Renal Histopath Flashcards
Triad of nephrotic syndrome
Proteinuria > 3g/ day Oedema (also have dys/hyperlipidaemia (liver)) Hypoalbuminaemia
Nephrotic syndrome oedema pattern (1)
Starts peri orbitally
Minimal change disease: epidemiology, Light micrscopy (1), Electron microscopy (1), immunofluorescence (1), response to steroids (1), Prognosis (1)
Most common in children - 75% rest elderly
no changes on light microscopy
Electron microscopy - loss of podycyte foot processes
IF - no deposits
Response to steroids - 90% Prognosis -<5% ESRF
Membranous glomerular disease: epidemiology, Light micrscopy (1), Electron microscopy (2), immunofluorescence (2), response to steroids (1), Prognosis (1)
Common in adults
Diffuse GBM thickening
EM - loss of podocyte foot processes, subepithelial deposits (spikey)
IF - Ig & complement in granular deposits along GBM
Poor response to steroids 40% get ESRF after 2-20 yrs
Focal segmental glomerulonephritis: epidemiology, Light micrscopy (3), Electron microscopy (1), immunofluorescence (2), response to steroids (1), Prognosis (1)
Common in afro-carribean
LM - Focal & segmental glomerular consolidation + scarring, + hyalinosis (change in tissue to less functional/lower form)
EM - loss of podocyte foot processes
IF - Ab + complement in SCARRED areas 50% respond to steroids 50% ESRF in 10 yrs can be secondary to obesity HIV nephropathy
What are secondary causes of nephrotic syndrome? (2)
Diabetes
Amyloidosis
Nephrotic syndrome secondary to diabetes: histology (2)
Diffuse GBM thickening
Mesangial matrix nodules - KIMMELSTIEL WILSON NODULES (usually asian)
Nephrotic syndrome secondary to amyloidosis: histology (1)
APPLE GREEN BIREFRINGENCE with CONGO red stain
Nephrotic syndrome secondary to amyloidosis: + hints in question (6)
May have chronic inflammation: RA
May have chronic infection: TB - causes AA protein deposition
May have Ig light chain deposition from multiple myeloma (AL protein deposition)
Clinical clues for amyloidosis - Macroglossia, HF, hepatomegaly
Pathology of acute tubular injury (ATI)/ ATN (4) (the most common cause for ARF)
Damage to tubular epithelial cells Blockage of tubules by casts Reduced flow + haemodynamic changes ARF
Causes of ATN (5)
Ischaemia - burns, septicaemia Nephrotoxins - drugs (NSAIDs, gentamicin), radiographic contrast agents, heavy metals, myoglobins
Histopathology of ATN (1)
necrosis of short segments of tubules
Acute pyelonephritis: most common causative pathogen (1) Presentation (8), What is seen in urine (1)
Bacterial infection of kidney due to ascending infection by E. coli. Presentation: fevers, chills, flank pain, renal angle tenderness, dysuria, haematuria Leukocytic casts are seen in urine
Chronic pyelonephritis & reflux nephropathy: what is it? Causes (3)
Inflammation + scarring of the parenchyma due to recurrent & persistent bacterial infection Causes: obstruction - posterior urethral valves, renal calculi Urine reflux - reflux nephropathy
What is acute interstitial nephritis?
A hypersensitivity rxn, usually to a drug (abx, NSAIDS) Usually begins days post exposure
Acute interstitial nephritis presentation (5)
Eosinophilia, haematuria, fever, skin rash, proteinuria
Chronic interstitial nephritis/ analgesic nephropathy, cause (1) & symptoms (4)
Usually in elderly due to chronic use of NSAIDs symptoms (occur late in disease): haematuria, proteinuria, HTN, anaemia
What is ARF?
Rapid loss of renal function manifesting as increased Urea & creatinine
Pre-renal causes of ARF ( 3) (most common cause of ARF)
Renal hypo perfusion - sepsis, hypovolaemia, burns, renal artery stenosis, acute pancreatitis
Renal causes of ARF (3)
ATN - most common renal cause Acute GN thrombotic microangiopathy
Post renal causes of ARF (4)
Obstruction - stones, tumours, prostatic hypertrophy, retroperitoneal fibrosis
What is CRF?
Progressive, irreversible loss of renal function + symptoms of uremia - itching, anorexia, fatigue & confusion if severe
Commonest causes of CRF in UK (5) (in order)
Diabetes GN HTN Reflux nephropathy Polycystic kidneys
5 Stages of CRF
Stage 1 - kidney damage + normal renal function (proteinuria may be there) GFR > 90 Stage 2- mildy impaired; GFR 60-89 Stage 3 - moderately impaired; GFR 30-59 Stage 4 - severely impaired; GFR 15-29 Stage 5 - renal failure
