Renal Gross Anatomy and Pathology

Question 1

What does chronic kidney disease tend to do to the gross size of the kidney?

Answer 1

CKD -> smaller kidneys

Question 2

What is the normal surface of the kidney (under the capsule) like?
What if it’s not normal?

Answer 2

Smooth = normal.

Finely granular surface = longstanding disease.

Question 3

Scars in the renal cortex are suggestive of…

Answer 3

Infarcts, be they large or small.

Question 4

Where in the kidney are scars associated with reflux typically located?

Answer 4

At the poles

Question 5

Multiple irregular yellow patches on a kidney?

Answer 5

Probably infection with bacteria or fungi.

Question 6

If you see cortex with variegated color including occasional dark spots, what might it be?

Answer 6

Petechial bleeds, e.g. from DIC.

Question 7

How is cortical thickness often altered in CKD?

Answer 7

It becomes thinner in CKD

Question 8

Say you see a kidney with a bunch of cysts, what helps differentiate between ADPKD (autosomal dominant polycystic kidney disease) and ESRD + dialysis?

Answer 8

In ESRD + dialysis, the kidneys are usually smaller.

Question 9

Most common cancer of kidneys?

Answer 9

Renal cell carcinoma.

he showed one associated with VHL defect -> von Hippel-Lindau disease

Question 10

What causes hydronephrosis?

Answer 10

Obstructions to urine outflow anywhere after the collecting duct -> dilated calcyces and thinned cortex.

Question 11

Brief description of normal glomerular capillary appearance in histology?

Answer 11

Open, relatively unifom capillary loops with a thin basement membrane.

Question 12

What does silver staining highlight in the glomerulus?

Answer 12

Basement membrane and mesangium

Question 13

What do normal tubules in the cortex look like?

Answer 13

Uniform, back-to-back tubules (there’s very little interstitium)

Question 14

Normal arteriole appearance?

Answer 14

Thin walls, no eosinophils

Question 15

What does immunofluorescence in the glomerulus light up?

okay, I guess it could be anything you make an antibody against… but for the most common diagnostic purposes…

Answer 15

IgG, IgA, IgM, and components of complement.

Question 16

What different processes does granular and linear immunofluorescence patterns in the capillary loops of the glomerulus suggest?

Answer 16

Granular: immune complex deposition
Linear: Abs against the glomerular basment membrane (can also be immune complexes)

Question 17

2 processes that EM really helps you see in the glomerulus?

Answer 17

If the podocyte foot processes are intact.

Electron-dense deposits.

Question 18

Review: What’s between podocyte foot processes? What’s a protein there to remember?

Answer 18

Slit diaphragms.

Nephrin is there (with lots of other things)

Question 19

3 compartments of the glomerulus that can have hypercellularity?

Answer 19

Capillaries -> “endocapillary proliferation”
Mesangium.
Epithelium (podocytes) -> crescentic proliferation.

Question 20

What does segmental vs. diffuse hypercellularity refer to?

Answer 20

Segmental: only part of affected glomeruli is affected.
Diffuse: all of that compartment is affected.
(applies to hypercellularity, sclerosis, etc.)

Question 21

Can glomerular necrosis disrupt the basement membrane?

Answer 21

Sure can.

Question 22

Describe how necrosis in the tubular compartment appears on H&E?

Answer 22

Anuclear eosinophilic debris in the tubules;

Question 23

Interstitial inflammation and interstitial edema look like what you’d expect them to look like.

Answer 23

Indeed they do, with increased space between the tubules - loss of “back to back” appearance.

Question 24

What do you call it when you can no longer see individual foot processes on the GBM?

Answer 24

Effacement.

This is highly correlated with proteinuria

Question 25

What’s a common underlying cause of a really thick GBM?

Answer 25

Diabetes mellitus

Question 26

What helps you make sense of electron dense deposits that you see in EM?

Answer 26

Determine which compartment they’re in.