Renal Flashcards
Renal calculus that gets submitted for chemical analysis
Calcium oxalate most common stone, due to drugs or stones
Which of the following is NOT considered a cystic disease of the kidney?
Cystic renal cell cancer of the kidney
What is false about autosomal dominant polycystic kidney disease?
- They are high penetrance
- Parenchymal destruction
- Renal failure 10% of all transplant patients
- Renal failure early onset disease
Renal failure early onset disease
What gene mutations are associated with ADPKD?
PKD1 (85%)
PKD2 (15%)
Which of the following is false of autosomal recessive polycystic kidney disease?
- complications attributed to low urine output
- early mortality is rare
- almost never associated with pulmonary complications
- 5 year survival is 89%
- No other cysts other than liver and kidney
Almost never associated with pulmonary complications
Potter sequence
Small lungs, flat face
What is false regarding medullary sponge kidney?
- It is usually associated with hemihypertrophy
- Usually is asymptomatic
- 5 year survival is good
- Don’t progress to end stage renal disease
- Treat with cranberry juice
- Presents in childhood
Presents in childhood
Nephritic syndrome sequence
Neutrophils in glomerulus, RBC casts, sometimes WBC casts (not very often)
Nephrotic sequence
Cytokine mediated, fusion of podocytes, negative charges across GBM is affected
Which of the following is false regarding focal segmental glomerulonephritis?
- Has an excellent response to steroids
- Sclerosis of some but not all glomeruli
- Hematuria and decreased GFR
- Hypertension more frequent than in minimal change disease
- Inherited from of nephrotic syndrome
- Chronic renal failure at 10 years
Has an excellent response to steroids
Which of the following regarding Alport syndrome is false?
- X-linked form (80%) due to mutation in the alpha-5 gene at Xq22
- More likely to progress to renal failure in males
- Thin basement membrane that doesn’t stain very well and it duplicates
- Can see fetal type glomeruli
- There is only an adult variant of Alport syndrome
There is only an adult variant of Alport syndrome
What is FALSE regarding nephrotic syndrome?
- Proteninuria > 3.5 g/dl/day
- Serum albumin levels almost always are high
- Can get generalized edema, anasarca, pitting edema
- Hyperlipidemia and hyperlipiduria are seen leading to maltese cross
- You will get increased sodium and water retention
Serum albumin levels almost always are high
A non-glomerulonephritic glomerulopathy with low cellularity and nephrotic syndrome would include all BUT which of the following:
- Minimal change disease
- Diffuse mesangial change
- Membranous glomerulonephropathy
- Mesangial sclerosis
- Acute post-strep glomerulonephritis
Acute post-strep glomerulonephritis
Which of the following is NOT true to minimal change disease (lupoid nephrosis):
- Common in kids
- Responsive to steroids
- Loss of visceral podocytes
- Can follow immunization or respiratory failure
- Common to see IG depositied in IF or EM
Common to see IG deposited in IF or EM
Which of the following is FALSE regarding membranous glomerulonephritis:
o Most common cause of adult nephrotic syndrome in males
o C5-9 MAC complex is the mechanism of pathology
o You get subepithelial IC on EM with IgG and C3
o Variable disease progression
o Immunoflouresence is negative
Immunoflourescence is negative
What is FALSE regarding IgA nephropathy of Berger’s disease:
o Uncommon disease
o Some progress to renal failure
o Can be seen in young males, especially smokers
o Mesangial IgA deposition
o Increased serum IgA and decreased C3 are characteristic
Uncommon disease
Which of the following statements regarding rapidly progressive crescentic GN is
FALSE:
o It is an aggressive form of glomerulonephritis
o Type I is associated with anti-GBM Goodpasture’s disease with linear
deposits of Ig seen on IF
o Type II is immune mediated granular “lumpy bumpy” IC disease; associated
with post-strep GN, IgA nephropathy, Henoch-Schonlein Purpura
o Type III is pauci-immune Wegener’s Granulomatosis
o Type III is not often associated with c-ANCA or Wegener’s disease
Type III is not often associated with c-ANCA or Wegener’s disease
Goodpasture’s syndrome sequence
Smooth IF
Which of the following is FALSE regarding thin basement membrane:
o Thin basement membrane with benign hematuria
o You’ll see histological thinning of glomerular basement membrane
o Often found as an incidental finding on routine urinalysis
o Mild to moderate protein loss
o Have to rule out Berger’s and Alport syndrome
o It is an uncommon cause of familial asymptomatic hematuria
It is an uncommon cause of familial asymptomatic hematuria
What are the characteristics of nephritic syndromes:
o Hematuria associated w/ RBC o Azotemia o Oliguria o HTN o Varying degrees of protein loss o All of the above
All of the above
Which of the following statements about circulating immune complexes in
glomerulonephritis is FALSE:
o Electron dense clumps in mesangium
o Deposits in endothelial cells and basement membrane
o Temporary exposure to antigens can lead to limited disease
o You will see a smooth linear IF pattern
You will see a smooth linear IF pattern
Which of the following antigens have been associated with endogenous
glomerulonephritis:
o DNA o Extractable nuclear antigens (RNP?) o CEA o Thyroglobulin o All of the above
All of the above
The pathology report reads: focal proliferative and necrotizing GN, pathologist
recommends obtaining a c-ANCA and checking the nose and sinuses, what disease
are they suspecting?
o Wegener’s Granulomatosis
o Goodpasture’s disease
o Alport’s
o Colon cancer
Wegener’s Granulomatosis
Path report reads: focal proliferative IC mediated GN which has linear stain with
anti-GBM on IF, pathologist recommends checking if there is any fulminant disease:
Goodpasture’s disease
Which of the following statements regarding Hanta virus is true:
o Presents with flu like syndrome o See thrombocytopenia o Acute renal injury o Rodent RNA virus o 7% mortality o All of the above
All of the above
Which is NOT true regarding BK polyoma virus:
o These viruses are non-enveloped DNA viruses
o Members of papovavirus
o Polyoma virus BK is widely present in healthy patients
o It’s latent in kidneys, B cells, and CNS
o JC and BK virus infection is rare in the first 2 years after a kidney
transplant
JC and BK virus infection is rare in the first 2 years after a kidney transplant
Which of the following diseases are associated with a specific GN disease:
o Amyloid o Diabetes o Henoch-Schonlein o Systemic lupus o All of the above
All of the above
Which WHO classification of lupus is INCORRECT?
o Class I: normal or minimal cellularity
o Class II: 10-20% of cases with mesangial expansion
o Class V: 10-15%, has a membranous component
o Class VI: advanced sclerosis
o Class IV: 30-40%, focal proliferative glomerulonephritis
Class IV: 30-40%, focal proliferative glomerulonephritis → HE SAID
THE ANSWER WOULD BE “C”; HE BASICALLY JUST FLIPPED
THE DEFINITION OF CLASS 3 AND 4 AROUND, SO IF YOU SEE
SOMETHING TALKING ABOUT EITHER OF THESE TWO
CLASSES, THAT’S THE ANSWER
Which of the following is FALSE regarding Henoch-Schonlein Purpura:
o In children, 3-8 years it has a great prognosis
o In adults, it is a more severe disease
o Renal manifestations are seen in about 33% of patients
o Mesangial IgA deposits, and sometimes IgG and C3 are seen on histology
o Excellent prognosis is seen in crescentic GN
Excellent prognosis is seen in crescentic GN
What is FALSE regarding diabetic glomerulosclerosis:
o It is an uncommon cause of renal failure in the US
o It is associated with 20% of deaths with type I DM
o Glomerular lesions are called Kimmelstiel-Wilson
o Associated with proteinuria and nephrotic syndrome
o Proteinuria and urine microalubumin is earliest clinical manifestation of renal
failure in diabetes patients
It is an uncommon cause of renal failure in the US
Which of the following statements regarding myeloma kidney is FALSE:
o Renal dysfunction occurs in 50%
o Renal dysfunction has an excellent treatable prognosis
o You see amyloid deposition
o Renal dysfunction is due to Bence-Jones protein
o Bence-Jones proteins are monoclonal light chains that overwhelm the kidney
Renal dysfunction has an excellent treatable prognosis
Which of the following regarding acute tubular necrosis is FALSE:
o Reversible destruction of tubular cells
o Ischemic, nephrotic, and non-oliguric ATN types exist
o There are 3 phases: initiating, maintenance, and recovery
o Urinalysis shows epithelial or epithelial-type casts
o It is an uncommon cause of renal failure
o It is potentially treatable
It is an uncommon cause of renal failure
Potential causes of acute pyelonephritis:
o Bacterial UTI through ascending route o Vesicouretal reflux o Spinal cord injuries o Intrarenal reflux with o All of the above
All of the above
Different entities of acute pyelonephrtitis:
Proteus is the one he’s seen most often but E. coli is most common;
Porteus is the one causing protein splitting struvite triple phosphate stones
What is FALSE regarding interstitial nephritis:
o Associated with PCN, rifampin, thiazides, phenylbutazone, cimetidine o Onset 15 days after exposure o S/S=rash, proteinuria, eosinophilia o Treatment is to stop the drug o Always dose related
Always dose related
Which of the following is true of malakoplakia:
o All of the above
o Associated w/ transplants
o Defective macrophage
o Can look like tumors (foamy histiocytes)
All of the above
Which of the following is FALSE with pre-eclampsia:
o Granular kidney with atherosclerotic change
o Onion skinning
o It’s a pregnancy induced disease
o 5-7 percent of first pregnancies
o Shows up around gestational week 20 or greater
o Affects women at extremes of reproductive age
o It causes endothelial vascular coagulation necrosis
o It has a poor prognosis and is almost uniformly fatal
It has a poor prognosis and is almost uniformly fatal
What is true of angioliomypoma:
o It’s a malignant tumor
o It’s histological replacement of renal pole parenchyma with foamy histiocytes
o Related to polyoma virus
o Caused by alterations in TSC2/PKD1 gene
Caused by alterations in TSC2/PKD1 gene
Angioliomypoma is associated with:
Tuberous Sclerosis (TSC2/PKD1 gene)
What is FALSE of metanephric adenoma:
o It is a very common tumor o 40-50% are incidental o 2/3rd are female o Typically benign o Associated w/ P. vara paraneoplastic syndrome
It is a very common tumor
What are the incidental features of metanephric adenoma:
hemorrhage
necrosis
calcifications (psamomma bodies)
cysts
What is FALSE regarding oncocytomas:
o Composed of uniform polygonal cells with granular eosinophilic cytoplasm o 4-7% of adult renal neoplasm o 2/3 male o May be incidental o May coexist with renal cell cancer o It is malignant 75% of the time
It is malignant 75% of the time
What is FALSE regarding Birt-Hogg-Dube syndrome:
o Associated with 17p12q11 abnormality
o See follicular lesions on face
o Associated with multiple renal tumors (usually chromophobe carcinomas or
oncocytomas)
o It is a very common autosomal recessive syndrome
It is a very common autosomal recessive syndrome
What is FALSE regarding papillary adenoma/adrenal cortical adenoma:
o Low grade neoplasm commonly found on autopsy
o Multiple adenomas can be associated with papillary renal cell
o WHO classification of a benign tumor is >1 cm
WHO classification of a benign tumor is >1cm
Which statement regarding renal cell carcinoma is INCORRECT:
o Usually seen in patients over 50
o 2/3 male
o 1% are bilateral
o Metastasis show lung, bone, lymph node
o Cure is possible even with extension into renal vein
o Excision of solitary metastasis can be very effective
o Metastasis are almost never seen late
Metastasis are almost never seen late
46) Which of the following is true regarding acquired cystic renal disease of the
kidney associated with renal cell carcinoma:
o Unique morphology characterized by papillary, solid, eosinophilic and clear
cell-like areas
o Occurs in 35% of long term dialysis patient
o Grossly it is a dominant mass
o Can be very subtle
o All of the above
All of the above
Which of the following is not a familial renal cell carcinoma:
o Von-Hippel Lindau o Clear cell cancer o Hereditary papillary o Britt-Hogg-Dube o Tuberous Sclerosis o All of them are familial
All of them are familial
Which of the following is NOT true of the rhabdoid variant of clear cell carcinoma:
o A distinct histological entity in children but in adults it is merely descriptive
o Usually presents with abdominal mass
o Often high stage high grade, median survival is about 8 months
o Lymph node metastasis
o Seldom seen in children
Seldom seen in children
Which of the following regarding translocation renal cell is true:
o Renal cell carcinoma with papillary growth pattern o Also called xp-11 translocation o It is aggressive o 80% women o All of the above
All of the above
Which of the following statements regarding collecting duct cancer is FALSE:
o It is aggressive o Epithelial malignancy o Less than 1% adult renal tumors o Diagnosis of exclusion o Presents with hematuria o It has an excellent prognosis
It has an excellent prognosis
Which of the following regarding sarcomatoid renal cell cancer is FALSE:
o Also called spindle cell cancer
o A clear and distinct histological cancer
o 5% of all renal cells have some component
o High metastasis and aggressive
A clear and distinct histologic cancer
Which of the following statements regarding clear cell carcinoma of the kidney is
INCORRECT:
o Mean age of dx is 36 months
o It’s a common pediatric disease (53% of all pediatric malignancies)
o Molecular changes are a translocations of 10;17
o Interstitial deletions of 14
o Frequent recurrence and relapse with metastasis to bone
o Highly aggressive but highly responsive to treatment
It’s a common pediatric disease (53% of all pediatric malignancies)
What is FALSE regarding neuroblastoma:
o Most common tumor before age 1
o Causes 15% of all childhood cancer deaths
o Tumors never regress or mature
o Associated with Hirschsprung’s disease and neurofibromatosis
o Metastases are usually early and widespread
Tumors never regress or mature
What is true of rhabdoid tumor of infancy:
o Very aggressive renal cancer o 1-2% of childhood cancers o Usually stage 2 or higher o Often bilateral o All of the above
All of the above
Which of the following is NOT a feature of the WAGR syndrome:
o Associated with Wilm’s Tumor o Aniridia o Genitourinary abnormalities o Mental retardation o Not usually associated with 11p13 deletion
Not usually associated with 11p13 deletion
Which of the following is INCORRECT regarding staging of pediatric renal cancers:
He said he just copy pasted the first 4 stages as choice A, B, C, D but
didn’t list 5, so its either going to be an “ALL OF THE ABOVE” or the
answer will have something talking about stage 5 not being there
