Pathology Questions Flashcards
Name the renal syndrome:
Results from glomerular injury and is dominated by the acute onset of gross hematuria and RBC casts, mild proteinuria, azotemia, edema, and HTN.
Nephritic Syndrome
What is the classic disease that presents with Nephritic Syndrome?
PSGN Post-Streptococcal Glomerulonephritis
Name the renal syndrome: Glomerular syndrome characterized by heavy proteinuria (>3.5 g/day), hypoalbuminemia, severe edema, hyperlipidemia, and lipiduria.
Nephrotic Syndrome
Name the Renal Syndrome: Associated with severe glomerular injury, and results in acute kidney failure within days/weeks. Manifested by microscopic hematuria, dysmorphic RBCs and RBC casts, and mild to moderate proteinuria.
Rapidly Progressive Glomerulonephritis
Name the renal syndrome: Recent onset of oliguria/anuria, and azotemia (elevated BUN). Can result from Pre-renal, Intra-renal, or Post-renal causes.
Acute Kidney Injury
Name the renal syndrome: Bacteruria and pyuria. Pain with urination.
UTI Can involve only the lower urinary tract or the kidney (pyelonephritis) or the bladder (cystitis)
Name the renal syndrome: Gradual increase in plasma creatinine levels over time, to greater than 50% of baseline.
Chronic Kidney Injury
Name the renal syndrome: Hematuria with no RBC casts. Hypercalcuria.
Nephrolithiasis
What is the main prognostic indicator of a nephrotic syndrome?
Degree of proteinuria
How do you treat Nephrotic syndromes?
Depends on whether it is a primary syndrome or secondary to systemic disease. Primary: CORTICOSTEROIDS, immunosuppression SECONDARY: Treat the underlying cause: HTN, diabetes, etc… cause they won’t respond to steroids or immune suppression.
Immune deposits in the _________ layer of the glomerulus produces Nephrotic syndrome symptoms.
SubEPIthelium. Example: Membranous Nephropathy
What glomerular disease is weird, in that it deposits Subepithelially but produces a Nephritic syndrome? How does it do this?
Post-Streptococcal Glomerulonephritis Originally deposits in the subdendothelium and mesangium, eliciting an immune response and causing damage, but late in the disease, deposits in the subEPIthelium.
T/F: Subepithelial immune complex deposits occur post-infection of some sort.
TRUE! Membranous Nephropathy: 80% are because of autoantibodies against podocytes, and the rest are due to Hep B, syphillis, etc…. Post-Strep Glomerulonephritis (self-explanatory)
Subendothelial and mesangial deposits occur how? Do they present with nephrotic or nephritic syndrome?
Circulating immune complex deposition or in situ immune complex formation. Subendothelial and mesangial deposits cause a nephritic syndrome.
Which part of the GBM is mostly responsible for the filtration SIZE barrier?
Lamina Densa
Which part of the GBM is responsible for the CHARGE barrier to filtration?
Lamina Rara Interna (negatively charged… keeps albumin in the capillaries. Albumin is small enough to filter otherwise)
Which filters easier, a + charged ion or a (-) charged ion?
+ ions are attracted to the - charge of the GBM and filter easier.
How are crescents formed?
Proliferation of the parietal cells of Bowman’s capsule, and the infiltration of Bowman’s space by macrophages/monocytes.
Rapidly progressive glomerulonephritis (RPGN) is a SYNDROME not a specific disease. It is characterized by what?
Progressive loss of renal function, nephritic characteristics, and severe oliguria. CRESCENTS in the glomeruli
What types of RPGN are curable?
RPGN can arise from many glomerular diseases. It can be cured via PLASMAPHORESIS in the case of Anti-GBM Goodpasture’s Wegener’s (ANCA) RPGN due to immune complex deposition does not respond to plasmaphoresis.
The most common cause of death from lupus is….
Renal Failure
A 3 year old boy presents with sudden onset of irritability, weakness, pallor, and oliguria. His mom says he had a stomach virus a week ago, with bloody diarrhea. Physical exam indicates hepatosplenomegaly, dehydration, and blood test revealed thrombocytopenia and schistocytes. What does he have?
Hemolytic Uremic Syndrome
Describe the 2 types of Hemolytic Uremic Syndrome.
Acquired: Kids under 5 with E.coli H7:O157 GI infections. SHIGA TOXIN. The glomerular epithelium has receptors for Shiga toxin, and its binding causes injury and activation: little clots! 10% inherited: Aquired mutation in Factor H (complement regulator). In these patients a minor endothelial injury results in uncontrolled complement activation. ATYPICAL HUS
Finding microangiopathic hemolytic anemia and thrombocytopenia in a older adult with no other explanation for them = what diagnosis? How do you treat them?
Thrombotoc Thrombocytopenic Purpura TTP= ADAMTS13 deficiency (via lack of enzyme or antibody to it) Treat with PLASMAPHORESIS
Where in the GBM are LUPUS antibody complexes deposited?
Subendothelium Type IV (Diffuse Proliferative) SLE is characterized by confluent circumferential sub endothelial deposits under the glomerular capillary walls. WIRE LOOP LESIONS
What does the term “full house immunofluorescence” mean, and what disease can it be seen in?
Immunofluorescence staining of all 3 Igs: IgG IgM IgA with C3 AND C4 as well. LUPUS
How do you treat lupus?
ASPIRIN, Glucocorticoids (steroids) and immunosuppressants
You see this on the test, and your patient has a URI, hemoptysis, and hematuria. What do they have?
What are the numbers pointing at?
They have Wegener’s Granulomatosis.
(Gramulomatosis with Polyanigiitis)
Those are GIANT CELLS –> Part of the necrotizing granulomatous inflammation that is part of Wegener’s disease process.
This type of pattern looks like a map… and it’s called PATHERGIC.
What is a Thrombotic Microangiopathy and what diseases fall under this category?
Thrombotic Microangiopathies occur when the endothelium has lost its thromboresistance, and abnormal clotting occurs.
TTP
HUS
How do you distinguish a Thrombotic Microangiopathy (clotting problem) from DIC (Bleeding problem)?
The PT and PTT are prolonged in DIC, but normal in Thrombotic Microangiopathies (HUS, TTP)
SLE presents in the kidney as Nephrotic or Nephritic syndrome?
NEPHROTIC
What type of Lupus is this?
TYPE 2: Mesangial Proliferative
Mild Form
What type of Lupus is this?
Type 3: Focal Proliferative
Mild
What type of Lupus is this?
Type 4: Diffuse proliferative
SEVERE
and the most common…
See the crescent?
What are these called, and in which type of LUPUS glomerulonephritis do you see them?
Wire Loop Lesions
Type 4 Lupus Glomerulonephritis
Also see the Hyaline deposit in the capillary? Looks like a clot. It’s not.
What Type of Lupus is this?
What does this condition present with?
Type 5 Lupus Glomerulonephritis
Menbranoproliferative
Causes NEPHROTIC SYNDROME
= Membranous Nephropathy
If you see Nephrotic Syndrome in a LUPUS patient, it’s Membranous Nephropathy, and Type 5 Lupus.
Your patient has a disease that causes THIS to happen in the INTERLOBAR arteries of the kidneys.
What is this lesions called?
What is the disease?
How do you treat it the kidney crisis version of the disease?
Onion SKin Lesions - intimal thickening
Scleroderma
Treat with ACE Inhibitors
The most common cause of Acute Tubular Necrosis is…
Ischemia
The most common cause of the ischemia that causes the Acute Tubular Necrosis is septic shock.
What part of the kidney is the most vulnerable to ischemic injury?
Why?
The outer medulla.
This is where the Straight proximal tubule and the thick ascending limb are. They need a lot of ATP and oxygen to use their transporters and concentrate the urine and reabsorb Na+.
The inner medulla is more hypoxic (less perfused by blood vessels) but the actions of the thin limbs are passive. No energy needed.
What will you see in the urine of a patient with acute Tubular Necrosis?
Muddy Brown Granular Casts
If potassium levels get above _____mmol/L, it is a MEDICAL EMERGENCY
7 mmol/L
Most common cause of Pyelonephritis?
UTI with E.Coli
What are the 2 ways you can get Pyelonephritis (means of spreading to the kidneys) and what bacteria are associated with each route?
- Ascent through the bladder/ureters –> E. Coli
- Hematogenous spread–> Staph Aureus. (In this case the kidney isnt’ the only organ affected)
