Renal Disorders Flashcards
Unilateral multicystic renal dysplasia
- MCC of abd mass in newborns
* Remove affected kidney
ADPKD
- Manifests in 30s
- Bilateral, cystic parenchyma w/ enlarged kidneys
- Hepatic cysts and cerebral aneurysms also common
ARPKD
- Extremely large, smooth kidneys w/ fibrosis
- Many die from pulmonary hypoplasia
- Hepatic fibrosis also common
Minimal change disease
- Children
- Causes nephrotic syndrome
- Effacement of podocytes
- Excess lipids deposit as hyaline droplets in tubular epithelial cells
- Often resolves with steroids
Focal segmental glomerulosclerosis
- Causes nephrotic syndrome
- Capillaries obliterated by ECM or accumulated cells
- Sclerotic segments show IgM and C3 under IF
- May be caused by pamidronate
- HIV can cause rapid variant of this disease
Membranous glomerulonephritis
- Whites and Asians
* Subepithelial immune complex deposition in glomerular capillaries
Nephronophthisis/medullary cystic disease
- Nephronophthisis: childhood-adolescence
- MCD: adolescence-adulthood
- Cysts at corticomedullary jxn, atrophic tubules with thick basement membranes
- Salt wasting, azotemia, renal failure
Medullary sponge kidney
- Epithelium-lined cysts in papillae
* Sx at age 30-60; flank pain, dysuria, hematuria, “gravel” in urine (stones from cysts)
Diabetic glomerulosclerosis
- Basement membrane thickening, mesangium expansion, Kimmelstiel-Wilson nodules, hyaline accumulations along capillaries
- IgG and other proteins trapped linearly in GBM
Amyloidosis
- AA amyloid most common, assoc. w/ chronic inflammation
- Eosinophilic, Congo red stain
- Deposits in mesangium, then capillary walls
Alport syndrome (hereditary nephritis)
- Type IV collagen mutation
- Also causes hearing loss
- Glomerular sclerosis, tubular atrophy, interstitial fibrosis, foam cells, thick GBM
Postinfectious glomerulonephritis
- After beta-hemolytic strep or staph infections
- Complement-rich IC deposits in glomeruli
- “Humps” (subepithelial dense deposits)
Membranoproliferative glomerulonephritis
- Late childhood/early adulthood
- Glomeruli distorted by monocyte infiltration and mesangial cell proliferation; cap wall and GBM thickening
- Granular deposits of complement (and sometimes Ig) in cap loops and mesangium
C3 glomerulopathy
- Mostly children
- “Dense deposit disease”
- Ribbon-like zone of increased density in center of GBM and mesangium
IgA nephropathy
- Exacerbations triggered by resp or GI infections
- IgA deposits in mesangium
- Occurs w/ Henoch-Schönlein purpura
Anti-GBM Ab disease
- Abs versus type IV collagen in GBM
- With lung involvement: Goodpasture syndrome
- Diffuse linear GBM staining for IgG
- Crescents, fibrinoid necrosis common
- Rapid progression
ANCA glomerulonephritis
- Glomerular necrosis and crescents
* Often presents with small-vessel vasculitis
Hypertensive nephrosclerosis
- Small kidneys with granular surfaces, thin CTX
* Hyaline arteriolosclerosis
Renal artery HTN
- Increased renin, angiotensin II, aldosterone
* Small kidneys
Hemolytic uremic syndrome
- Children
- E. coli GI infections
- Thrombotic microangiopathy
Drug-induced hypersensitivity tubulointerstitial nephritis
- Type IV hypersensitivity w/ eosinophils
* NSAIDs, diuretics, some Abx
Light-chain cast nephropathy
- Multiple myeloma
- Hyaline, crystalline casts in distal tubule + collecting duct
- Interstitial Ca deposits
Urate nephropathy
- Chronic: gout
- Acute: increased cell turnover from chemo, diuretics
- Uric acid crystals (yellow streaks) obstruct tubules
Kidney stones
- Infection from Proteus or Providencia spp. creates stones from struvite (magnesium ammonium phosphate) or apatite (calcium phosphate); may become staghorns
- Uric acid stones: yellow and radiolucent
- Cystine stones: hereditary cystinuria in children
Papillary renal adenoma
- Increased incidence with age
* Papillary growth
Renal oncocytoma
- Derived from collecting duct intercalated cells
* Abundant, finely granular cytoplasm
Medullary fibroma
- Common, small
* Small stellate or polygonal cells in loose stroma
Angiomyolipoma
- Strong association with tuberous sclerosis
* Adipose tissue, smooth muscle, thick-walled vessels
Mesoblastic nephroma
- Found in infancy
* Spindle cells; mass with irregular margins
Wilms tumor
- Children
* Large tumors with mixed blastema, stroma, epithelium; possibly other components
Renal cell carcinoma
- Middle age, men > women
- Common
- Can be associated w/ VHL
- Often produces ectopic hormones and paraneoplastic syndromes (PTH-like hormone, erythropoietin, renin)
