Renal Gross Anatomy and Pathology Flashcards
What does chronic kidney disease tend to do to the gross size of the kidney?
CKD -> smaller kidneys
What is the normal surface of the kidney (under the capsule) like?
What if it’s not normal?
Smooth = normal.
Finely granular surface = longstanding disease.
Scars in the renal cortex are suggestive of…
Infarcts, be they large or small.
Where in the kidney are scars associated with reflux typically located?
At the poles
Multiple irregular yellow patches on a kidney?
Probably infection with bacteria or fungi.
If you see cortex with variegated color including occasional dark spots, what might it be?
Petechial bleeds, e.g. from DIC.
How is cortical thickness often altered in CKD?
It becomes thinner in CKD
Say you see a kidney with a bunch of cysts, what helps differentiate between ADPKD (autosomal dominant polycystic kidney disease) and ESRD + dialysis?
In ESRD + dialysis, the kidneys are usually smaller.
Most common cancer of kidneys?
Renal cell carcinoma.
he showed one associated with VHL defect -> von Hippel-Lindau disease
What causes hydronephrosis?
Obstructions to urine outflow anywhere after the collecting duct -> dilated calcyces and thinned cortex.
Brief description of normal glomerular capillary appearance in histology?
Open, relatively unifom capillary loops with a thin basement membrane.
What does silver staining highlight in the glomerulus?
Basement membrane and mesangium
What do normal tubules in the cortex look like?
Uniform, back-to-back tubules (there’s very little interstitium)
Normal arteriole appearance?
Thin walls, no eosinophils
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…
IgG, IgA, IgM, and components of complement.
What different processes does granular and linear immunofluorescence patterns in the capillary loops of the glomerulus suggest?
Granular: immune complex deposition
Linear: Abs against the glomerular basment membrane (can also be immune complexes)
2 processes that EM really helps you see in the glomerulus?
If the podocyte foot processes are intact.
Electron-dense deposits.
Review: What’s between podocyte foot processes? What’s a protein there to remember?
Slit diaphragms.
Nephrin is there (with lots of other things)
3 compartments of the glomerulus that can have hypercellularity?
Capillaries -> “endocapillary proliferation”
Mesangium.
Epithelium (podocytes) -> crescentic proliferation.
What does segmental vs. diffuse hypercellularity refer to?
Segmental: only part of affected glomeruli is affected.
Diffuse: all of that compartment is affected.
(applies to hypercellularity, sclerosis, etc.)
Can glomerular necrosis disrupt the basement membrane?
Sure can.
Describe how necrosis in the tubular compartment appears on H&E?
Anuclear eosinophilic debris in the tubules;
Interstitial inflammation and interstitial edema look like what you’d expect them to look like.
Indeed they do, with increased space between the tubules - loss of “back to back” appearance.
What do you call it when you can no longer see individual foot processes on the GBM?
Effacement.
This is highly correlated with proteinuria
What’s a common underlying cause of a really thick GBM?
Diabetes mellitus
What helps you make sense of electron dense deposits that you see in EM?
Determine which compartment they’re in.
