Pathology of the Kidney 1

Question 1

When creating a differential diagnosis what is useful to go throgu?

Answer 1

Anatomy then possible causes;

• Trauma,
• Swelling,
• Chronic,
• Acute,
• Stone

Question 2

Name an example of a congenital renal disease

Answer 2

• Hypoplasia,

- Potter Syndrome (bilateral renal agenesis

Question 3

Name an example of a genetic renal disease

Answer 3

Polycystic kidney disease

Question 4

name examples of primary and secondary glomerular disease

Answer 4

Primary (tends to be immunological) - Glomerulonephritis or glomerulopathy.
Secondary - Vascular, autoimmune (SLE), amyloid, diabetes acquired

Question 5

How is glomerulonephritis classified?

Answer 5

Hypersensitivity;
1 - Immediate (unlikely to be an issue),
2 - Antibody-dependant cellular cytotoxicity,
3 - Immunocomplexes,
4 - Cell mediated immunity

Question 6

Describe type 2 glomerulonephritis

Answer 6

Anti- GBM (glomerular basement membrane) antibodies, which results in complement fixation (formation of MAC) leading to damage and therefore fibrin leakage.

Question 7

Describe the clinical effects and causes of type 2 glomerulonephritis

Answer 7

Causes - Goodpastures syndrome, vasculitis, SLE and organic solvents.
Effects - Haematuria, proteinuria, long term less urine and can have lung involvement

Question 8

Describe type 3 hypersensitivity glomerulonephritis

Answer 8

• Deposition of immune complexes (size determines where) and there may/may not have complement fixation.

Question 9

Describe the clinical effects and causes of type 3 proliferative glomerulonephritis

Answer 9

Causes - Postinfectious (strep), vasculitis, SLE.

Effects - Haematuria, less urine, proteinuria, pain. Can cause nephritic syndrome

Question 10

What is nephritic syndrome?

Answer 10

It occurs due to inflammatory damage of the renal endothelium. It causes haematuria, proteinuria, raised serum creatinine and systemic hypertension

Question 11

Describe the clinical effects and causes of type 3 membranous glomerulonephritis

Answer 11

Causes - Male, adults, malignancy, Hep B, idiopathic penicillamine and SLE.
- Causes minimal haematuria, less urine, proteinuria, no pain and hypercholesterolaemia which leads to nephrotic syndrome.

Question 12

What is nephrotic syndrome?

Answer 12

Damage to the glomeruli which results in the leakage of proteins and hypercholesterolaemia and oedema.

Question 13

Describe features of minimal lesion

Answer 13

Occurs often with children with marked proteinuria and responds well to steroids. Patients enter remission with measles

Question 14

What are some other causes of proteinuria?

Answer 14

Diabetes and amyloidosis

Question 15

If patients with minimal lesion do not respond to steroids then what can they develop?

Answer 15

Focal and segmental glomerulosclerosis lesions

Question 16

Describe vascular causes can cause glomerular disease

Answer 16

• Hypertension,
• Vasculitis,
• Mesangial IgA disease,
• Thrombotic thrombocytopenic purpura
• haemolytic uremic syndrome

Question 17

Describe causes and clinical effects of tubulointerstital disease

Answer 17

Causes - Drug hypersensitivity,
- Acute tubular necrosis,
- Shock,
- Ascending infection,
- SLE,
-Ischaemia 
Clinical effects - Pain, fever, dysuria

Question 18

What is good pastures syndrome?

Answer 18

Type 2 sensitivity. Antibodies bind to every capillary loop resulting in activation of complement which blows a hole in the capillary. Therefore capillary loops shrunken and crushed. Bowmen’s space becomes filled with cells instead of blood