Renal and Urological Pathology Flashcards
what is nephritis
inflammation of the kidney
2 types of nephritis
infective - pyelonephritis
non-infective -glomerulonephritis
what holds together the glomerulus
mesangial cells
what is glomerulonephritis
inflammation in the glomerulus
what are the main causes of glomerulonephritis
Immune mediated
related to vasculitis
how does immune mediated causes cause glomerulonephritis
Direct attack of the glomerulus
Caused by circulating complexes getting stuck in the sieve
what blood tests would suggest immune glomerulonephritis
IgG antibodies against a sub unit of collagen
-goodpastures syndrome
what can trigger an immune response leading to complexes ending up in the glomerulus
Infection - hepatitis, viruses, bacteria, HIV
Drugs - Gold, Penicillamine
Cancer - often lymphomas
what vasculitis can cause glomerulonephritis
Granulomatosis with polyangitis
microscopic polyangitis
what type of vasculitis is associated with cANCA
granulomatosis with poly angitis
what type of vasculitis is associated with pANCA
Microscopic polyangitis
what are nephritic/nephrotic syndromes
a collection of symptoms!! - tells you how the patient is presenting
gives no information about underlying cause at all
what do patients with nephritic syndrome present with
haematuria
hypertension
what do patients with nephrotic syndrome present with
heavy proteinuria
non-dependent oedema
hyperlipidaemia
what is lost with proteinuria
proteins - antibodies, complement and proteins in clotting cascade
what 3 investigations do you do in glomerulonephritis
light microscopy
electron microscopy
immunoflouresence
what are crescents
are bad
indicate rapidly progressive disease
suggest glomerulonephritis
what does granulomas in a renal biopsy suggest
Granulomatosis with polyangitis
Sarcoid
what do you usually see on light microscopy in glomerulonephritis
hypercellularity (inflammatory cells and reactive proliferations)
sclerosis -on going damage
crescents - this is bad
may see vasculitis or systemic disease (sarcoid)
what does electrommicroscopy look at in glomerulonephritis
the basement membrane
allows you to see if there are deposits and usually where they are. usually either:
- subepithelial
- mesangial
- subendothelial
what does immunofluorescence show in glomerulonephritis
what kind of antibodies are involved and what kind of distribution
what does immunofluorescence show in good pasture’s syndrome
linear IgG deposits
what is minimal change disease
type of glomerulonephritis seen in kids
present with NEPHROTIC syndrome
most common cause of glomerulonephritis in kids
how do you treat minimal change disease
steroids
what is focal segmental glomerulosclerosis
type of glomerulonephritis caused by:
- obesity
- HIV
- sickle cell
- IV drugs
Presents with NEPHRITIC symptoms
what does FSGS look like on electron microscope?
glomerular sclerosis
focal and segmental
duh
what is membranous glomerulonephritis caused by
Infection (hepatitis, malaria, syphilus)
Drugs (penicillamine, NSAID, captopril, gold)
Malignancy (Lung, colon, melanoma)
Lupus -15% of all GMN in lupus
Autoimmune disease - thyroiditis
how does membranous glomerulonephritis present
adults
nephrotic
thich membranes, sub-epithelial immune deposits
less than 40% develop renal failure
silver stain
shows basement membrane
looks spikey when there are immune complexes
what causes IgA GMN
Genetic acquired defect -Coeliac (do anti-TTG test)
people get it post infection
what does IgA GMN look like
IgA deposition in mesangium
what is membranoproliferative GMN
idiopathic cause or can get type 2 from infection/lupus/malignancy
adults and children get it
presents with either nephritic or nephrotic
how does membranoproliferative GMN present
big lobulated hyper cellular glomeruli with thick membranes
instead of 1 line theres 2
tram tracks
how does diabetes affect the kidney
diffuse and nodular glomerulosclerosis
nodules (Kimmel Stiel Wilson Lesion)
microvascular disease - arterial sclerosis
infection - pyelonephritis, papillary necrosis
what are cystic kidney diseases
Variety of congenital, inherited and acquired cysts
lot of early cancers are cystic so be careful
what score predicts risk of cancer with kidney cysts
Bosniak score
what are acquired cysts
v common benign cysts
often associated with long term dialysis
simple cysts
what are the 2 main subtypes of polycystic kidneys
Autosomal dominant PCKD
Autosomal recessive PCKD
what is ADPCKD
Due to a mutation in nephron
lots and lots of cysts present over time
kidney can become huge
what lines cysts in ADPCKD
simple epithelium
what secondary pathology can be seen in ADPCKD
haemorrhage
infaction
rupture
symptoms of ADPCKD
size of kidney - present with mass like lesion
pain
haematuria due to rupture
systemic disease - associated with sub arachnoid haemorrhage
when does ARPCKD present
in childhood
what do kidneys look like in ARPCKD
normal size of kidney with a smooth surface
what worsens the prognosis of ARPCKD
the younger you present with it
what infection can cause a mass that is commonly mistaken for a tumour
xanthogranuomatous pyelonephritis
what is the benign kidney tumour u should know about
oncocytoma
what malignant kidney tumours should you know about
chromophobe
clear cell
papillary
collecting duct
what does an oncocytoma look like
small
oval
well circumscribed
mahogany brown with central stellate scar
there is a v pink and granular cytoplasms in the cells
what does a chromophobe look like
looks like oncoytoma but with raisonoid nuclei and perinucler halos
uncommon
what is the 2nd most common renal cancer
papillary
what does papillary renal cancer look like
papillary finger like projections
generally low grade
what is collecting duct carcinoma
v bad malignant tumour
least common
poor survival
what does collecting duct carcinoma look like
high grade appearance with a very sesmoplastic stroma
what is the most common renal cancer
Clear cell carcinoma
what are the risk factors from clear cell carcinoma
obesity ++
genetic influence
how does clear cell carcinoma present
haematuria
mass
hypertension
what does clear cell carcinoma look like
macro
often partly cystic
heterogenous surface
BRIGHT YELLOW tumour surface
(clear cell -d’oh yellow like simpsoms)
how do you stage clear cell carcinoma
size
invasion of other structures
what type of cancer tends to protrude into the renal vein
clear cell carcinoma
-can go all the way to the heart
what mutation is most common causing sporadic renal cancers
VHL - codes for HIF which is associated with hypoxia
what happens when there are mutations in the TCA cycle
renal cancers
