Pathoma (HIGH YIELD)

Question 1

What is Potter sequence, what causes it, and what renal abnormality is it associated with?

Answer 1

Developmental defects of extremities (and lung hypoplasia); Oligohydramnios; bilateral renal agenesis (also recessive PKD)

Question 2

Describe the inheritance pattern and features of dysplastic kidney (disease)

Answer 2

Noninherited; congenital malformation of renal parenchyma characterized by cysts and presence of abnormal tissue (especially cartilage)

Question 3

In the context of acute renal failure, what is the effect of “prerenal” azotemia on the serum BUN:Cr ratio? Why does this occur?

Answer 3

Serum BUN:Cr rises to > 15; in prerenal azotemia, decr. BF to kidney (which decr. GFR) leads to activation of RAAS, incr. aldosterone, which incr. Na+ reabsorption, thusly incr. water reabsorption, which in turn leads to incr. BUN reabsorption (remember Cr is not able to be reabsorbed)

Question 4

Why/how does ethylene glycol cause acute renal failure? What should you look for if suspected?

Answer 4

Ethylene glycol consumption causes acute tubular necrosis, which causes intrarenal azotemia (a type of acute renal failure); ethylene glycol has a blue color and is sweet so children sometimes mistake it for juice; oxalate crystals in urine

Question 5

What clinical feature is “almost” pathognomonic of Acute Interstitial Nephritis?

Answer 5

Eosinophils in urine (acute interstitial nephritis itself is a cause of intrarenal azotemia, a type of ARF)

Question 6

Cancer associated with Minimal Change Disease (and why)

Answer 6

Hodgkin Lymphoma (b/c Reed-Sternberg cells produce a plethora of cytokines, which “knock out” the podocytes of the glomerulus)

Question 7

Diseases associated with Focal Segmental Glomerulosclerosis (FSGS)

Answer 7

Sickle cell disease (most important), heroin use, HIV

Question 8

What is the most common cause of nephrotic syndrome in caucasian adults?

Answer 8

Membranous nephropathy

Question 9

Diseases associated with Type I Membranoproliferative Glomerulonephritis

Answer 9

Hep B & C

Question 10

What is C3 nephritic factor? What disease is it associated with?

Answer 10

An autoantibody that stabilizes C3 convertase, which thusly activates complement, driving the disease process of Type II Membranoproliferative Glomerulonephritis

Question 11

What are Kimmelstiel-Wilson nodules pathognomonic of?

Answer 11

Diabetes (non-enzymatic glycosylation of basement membrane in glomeruli causes hyaline arteriolosclerosis, leading to hyperfiltration, and ultimately mesangial sclerosis)

Question 12

Shared characteristics of all Rapidly Progressive Glomerulonephritis (RPGN)

Answer 12

Crescents in Bowman’s space (comprised of fibrin and macrophages)

Question 13

Most common renal disease in SLE? Histologic characteristics?

Answer 13

Diffuse Proliferative Glomerulonephritis (2nd most common is membranous nephropathy); subendothelial immune complex deposition in glomeruli and granular appearance on IF (unfortunately not unique)

Question 14

What type(s) of kidney stones potentiate stag horn calculi formation?

Answer 14

Ammonium magnesium phosphate, Cysteine (more common in kids)

Question 15

Dialysis increases risk for what renal disease?

Answer 15

RCC

Question 16

What renal disease/abnormality is associated with tuberous sclerosis

Answer 16

Angiomyolipoma

Question 17

Which type of renal neoplasm is associated with multiple paraneoplastic syndromes? List them.

Answer 17

RCC:
	EPO – could lead to reactive polycythemia
	Renin – could lead to HTN
	PTHrP – could lead to hypercalcemia
	ACTH – could cause Cushing syndrome

Question 18

Left-sided varicocele could be a sign of what renal neoplasm? Why?

Answer 18

(Left) Renal cell carcinoma; this cancer shows preferential involvement of renal vein, which drains the spermatic vein (but only on L side of the body)

Question 19

RCC pathogenesis involves loss of what gene? What effect does this have?

Answer 19

VHL (tumor suppressor) on 3p; incr. IGF-1 (promotes growth) and incr. HIF (promotes VEGF and PDGF)

Question 20

Long-term cyclophosphamide use and phenacetin are associated with what?

Answer 20

Urothelial carcinoma

Question 21

Early p53 mutations are observed in what urothelial carcinoma “pathway”

Answer 21

The “flat” pathway

Question 22

2 distinct pathways to urothelial carcinoma

Answer 22

 Flat – start as high grade lesion, then invades

 Papillary – tumors start as low grade, then high grade, then invade

Question 23

Schistosoma hamartoma predisposes what type of lower urinary tract cancer? In what patients does it usually occur?

Answer 23

Squamous cell carcinoma; middle eastern males

Question 24

What type of GU cancer is associated with a urachal remnant, and where would it occur?

Answer 24

Adenocarcinoma; dome of the bladder

Question 25

Acute prostatitis on DRE

Answer 25

Tender and ‘boggy’

Question 26

Where does BPH usually occur? Why is this important?

Answer 26

Periurethral zone of the prostate; results in urethral compression

Question 27

Most important histologic feature of prostatic adenocarcinoma

Answer 27

Nuclei contain “dark nucleoli”

Question 28

What criteria determine Gleason scores?

Answer 28

Architecture alone, NOT nuclear atypia