Renal and Urological Pathology

Question 1

what is nephritis and what are the 2 types?

Answer 1

inflammation of the kidney
infective (e.g pyelonephritis)
non-infective (glomerulonephritis)

Question 2

what holds the glomerulus together?

Answer 2

mesangial cells between capillaries

visceral and parietal epithelium

Question 3

what is glomerulonephritis and what are the main groups?

Answer 3

inflammation in the glomerulus

• immune mediated (immune complexes in the glomerulus either due to immune complexes being directed at glomerulus or caused by circulating complexes getting stuck in the sieve of the glomerulus)
• related to vasculitis

Question 4

features of glomerulonephritis due to direct attack on glomerulus?

Answer 4

IgG antibodies against subunit of collagen

- good pastures syndrome

Question 5

causes of circulating immune complexes?

Answer 5

infection (hepatitis, HIV, strep)
drugs (gold, penicillamine)
cancer (any but most often lymphomas)

Question 6

what vasculitis can cause glomerulonephritis and what are the antibody markers?

Answer 6

GPA = cANCA
MPA = pANCA

Question 7

how do immune complexes cause issues?

Answer 7

they get stuck in the glomerulus sieve and clog it up, stopping it from working
disrupt the membrane charge and block membranes etc

Question 8

what are nephrotic and nephritic syndrome?

Answer 8

clinical description of symptoms

no information about underlying cause

Question 9

features of nephritis syndrome?

Answer 9

hypertension

haematuria

Question 10

features of nephrotic syndrome?

Answer 10

heavy proteinuria
non-dependant oedema
hyperlipidaemia

Question 11

protein loss includes loss of what?

Answer 11

antibodies
complement
proteins in clotting cascade

Question 12

how is cause of glomerulonephritis diagnosed?

Answer 12

light microscopy
electron microscopy
immunoflouresence

Question 13

what histological features can indicate rapidly progressive glomerulonephritis?

Answer 13

crescents

Question 14

3 examples of granuloma causing disease in the kidney?

Answer 14

GPA

sarcoidosis

Question 15

what might be seen on light microscopy in GMN?

Answer 15

hypercellularity (inflammatory cells, reactive proliferants)
sclerosis
crescents (if bad)
may see sarcoid etc if systemic disease

Question 16

hat might be seen on electron microscopy in GMN?

Answer 16

deposits in basement membrane

• subepithelial
• mesangial
• subendothelial

Question 17

what can immunofluorescence show?

Answer 17

what kind of antibody

e.g - linear IgG at basement membrane in good pastures disease

Question 18

what is minimal change disease?

Answer 18

type of glomerulonephritis with no known cause

Question 19

how does minimal change present?

Answer 19

puffy face in children(nephrotic)
barely any changes on investigation
usually resolves with steroids

Question 20

hat is FSGS?

Answer 20

type of GMN which can result from obesity, HIV, sickle cell, IV drug use

Question 21

how does FSGS present?

Answer 21

nephritic adults

only a small area of sclerosis in some glomeruli (not all)

Question 22

what is membranous?

Answer 22

type of GMN which causes thickened basement membrane

Question 23

what causes membranous?

Answer 23

infection (hepatitis, malaria, syphilis)
drugs (penicillamine, NSAIDs, captopril, gold)
malignancy
lupus
autoimmune disease

Question 24

presentation of membranous?

Answer 24

nephrotic syndrome
thick membranes
sub-epithelial immune deposits
variable prognosis

Question 25

what causes IgA GMN?

Answer 25

genetic acquired defect - coeliac (as already have circulating IgA) usually occurs post infection (strep)

Question 26

how does IgA GMN present?

Answer 26

nephritic "smokey urine after strep infection" IgA deposition in mesangium

Question 27

what causes membranoproliferative GMN?

Answer 27

idiopathic | type 2 = infection, lupus, malignancy (lymphoma)

Question 28

how does membranoproliferative present?

Answer 28

tram tracks - big lobulated hypercellular glomeruli with thick memrbanes (duplicated membranes) can be nephritic or nephrotic

Question 29

ow does diabetes affect the kidney?

Answer 29

diffuse and nodular glomerulosclerosis kimmel steil Wilson lesion (nodules) microvascular disease (arterial sclerosis) infection (pyelonephritis, papillary necrosis)

Question 30

what is cystic disease?

Answer 30

variety of congenital, inherited and acquired cysts | can predispose to development of cancers

Question 31

how can cancer risk of a lesion be predicted?

Answer 31

bosniak score

Question 32

what are acquired cysts>

Answer 32

benign, degenerative change in kidneys very common often associated with long term dialysis simple cysts

Question 33

what are the types of polycystic kidneys?

Answer 33

AD | AR

Question 34

what is ADPCKD?

Answer 34

autosomal dominant polycystic kidney disease due to mutation in nephrin gene (Chromosome 16 or 4) causes lots and lots of simple thin walled cysts to develop in kidneys over time causing kidney to become huge

Question 35

secondary changes in ADPCKD?

Answer 35

haemorrhage infection rupture

Question 36

how can ADPCKD present?

Answer 36

large kidney - presents with mass like lesion pain, haematuria due to rupture, infarction etc systemic disease (liver cysts and cerebral aneurysms)

Question 37

escribe kidneys in ARPCKD?

Answer 37

kidney is normal size and has smooth surface (would hardly know there were cysts)

Question 38

how does ARPCKD present?

Answer 38

``` usually in childhood (more dangerous the younger age at presentation) systemic issues (liver cysts) ```

Question 39

what infection can commonly be mistaken for a malignancy in the kidney?

Answer 39

xanthogranulomatous pyelonephritis

Question 40

main benign renal tumour?

Answer 40

oncocytoma

Question 41

main malignant renal tumours?

Answer 41

chromophobe clear cell papillary collecting duct

Question 42

describe features of oncocytoma?

Answer 42

small, oval and well circumscribed mahogany brown with central stellate star cytoplasm is very pink and granular cytoplasm

Question 43

what is a chromophobe carcinoma?

Answer 43

uncommon malignancy in the kidney | look very similar to oncocytoma but have raisonoid nuclei and perinuclear haloes

Question 44

2nd most common renal cancer?

Answer 44

papillary | generally low grade and fairly easy to remove

Question 45

what do papillary carcinomas look like?

Answer 45

finger like projections

Question 46

what is the least common renal tumour and describe prognosis

Answer 46

collecting duct carcinoma | high grade with poor prognosis

Question 47

what is the most common renal cancer and how does it present?

Answer 47

clear cell carcinoma haematuria mass hypertension sometimes

Question 48

risk factors for clear cell carcinoma?

Answer 48

obesity | genetic influence

Question 49

what does clear cell carcinoma look like?

Answer 49

very yellow surface partly cystic and very heterogenous surface presence of clear cells

Question 50

how is clear cell carcinoma staged?

Answer 50

size then invasion of other structures (usually renal vein)

Question 51

where can cell carcinomas often invade?

Answer 51

grow into renal vein, up into IVC and grow up towards the heart

Question 52

what genotype is associated with renal cancers and why?

Answer 52

VHL VHL codes for HIF (hypoxia inducible factor) normally VHL ubiquitinates HIF (inactivates it by adding ubiquinate) in low O2 they dissociate and HIF acts as a transcription factor for VEGF, PDGFRB and EPO