renal Flashcards
RBC casts?
glomerulonephritis
malignant HTN
WBC casts
tubulointerstitial
pyelo
transplant rejection
fatty casts?
nephrotic syndrome
muddy brown casts?
aka granular casts
ATN
waxy casts?
ESRD, CRF
hyaline casts?
concentrated urine
focal vs diffuse glomerular process?
under/over 50%
pathogenesis of nephritic syndrome?
GBM disruption
pathogenesis of nephrotic syndrome?
podocyte disruption –> charge barrier impaired
LM findings in post strep glomerulonephritis?
hypercellular enlarged glomeruli
IF findings in post strep glomerulonephritis?
starry sky granular appearance - lumpy bumpy
IgG, IgM, C3 deposition in GBM and mesangium
EM findings in post strep glomerulonephritis?
subepithelial immune complex humps
what kind of reaction is post strep glomerulonephritis?
type III hypersensitivity
LM/IF findings in RPGN?
crescents!
consist of fibrin, plasma proteins (C3b), glomerular parietal cells, monocytes, macrophages
dz that cause RPGN?
Goodpasture (type II hypersensitivity; anti GBM and alveolar Abs) Wegeners (c-ANCA) microscopic polyangiitis (p ANCA)
LM findings in DPGN?
wire looping of capillaries
IF findings in DPGN?
granular
EM findings in DPGN?
subendothelial IgG based immune complexes
often with C3 deposition
cause of DPGN?
SLE (MCC of death)
MPGN
** often copresents as nephrotic syndrome
LM findings in IgA nephropathy?
mesangial proliferation
IF findings in IgA nephropathy?
IgA based IC deposits in mesangium
EM findings in IgA nephropathy?
mesangial IC deposits
presentation of IgA nephropathy?
renal insufficiency or acute gastro
episodic hematuria with RBC casts
** same pathology as HSP
can’t see, can’t pee, can’t hear a bee?
Alport - XL mtn in type IV collagen
thinning and splitting of GBM = basket weave on EM
findings in type I MPGN?
subendothelial IC deposits, granular IF
tram track on PAS/H&E due to GBM splitting
causes of type I MPGN?
HBV
HCV
idiopathic
findings in type II MPGN?
intramembranous IC deposits
dense deposits
causes of type II MPGN?
C3 nephritic factor –> stabilizes C3 convertase –> decreased C3 levels
mechanism of hypercoagulability in nephrotic syndrome?
loss of ATIII in urine
LM findings in FSGS?
segmental sclerosis and hyalinosis
IF findings in FSGS?
nonspecific
focal deposits of IgM, C3, C1
EM findings in FSGS?
foot process effacement
causes of FSGS?
MC nephrotic syndrome in AfAm, Hispanic
idiopathic or 2ary - HIV, sickle cell, heroin use
inconsistent steroid response
LM/IF findings in MCD?
nada
EM findings in MCD?
foot process effacement
causes of MCD?
MC nephrotic syndrome in children
idiopathic, possible trigger by recent infection/immunization
RARE: 2/2 lymphoma
good steroid response
LM findings in membranous nephropathy?
diffuse capillary and GBM thickening
IF findings in membranous nephropathy?
granular - IC deposition
EM findings in membranous nephropathy?
spike and dome - subepithelial deposits
causes of membranous nephropathy?
MC nephrotic syndrome in Caucasians
idiopathic
2ary: drugs, HBV, HCV, SLE, tumors
poor steroid response
LM findings in renal amyloid?
Congo red stain –> apple red birefringence
LM findings in diabetic nephropathy?
mesangial expansion
GBM thickening
eosinophilic nodular glomerulosclerosis = Kimmelstiel Wilson lesions
envelope or dumbbell shaped kidney stones?
calcium! (phosphate or oxalate)
alkaline pee favors phosphate, acidic pee favors oxalate
ethylene glycol, vit C, hypocitraturia, malabsorption –> oxalate stones
** tx: hydration, thiazides, citrate
coffin shaped kidney stones?
struvite = NH4 Mg Ph
infx with urease + bugs
staghorn calculi
precipitate with alkaline pee
** tx: treat infection, surgical removal
rhomboid or rosette shaped kidney stones?
uric acid
RADIOLUCENT - seen on CT, US
acidic pee favors precipitation
assoc with decreased urine vol, hyperuricemia, leukemia
** tx: alkalinization of urine, allopurinol
hexagonal shaped kidney stones?
cystine
RADIOLUCENT
acidic pee favors precipitation
AR - defect in PCT transporter that reabsorbs cystine –> cystinuria
- dx: sodium cyanide nitroprusside test
- tx: alkalinize urine
renal biopsy: polygonal clear cells filled with lipids and carbs?
renal cell carcinoma
originates from PCT cells
increased in smoking, obesity, older men
hematuria, palpable mass, flank pain, 2ary polycythemia
- invades renal vein –> IVC –> hematogenous spread
- resistant to chemo or rads
genetics of renal cell carcinoma?
deletion of RCC on chrom 3
either sporadic or assoc with VHL
paraneoplastic syndromes of renal cell carcinoma?
EPO
ACTH
PTHrP
renal biopsy: large eosinophilic cells, abundant mitochondria, no perinuclear clearing?
renal oncocytoma
benign epithelial cell tumor
painless hematuria, flank pain, abdominal mass
** often resected to r/o malignancy
child with large palpable unilateral flank mass, +/- hematuria?
wilms tumor
loss of function mtn of WT1 or WT2 (chrom 11) - tumor suppressor
Beckwith Wiedemann?
Wilms
macroglossia
organomegaly
hemihypertrophy
WAGR?
Wilms
aniridia
GU malformation
mental retardation
transitional cell carcinoma?
MC tumor of urinary system
painless hematuria
** phenacetin (NSAID), smoking, aniline dyes, cyclophosphamide
risk factors for squamous cell ca of bladder?
Schistosomiasis
chronic cystitis
smoking
chronic nephrolithiasis
kidney with coarse asymmetric corticomedullary scarring, blunted calyx; tubules containing eosinophilic casts?
chronic pyelo
usually requires predisposing factor
diffuse cortical necrosis?
acute generalized cortical infarction of B/L kidneys
2/2 combo of DIC and vasospasm
** obstetric catastrophes, shock
stages of ATN?
1) inciting event
2) maintenance: oliguria, risk of hyperK, met acidosis, uremia
3) recovery: polyuria, risk of hypoK
which cells of kidney susceptible to ischemic injury?
PCT
thick ascending limb
which cells of kidney susceptible to toxic substances?
PCT
sudden gross hematuria and proteinuria?
renal papillary necrosis
may be triggered by recent infx or immune stimulus
** assoc with sickle cell, acute pyelo, NSAIDs, DM
lab findings in prerenal azotemia?
FENa < 1%
increased BUN/Cr ratio (> 20)
UOsm > 500
UNa < 20
lab findings in intrinsic renal failure?
FENa > 2%
decreased BUN/Cr ratio (< 15)
UOsm < 350
UNa > 40
lab findings in postrenal azotemia?
FENa > 1% or > 2% if severe
UOsm < 350
UNa > 40
signs/sx of uremia?
nausea, anorexia pericarditis asterixis encephalopathy platelet dysfunction
B/L enlarged kidneys with many cysts, flank pain, hematuria, HTN?
ADPKD - mtn in PKD1 (chrom 16) or PKD2 (chrom 4)
death from CKD complications or HTN
** assoc with berry aneurysms, MVP, benign hepatic cysts
infant with significant oliguric renal failure, possible Potter sequence in utero?
ARPKD
assoc with congenital hepatic fibrosis
systemic HTN, progressive renal insufficiency, portal HTN
shrunken kidneys on US, progressive renal insufficiency with inability to concentrate urine?
medullary cystic kidney disease
inherited
tubulointerstitial fibrosis, medullary cysts
poor prognosis
kidney cysts filled with ultrafiltrate?
simple cysts
anechoic on US
benign
septated, enhanced, or solid kidney cysts?
complex
require f/u or removal to r/o renal cell carcinoma