disease mainly due to?

Answer 5

A genetically dominant disease

Question 6

What is primary glomerular disease usually due to?

Answer 6

Immunological disease (MHC/HLA association)

Question 7

What is primary glomerular disease called?

Answer 7

Glomerulonephritis (plural glomerulonephritides)

Question 8

What can secondary causes of glomerular disease be due to?

Answer 8

• Vascular
• Autoimmune e.g
  SLE, Amyloid, diabetes, aquired

Question 9

Where is the mesangium located?

Answer 9

Inside the basement membrane

Question 10

What antibodies are compliment activated?

Answer 10

• IGg1 and 3

- IgM

Question 11

How does a type 2 hypersensitivity reaction affect the glomerulus?

Answer 11

• Membrane attack complex forms a hole in the basement membrane
• plasma proteins, platelets, neutrophils, fibrin can all move through the BM into the urinary space
• Parietal cells which line bowmans capsule activated and proliferate
• Acute inflammation, shrinks glomerulus, glomerular function rapidly lost, ability to excrete lost, glomerular flow decreased and urinary output decreased significantly
• Oliguric with proteinuria plus haematuria or anuric

Question 12

What is a type 2 hypersensitivity reaction which affects the kidneys?

Answer 12

Goodpasture syndrome

Question 13

What can cause renal hypoplasia?

Answer 13

• Congenital renal artery stenosis

Question 14

What is vesicoureteric reflux?

Answer 14

• Urine flows backwards from bladder into ureter and possiblt kidneys

Question 15

What can be seen histologically in goodpasture syndrome?

Answer 15

Crescents - proliferation of parietal epithelium and inflammatory cells

Question 16

How is goodpasture syndrome treated?

Answer 16

• Filtering the blood and antibodies
• High dose immunosuppressants
• Must be treated quickly

Question 17

What other organ can goodpastures syndrome affect?

Answer 17

Lungs

Question 18

What can cause nephritic syndrome?

Answer 18

• Postinfectious - strep
• Vasculitis - ANCA
• SLE

Question 19

What does nephritic syndrome present with?

Answer 19

• Pain
• Haematuria
• Protenuria

Question 20

What is nephrotic syndrome?

Answer 20

• Leaky capillaries - filter problem
• Proteinuria, no blood loss
• Hypertension
• Hyperlipidemia
• Associated with cancer, hep B can be idiopathic
• More common in males

Question 21

What is minimal change disease?

Answer 21

• Nephrotic syndrome
• Podocytes flattened no foot processes, causes flooding of proteins
• No histological abnormalities seen on biopsy
• Associated with measels, thought to be caused by CD8 lymphocyte
• Most common in children
• Treated with steroids

Question 22

What is focal and segmental glomerulosclerosis?

Answer 22

• Type of nephrotic syndrome
• Biopsy would show segmental sclerosis and hyalinosis
• Common in african origin

Question 23

What vascular diseases can cause kidney disease?

Answer 23

• Hypertension
• Vasculitis
• Mesangial IgA disease
• TTP
• HUS

Question 24

How do you differentiate between focal and segmental glomerulosclerosis?

Answer 24

> 50% of nephrons involved = segmental

< 50% = focal

Question 25

What can cause tubulointerstitial disease?

Answer 25

• Drug hypersensitivity
• Acute tubular necrosis
• Shock
• Ascending infection
• SLE
• Ischaemia