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Step 1 > Pathology - renal > Flashcards

Pathology - renal Flashcards

1
Q

RBC casts

A

glomerulonephritis, malignant hypertension

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2
Q

WBC casts

A

tubulointerstitial inflammation, acute pyelonephritis, transplant rejection

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3
Q

fatty casts

A

Nephrotic syndrome

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4
Q

granular casts

A

acute tubular necrosis

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5
Q

Waxy casts

A

end-stage renal failure

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6
Q

Nephritic syndrome

A

sign of GBM disruption

incr. BUN/Cr, oliguria, hematuria, RBC casts

Causes: acute post-streptococcal, rapidly progressive glomerulonephritis, IgA nephropathy, Alport syndrome, membranoproliferative glomerulonephritis

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7
Q

Nephrotic syndrome

A

podocyte disruption –> charge barrier impaired

Massive proteinuria w/ low serum albumin, incr. lipids, edema, can lead to hyperthrombotic state (loss of antithrombin-3)

primary podocyte damage: PSGS, MCD, membranous nephropathy

secondary podocyte damage: amyloidosis, diabetic glomerulonephropathy

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8
Q

Peripheral/periorbital edema 2 weeks after GABHS infection, cola-colored urine, hypertension

Hypercellular glomeruli
IgG/IgM/C3 deposition along GBM and mesangium

A

Acute post-streptococcal glomerulonephritis

Subepithelial immune complex humps (Type III reaction!)

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9
Q

Rapidly deteriorating renal function, hematuria

crescents of fibrin and plasma proteins (C3b), with glomerular parietal cells, monocytes, macrophages

A

RPGN (incl Goodpasture’s, Wegener’s c-ANCA, microscopic polyangiitis p-ANCA)

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10
Q

SLE, presents often as nephrotic and nephritic syndromes concurrently

wire looping of capillaries
immune complex deposition
granular appearance on IF

A

Diffuse proliferative glomerulonephritis

**most common cause of death in SLE

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11
Q

Renal insufficiency and gasteoenteritis (Henoch-Schonlein Purpura)
Episodic hematuria

mesangial proliferation

A

IgA nephropathy

mesangial IgA-based IC deposits in mesangium

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12
Q

Eye problems, glomerulonephritis, sensorineural deafness

thinning of GBM

A

Alport syndrome

Type IV collagen defect

X-linked

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13
Q

Copresentation of nephritic and nephrotic syndrome

A

Membranoproliferative glomerulonephritis

Type 1: subendothelial IC deposits, tram-track appearance (GBM splitting)
Type 2: intramembranous IC deposits, C3 nephritic factor

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14
Q

Most common cause of nephrotic syndrome in AAs/Hispanics, secondary to sickle cell/HIV/heroin abuse/obesity

A

FSGS

segmental sclerosis, effacement of podocyte foot processes

inconsistent response to steroids

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15
Q

Most common cause of nephrotic syndrome in children, lots of triggers

A

MCD

normal glomeruli but podocyte effacement

may be secondary to lymphoma, excellent response to steroids

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16
Q

Most common cause of nephrotic syndrome in Caucasian adults, lots of triggers, assoc w/ SLE and solid tumors (lung, colon)

Diffuse granular capillary and GBM thickening, spike and dome appearance with subepithelial deposits, can have antibodies to podocyte transmembrane proteins

A

Membranous nephropathy

nephrotic presentation of SLE, poor response to steroids

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17
Q

Congo red stain shows apple green bifringence

A

Amyloidosis

Nephrotic syndrome

18
Q

Diabetic glomerulonephropathy

A

Mesangial expansion, GBM thickening, esoinophilic nodular glomerulosclerosis

Glycosylation of GBM –> incr. permeability and thickening

Glycosylation of efferent arterioles –> incr. GFR –> mesangial expansion

19
Q

Kidney stones seen in pt w/ hypercalciuria and normocalcemia

Envelope or dumbbell-shaped calcium oxalate stones

A

Calcium stones

Oxalate: ethylene glycol poisoning, Vit. C abuse, malabsorption, precipitate at low pH

tx: hydration, thiazides, citrate, pyridoxine, low protein diet

20
Q

Kidney stones seen in pt w/ infection by urease + bugs (proteus, klebsiella, staph sapro)

Coffin lid-shaped stones

A

Struvite (ammonium magnesium phosphate)

Commonly form staghorn calculi

21
Q

Kidney stones seen in pt w/ dehydration or incr. cell turnover

Rhomboid-shaped or rosettes

A

Uric acid

tx: allopurinol, alkalinization of urine, low protein diet

22
Q

Kidney stones in pt w/ loss of cystine-reabsorbing PCT transporter

Hexagonal shaped

A

Cystine stones

Hexagonal shaped

Mostly seen in children, with positive sodium cyanide nitroprusside test, and they also have aminoaciduria

tx: alkalinization of urine

23
Q

Renal cell carcinoma pathology

A

PCT cells, polygonal clear cells filled with accumulated lipids and carbs/glycogen

invades renal vein then IVC and spreads hematogenously

gene deletion on Ch.3 (sporadic or von Hippel Landau)

assoc. with lots of paraneoplastic syndromes

24
Q

Renal oncocytoma

A

Benign epithelial cell tumor

Large eosinophilic cells with abundant mitochondria without perinuclear clearing

25
Q

Wilms tumor

A

large, palpable, unilateral flank mass

loss of function of tumor suppressors WT1/WT2

May be part of Beckwith-Wiedemann or WAGR (wilms, aniridia - absence of iris, GU malformation, mental retardation)

26
Q

SCC of bladder

A

chronic irritation of bladder (Schistosoma haematobium infection)

presents with painless hematuria

27
Q

Causes of UTIs

A

E. coli
Staph sapro
Klebsiella
Proteus - ammonia scent

nitrites in gram negatives (E. coli)

negative cultures suggest urethritis

28
Q

Pyelonephritis

A

neutrophils infiltrate renal interstitium

striated parenchymal enhancement on CT

complications: renal papillary necrosis, perinephric abscess, urosepsis

29
Q

Chronic pyelonephritis

A

vesicoureteral reflux or chronic kidney stones

asymmetric corticomedullary scarring, blunted calyx

tubular can contain eosinophilic casts resembling thyroid tissue (thyroidization of kidney)

30
Q

Signs of drug-induced interstitial nephritis

A

Pyuria and azotemia

Drugs act as haptens, inducing hypersensitivity

31
Q

Muddy brown granular casts

A

Acute tubular necrosis

3 stages: inciting phase, maintenance phase, recovery phase

ischemic - decr. renal blood flow (hypovolemia, shock)
nephrotoxic - toxins, crush injury, hemoglobin, most common in PCT

32
Q

Gross hematuria and proteinuria

A

Renal papillary necrosis

Seen in SAND…
sickle cell, acute pyelonephritis, NSAIDs, diabetes

33
Q

incr. Cr and incr. BUN

A

acute kidney injury

34
Q

FENa values for AKI

A

2% = intrinsic renal, postrenal

35
Q

Low Vit. D, low serum Ca, high serum PO4

A

renal osteodystrophy

36
Q

ADPKD

A

autosomal dominant, mutation in PKD1

assoc. w/ berry aneurysms, mitral valve prolapse, benign hepatic cysts

37
Q

ARPKD

A

infantile polycystic kidney disease

congenital hepatic fibrosis, can lead to Potter sequence

38
Q

Progressive renal insufficiency with inability to concentrate urine

A

Medullary cystic disease

not visualized, but shrunken kidneys on ultrasound

39
Q

Anechoic cysts vs. solid components

A

Simple vs. complex renal cysts

Simple are filled w/ ultrafiltrate
Complex are septated, enhanced or solid, and must be removed due to incr. risk of RCC

40
Q

Evaluating metabolic alkalosis

A

First, assess urine chloride (low = vomiting), then volume status

Three most common causes: vomiting/NG suction, thiazide/loop diuretic use, mineralocorticoid use

41
Q

Hemolytic uremic syndrome (HUS)

A

s/p E.coli (O157:H7) or Shigella infection

toxins injure endothelium of preglomerular arterioles, leading to platelet aggregation and formation of microthrombi (shear stress –> hemolysis)

Look for thrombocytopenia, anemia and AKI

Step 1 (32 decks)

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