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System Path II > Renal/Male > Flashcards

Renal/Male Flashcards

1
Q

normal histology of glands of prostate?

A

inner layer of luminal cells and outer layer of basal cells

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2
Q

19 year old male presents with dysuria, fever and chills. On DRE, prostate feels tender and boggy. Diagnosis? What will you see in prostatic secretions? Pathogenesis? What if the patient was 55?

A

WBCs and a +bacterial culture
in young adults: Chlamydia or Neisseria
in older men: E. coli or Pseudomonas

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3
Q

Male presents with dysuria and pelvic/low back pain. On exam of prostatic secretions you notice WBCs but cultures are negative. Diagnosis?

A

chronic prostatitis

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4
Q

BPH is very common condition. Do people usually show symptoms? What is the increased risk of carcinoma?

A

No, only 10% are symptomatic

0% risk of cancer, exception for hyperplasia

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5
Q

What enzyme is targeted in treatment of BPH? Why?

A

5-alpha reductase
converts testosterone to DHT in stromal cells which acts on androgen receptors of both stromal and epithelial cells -> hyperplasia

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6
Q

60 year old man presents with difficulty urinating, and frequently has to wake up to use the bathroom. Diagnosis? Two important complications?

A

BPH
increased risk of bladder infection
hydronephrosis

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7
Q

What are the effects of treating BPH with testosterone? Explain

A

testosterone itself does not aggravate BPH, it is thought that estrogen sensitizes the androgen receptors so they respond even with the natural decline in testosterone with age

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8
Q

On examination of the prostate you see inspissated secretions in the lumen of the glands. What is the name of this histology and what condition do you see it in?

A

Corpora amylacea of BPH

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9
Q

Are you more likely to see symptoms with BPH or adenocarcinoma of the prostate? why?

A

BPH, occurs periurethral leading to compression of the urethra and symptoms. Adenocarcinoma is usually found on the outside of the gland, and must become very large to cause symptoms

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10
Q

what is the advantage of treating BPH with transurethral resection as opposed to drugs?

A

Can sometimes find incidental signs of cancer on tissue exam after TURP

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11
Q

63 year old man presents complaining of difficulty maintaing a stream of urine and frequency. Microscopic hematuria is present and PSA levels are slightly elevated. Diagnosis? The resulting hypertrophy of the bladder wall can lead to an increased risk of what?

A

BPH

bladder diverticula

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12
Q

Prostate cancer is more common in what race? Is least common in what race? what kind of diet increases risk?

A

Blacks at highest risk
Asians at lowest risk
high fat diet

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13
Q

66 year old male has a family history with HPC1 and RNASEL genes. What is he at risk for?

A

prostatic adenocarcinoma

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14
Q

67 year old male presents with back pain, fatigue, weight loss, and dysuria. DRE reveals an irregular, nodular, firm prostate. Diagnosis? What is unique about grading?

A

Prostatic adenocarcinoma

Gleason grading system based on architecture NOT atypia like most cancers

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15
Q

What is important to do when taking a biopsy of the prostate?

A

Take multiple biopsies from many different locations

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16
Q

On a routine screening PSA test, you note a decreased % of free-PSA. Does this have a good or bad prognosis? Why?

A

bad, suggests cancer which makes bound-PSA

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17
Q

On biopsy of the prostate you notice glands are lined by a single layer of cuboidal epithelium that are missing outer basal layer of epithelial cells. Diagnosis? what is another important histological feature?

A

prostatic adenocarcinoma

back to black glands

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18
Q

You measure a PSAd to be >0.155. What is PSAd? What does this finding tell you?

A

PSAd = PSA density: ratio of the serum PSA to the volume of the prostate

PSAd > 0.125 is assoc with 80% chance of finding cancer

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19
Q

You notice one of your elderly male patient’s PSA levels have increased by .55ng/mL since last year. Should you be concerned?

A

No, but an increase in .75ng/mL/yr indicates prostate cancer

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20
Q

what is the difference between a Gleason score of 4/10 and 8/10? Which is better prognosis? What are you looking at to give a score?

A

the lower the score, the better the prognosis

you are looking at ARCHITECTURE not atypia!!

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21
Q

On biopsy of prostate you see small, invasive glands in a back to back arrangement. Diagnosis? what is the expected description of these cells nucleoli?

A

prostatic adenocarcinoma

darkly staining, prominent nucleoli

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22
Q

Reinke crystals are formed in what kind of cells?

A

Leydig cells in the testicular interstitium

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23
Q

1 year old infant presents with a nonpalpable testicle. Diagnosis? Which side is more common? Risk factor? How common?

A

Cryptorchidism
usually right sided
prematurity
1% of male infants

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24
Q

A male with an undescended testicle has surgery at the age of 6 to fix this condition. What is he at an increased risk for?

A

After the age of 5: sterility and seminoma

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25
Q

A male with an undescended testicle has surgery at the age of 18 months to fix this condition. What is he at an increased risk for?

A

Nothing, before age 2, no complications

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26
Q

A male with an undescended testicle has surgery at the age of 3 to fix this condition. What is he at an increased risk for?

A

After the age of 2: Infertility

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27
Q

an 18 month old male is noted to have obesity, short fingers, and mental retardation. Name of this condition? what is he at increased risk for?

A

Prader-willi syndrome

cryptorchidism

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28
Q

On examination of a testicle, you note a thickened basement membrane of the tubules, hyalinization, leydig cell hyperplasia, and tubular atrophy. What is the most likely cause of this histology? What age would the patient be?

A

Cryptorchidism

adolescent, hyalinization is not seen until this age

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29
Q

orchiopexy is what?

A

a surgery to correct cryptorchidism

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30
Q

What stimulates leydig cells to produce what?

A

LH stimulates them to produce testosterone

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31
Q

28 year old male presents with inflammation of his testes. What are the 2 most likely causative agents? At what age do these agents change and what do they change to?

A

Gonorrhea and Chlamydia
35
>35: E. coli and pseudomonas

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32
Q

19 year old male presents with inflammation of his testes. What is the name of this condition? would he complain about loss of libido? why or why not

A

Orchitis

no, leydig cells are not affected, testosterone levels would be normal, not affecting libido

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33
Q

Patient presents with testicles that have a “bag of blood” appearance. Diagnosis? Pathogenesis? Usual cause?

A

testicular torsion
spermatic cord twists, thin-walled veins are obstructed -> hemorrhagic infarction (blood can get in, but can’t get out)
Due to congenital failure of testes to attach to inner lining of the tunica vaginalis

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34
Q

18 year old male presents with sudden testicular pain and absent cremasteric reflex. Diagnosis?

A

testicular torsion

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35
Q

scrotal “bag of worms” - diagnosis? What is it? which side is more common? What is an important association? why?

A

Varicocele: dilated spermatic vein due to impaired drainage
left side more common, drains into left renal vein (right testicular vein drains directly into IVC)
assoc with renal cell carcinoma - likes to invade renal vein, blocks drainage of left testicular vein

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36
Q

incomplete closure of the processus vaginalis in infants can lead to what pathology?

A

hydrocele

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37
Q

blockage of lymph drainage of the testes in adults can lead to what? Can it be transilluminated?

A

hydrocele

yes, cysts can be, tumors cannot

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38
Q

testicular tumors are more common in what race?

A

whites

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39
Q

when should you biopsy a suspicious testicular mass? why?

A

Never! its usually cancer and you dont want to seed it

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40
Q

most common testicular tumor in children? 15-30? 30-50? >60?

A

children: teratoma and yolk sac
15-30: mixed germ cell tumor
30-50: seminoma
>60: lymphoma

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41
Q

2 types of testicular tumors? which is more common?

A 
germ cell (95%)
sex cord-stroma
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42
Q

Male presents with gynecomastia, unilateral mass in scrotum that cannot be transilluminated, and heaviness in the scrotum. Should you be concerned?

A

Yes, most solid masses in testicles are malignant

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43
Q

What are the 2 subdivisions of germ cell tumors of the testes?

A

seminoma

non-seminoma

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44
Q

Give the 5 divisions of non-seminoma germ cell tumors of the testes. Which is most common?

A 
embryonal carcinoma
yolk sac (endodermal sinus) tumor
choriocarcinoma
teratoma
mixed germ cell tumor (most common)
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45
Q

This testicular tumor has an excellent prognosis, metastasizes late, and is very responsive to radiotherapy?

A

seminoma

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46
Q

This testicular tumor is comprised of large cells with clear cytoplasm and central nuclei. Form a homogenous mass.

A

seminoma

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47
Q

This testicular tumor has immature, primitive cells that can produce glands. It is aggressive with early hematogenous spread - diagnosis? how to treat? complication of treatment?

A

embryonal carcinoma

chemotherapy - can result in differentiation to another type of mature germ cell tumor (teratoma)

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48
Q

Isochromosome 12p
OCT3/4
NANOG
c-KIT amplification

A

Seminoma

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49
Q

how do seminomas spread? non-seminomas?

how does treatment vary for these?

A

seminomas: lymph - radiotherapy

non-seminomas: blood and lymph - chemotherapy

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50
Q

which testicular tumor is associated with gonadal dysgenesis? what disease could cause this?

A

seminoma

Kleinfelter’s

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51
Q

testicular tumor with sheets of cells resembling fried eggs with lymphocytic infiltrate and fibrovascular septae - diagnosis? name 2 other conditions with identical pathology

A

seminoma
dysgerminoma in ovary
medullary breast carcinoma

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52
Q

This testicular tumor is associated with high levels of AFP. The cells have cytoplasmic pink inclusions with eosinophilc hyaline globules - diagnosis? what is characteristic on histo?

A 
Yolk sac (endodermal sinus) tumor
Schiller-Duval bodies
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53
Q

Schiller-Duval bodies are common in what testicular cancer? What do they look like?

A 
yolk sac (endodermal sinus) tumor
look like glomeruli from the kidney
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54
Q

19 year old male presents with signs of hyperthyroidism and gynecomastia. You notice a mass in his testicles that has small, painless nodules. Chest x-ray shows cannon-ball nodules in the lungs. Diagnosis? what is elevated in serum? explain his symptoms. prognosis?

A

Choriocarcinoma
elevated beta-hCG
alpha subunit of hCG acts similar to FSH, LH, and TSH
prognosis is poor

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55
Q

histo of a testicular tumor shows embryonic epithelial tissue and immature neuronal tissue. Diagnosis? how does the prognosis differ from that of a female?

A

teratoma

malignant in males after age 12, benign in females

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56
Q

if your testicular mass is hemorrhagic with signs of necrosis, what differential can you rule out?

A

seminoma

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57
Q

you find Reinke crystals on histo of a testes specimen. Diagnosis? should you be concerned?

A

Leydig cell tumor (sex cord-stromal tumor)

no, usually benign

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58
Q

pre-adolescent male presents with precocious puberty. you notice a non-transilluminated mass in his testicle. diagnosis? prognosis? how would this present differently in an adult?

A

leydig cell tumor (sex cord-stromal tumor)
good, usually benign
it produces androgens so it would lead to gynecomastia

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59
Q

65 year old male presents with a bilateral mass in his testicles that cannot be transilluminated. Diagnosis (specifically)?

A

diffuse large B-cell lymphoma

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60
Q

congenital malformation of the penis involving an abnormal positioning of the genital tubercle. Opening of the urethra on the dorsal surface. Diagnosis? how common?

A

epispadias, much less common than hypospadias

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61
Q

you notice bladder exstrophy of a newborn, what else would you expect to find?

A

epispadias

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62
Q

congenital malformation of the penis involving a failure of the urethral folds to close. Opening of the urethra on the ventral surface of the penis. Diagnosis? how common?

A

hypospadias, more common than epispadias

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63
Q

at what age do teratomas become malignant in males?

A

12, benign beforehand

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64
Q

male presents with balanitis. what is this? what is a predisposing condition?

A

non-specific infection of the glans (swollen and red)

uncircumcised males more at risk

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65
Q

phimosis - what is it? who is at risk? what causes it? increased risk of what (2)?

A

prepuce (foreskin) is too small to allow retraction of foreskin over penis. Uncircumcised males at risk, due to congenital anomaly or infection leading to scarring
inc risk of infection or cancer

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66
Q

paraphimosis - what is it? what does it cause? increased risk of what (2)?

A

happens when a phimotic prepuce is forcibly retracted over the glans leading to constriction, swelling, and pain
inc risk of UTI or necrosis of penis if severe enough and untreated

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67
Q

male presents with shiny, red plaque over glans of his penis - diagnosis? what is it? prognosis? what causes it?

A

Erythroplasia of Queyrat
in situ carcinoma of glans
can progress to squamous cell carcinoma in immunocompromised
high risk HPV 16, 18, 31, 33

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68
Q

male presents with solitary gray lesion on the shaft of his penis - diagnosis? what is it? prognosis? what causes it?

A

Bowen disease
in situ carcinoma
can progress to squamous cell carcinoma
high risk HPV 16, 18, 31, 33

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69
Q

male presents with multiple reddish plaques over the shaft of his penis - diagnosis? what is it? prognosis? what causes it?

A

Bowenoid disease
in situ carcinoma
does NOT progress to squamous cell carcinoma
high risk HPV 16, 18, 31, 33

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70
Q

raisin nuclei and koilocytic change are seen along with raised, nodules on surface of penis - diagnosis? etiology?

A

condyloma acuminatum

low risk HPV 6, 11

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71
Q

name 3 risk factors for penile squamous cell carcinoma

A

being uncircumcised
smoking
high risk HPV 16,18

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72
Q

you notice lymphatic spread to the paraaortic lymph nodes - diagnosis?

A

seminoma testis

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73
Q

you notice lymphatic spread to the inguinal lymph nodes - diagnosis?

A

penile squamous cell carcinoma

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74
Q

chimney sweepers and people who work around coal tar are more at risk for what type of cancer?

A

scrotal cancer

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75
Q

evagination of bladder wall - name of condition? two causes?

A

diverticula

congenital or acquired (BPH)

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76
Q

urine stasis increases the risk of what 2 benign conditions? give two causes

A

infection and bladder stones (calculi)

diverticula and BPH

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77
Q

what is the only painful testicular cancer?

A

embryonal carcinoma (non-seminoma)

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78
Q

you notice urine dribbling from the umbilicus of a new born - name of condition? what is he at increased risk for?

A

urachus

adenocarcinoma of bladder

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79
Q

what is cystitis? is it more common in males or females? why?

A

inflammation of the bladder

females, shorter urethras are more prone to infection

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80
Q

how can you tell the difference between cystitis and pyelonephritis on presentation?

A

cystitis does not have systemic symptoms like night sweats or fever

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81
Q

cystoscopic examination reveals edema hemorrhage, and ulceration - what area are you looking at? what should your next step be?

A

bladder

chronic cystitis looks like cancer on scope, so need to biopsy for diagnosis

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82
Q

on bladder tissue biopsy you seen urothelial papilloma - why do you need to be careful about this diagnosis?

A

urothelial papilloma are benign, but VERY rare, there is usually a low grade carcinoma there

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83
Q

on bladder biopsy you see intestinal metaplasia - diagnosis? important association?

A

adenocarcinoma of the bladder

urachus

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84
Q

person has been swimming in the nile and presents with urinary frequency and suprapubic pain - diagnosis? etiology?

A

squamous cell carcinoma of the bladder

schistosomiasis: ova irritate bladder wall, leading to metaplasia, dysplasia, and carcinoma

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85
Q

most common type of bladder cancer?

A

urothelial carcinoma - 90%

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86
Q

most important risk factor for bladder cancer?

A

smoking!!!!

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87
Q

someone who smokes and has been taking aspiring multiple times a day for many years has an increased risk of what?

A

urothelial carcinoma

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88
Q

patient presents with dysuria, urgency, flank pain, and painless hematuria - diagnosis?

A

painless hematuria is commonly associated with urothelial carcinoma

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89
Q

azo dyes increase your chance of what?

A

urothelial carcinoma

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90
Q

what are the two growth types of urothelial carcinoma? which has the worst prognosis and where does it metastasize to?

A

papillary/exophytic

flat/invasive - poorly differentiated, poor prognosis, metastasizes to regional nodes, liver, lung, bone

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91
Q

where can you get urothelial carcinoma?

A

urothelial epithelium extends from urethra to calyces of kidney

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92
Q

name 3 associations with urothelial carcinoma

A

bilateral hydroureter
hydronephrosis
stone formation

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93
Q

name three substances the kidney produces

A

erythropoietin
renin (JG cells)
prostaglandins

94
Q

normal GFR?

A

90mL/min

95
Q

endogenous substance used to predict renal clearance? why is it not perfect?

A

creatinine

-freely filtered, not reabsorbed, but is secreted by tubules so can increase GFR by up to 15%

96
Q

why is serum creatinine a poor marker of renal function?

A

its levels are influenced by muscle mass

97
Q

what is azotemia? what increases it?

A

increased BUN

urea and creatinine

98
Q

hallmark of nephritic syndrome? 2nd finding?

A

hematuria

HTN

99
Q

hallmark of nephrotic syndrome? 2nd finding?

A

proteinuria >3.5g

hypoalbuminemia/edema

100
Q

oliguria and azotemia indicate what pathology of the kidney?

A

acute renal failure

101
Q

polyuria, nocturia, and electrolyte disorders indicate what pathology of the kidney?

A

tubular defects

102
Q

what is the hallmark of a pre-renal disease leading to renal failure?

A

inadequate blood supply

103
Q

pruritis and uremia indicate what?

A

chronic renal failure

104
Q

heavy proteinuria (glomerular or tubulointerstitial)?

A

glomerular

105
Q

WBCs (glomerular or tubulointerstitial)?

A

tubulointerstitial

106
Q

oval fat bodies (glomerular or tubulointerstitial)?

A

glomerular

107
Q

RBC casts (glomerular or tubulointerstitial)?

A

glomerular

108
Q

poluria and electrolyte imbalance (glomerular or tubulointerstitial)?

A

tubulointerstitial

109
Q

RBC casts (nephritic or nephrotic)?

A

nephritic

110
Q

heavy proteinuria (nephritic or nephrotic)?

A

nephrotic

111
Q

white blood cells (nephritic or nephrotic)?

A

nephritic

112
Q

fatty casts (nephritic or nephrotic)?

A

nephrotic

113
Q

immune complexes activate which complement pathway? which molecule stabilizes the converstase?

A

alternative

properdin stabilizes C3bBb

114
Q

what is the difference between diffuse and focal in relation to the kidney?

A

diffuse involves all glomeruli, focal is just some of them

115
Q

what is the difference between global and segmental in relation to the kidney?

A

global means the entire glomerulus, segmental is just part of a glomerulus

116
Q

you have a young child with nephrotic syndrome, what should you not do during diagnosis?

A

don’t biopsy!

117
Q

why is hyperlipidemia associated with nephrotic syndrome?

A

albumin is being lost in the urine, so the liver tries to make up for this loss by increasing synthesis of proteins, including lipoproteins

118
Q

name the only two nephrotic diseases with immunoglobulin deposition

A 
membranous nephropathy
membranoproliferative glomerulonephritis (can also be nephritic)

Remember! if its nephrotic and has membrane in the name, it has immune complex deposition!

119
Q

name the 4 nephrotic disease that don’t involve immune complex deposition

A

minimal change
Focal segmental glomerulosclerosis (FSGS)
diabetic nephropathy
amyloidosis

120
Q

associated with hypercoagulable state (nephritic or nephrotic)? why?

A

nephrotic

loss of antithrombin III (breaks up thrombin and other clotting factors)

121
Q

most common nephrotic syndrome in kids

A

minimal change disease

122
Q

tram track appearance on H&E

A

membranoproliferative glomerulonephritis

123
Q

most common cause of nephrotic syndrome in Caucasian adults

A

membranous nephropathy

124
Q

most common cause of nephrotic syndrome in Hispanics and African Americans

A

focal segmental glomerulosclerosis (FSGS)

125
Q

this nephrotic syndrome can be associated with lymphoma or renal cell carcinoma

A

Minimal change disease

126
Q

A mother brings her 7 year old child in to see you because his shoes have not been fitting properly. On examination, you find low serum albumin, proteinuria, and no casts. Diagnosis? What is the cause of the damage? How to treat?

A

Minimal change disease
T cell cytokine mediated damage
treat with steroids (they are immune suppressant and counteract the cytokines)

127
Q

normal H&E, effacement of foot processes on EM, negative IF - 2 differentials, how to tell apart?

A

minimal change disease
FSGS
minimal change responds to steroids, FSGS does not

128
Q

“spike and dome” appearance on EM

A

membranous nephropathy

129
Q

pathogenesis of this kidney disease involves circulating glomerular permeability factors

A

minimal change disease

130
Q

prognosis of minimal change disease?

A

good, no tendency to progress to chronic renal disease or end stage renal disease, but relapses are common

131
Q

HIV, heroin use, and sickle cell are associated with what kidney pathology?

A

focal segmental glomerulosclerosis (FSGS)

132
Q

what is anasarca?

A

generalized edema

133
Q

kidney disease caused by a mutation of the protein podocin

A

focal segmental glomerulosclerosis (FSGS)

134
Q

African American with HIV presents with hypertension, massive proteinuria and microscopic hematuria. LM of a kidney biopsy looks normal. Diagnosis? Prognosis? why is biopsy normal?

A

focal segmental glomerulosclerosis (FSGS)

progresses to end stage renal disease in 5-20 years

biopsy can be normal because the disease is focal (not all glomeruli are involved)

135
Q

name 3 indicators of a poor prognosis for membranous nephropathy

A

male
>50 years old
>10 gm proteinuria

136
Q

this kidney disease is associated with hepatitis B/C, SLE, and chronic NSAID use

A

membranous nephropathy

137
Q

kidney disease with subepithelial deposits on EM, thick basement membrane on H&E, and granular deposition on IF - diagnosis? prognosis? what are the deposits on IF composed of?

A

membranous nephropathy

poor response to steroids, progresses to chronic renal failure

IgG C3

138
Q

kidney disease related to mercury and gold

A

membranous nephropathy

139
Q

glomerular disease with thickening of the basement membrane, mesangial cell proliferation, and infiltration of inflammatory cells

A

membranoproliferative glomerulonephritis

140
Q

kidney disease associated with hep B/C, subendothelial immune complexes of IgG, and tram track appearance on H&E - diagnosis? what are the deposits made of?

A

membranoproliferative glomerulonephritis
type I
IgG

141
Q

kidney disease with deposition in the glomerular basement membrane, low levels of C3 and associated with C3 nephritic factor -diagnosis? what are the deposits made of?

A

membranoproliferative glomerulonephritis
type II
C3

142
Q

kidney disease with tram tracks on H&E, and subendothelial deposits, mesangial deposits, and subepithelial deposits - diagnosis? what are the deposits made of?

A

membranoproliferative glomerulonephritis
type III
IgG and C3

143
Q

Which type of membranoproliferative glomerulonephritis involves complement activation via the classical pathway? alternate? what is normal age of onset? prognosis?

A

classical: type I
alternate: type II
age: <30
prognosis: most progress to ESRD within 10-15 years

144
Q

what is the leading cause of end stage renal disease in USA?

A

diabetic nephropathy

145
Q

a 55 year old man just received a kidney transplant from a donor who was just discovered to have diabetes mellitus and had diabetic changes in his kidney - should the recipient be concerned?

A

no, diabetic changes can reverse themselves when placed in a healthy patient

146
Q

in diabetic nephropathy, which arteriole is more affected by the hyalinization? why does this matter?

A

efferent -> inc GFR -> hyperfiltration and microalbuminia

147
Q

name the 2 early lesions in diabetic nephropathy

A

expansion of the mesangial matrix and thickening of the glomerular basement membrane

148
Q

Kimmelstiel-Wilson nodules are unique to which kidney pathology? what are they made of?

A

diabetic nephropathy

lipids and fibrin NOT collagen

149
Q

you notice deposits in the mesangium of the glomerulus that stains with congo red - diagnosis? how common is it? does it involve immune or inflammatory response?

A

amyloidosis

kidney is most common of systemic amyloidosis

neither immune or inflammatory reactions are provoked

150
Q

which amyloid is associated with primary amyloidosis? prognosis?

A

AL

aggressive, poor prognosis

151
Q

which amyloid is associated with secondary amyloidosis? prognosis?

A

AA

better prognosis than primary

152
Q

where does AA amyloid come from?

A

its an apolipoprotein produced by the liver as an acute phase reactant in response to long standing infection or inflammation

153
Q

LM shows nodular, amorphous hyaline material in mesangium and capillary loops that narrows or closes capillary lumens - EM shows subendothelial and mesangial fibers - diagnosis?

A

amyloidosis in kidney

154
Q

patient presents with purpura and easy bruising. Also proteinuria, edema, arrhythmias, malabsorption symptoms and orthostatic hypotension - diagnosis? prognosis?

A

amyloidosis in kidney

very poor prognosis, most die from end-organ failure from amyloid deposition

155
Q

inflamed glomeruli, hematuria and salt retention are characteristic of what kind of kidney disorder?

A

nephritic

156
Q

list the nephritic disorders with normal complement levels

A

IgA nephropathy/Henoch-Schonlein purpura
Alport’s syndrome (hereditary nephritis)
SLE (class I, II, V)
benign hematuria

157
Q

list the nephritic disorders with low complement levels

A 
post-streptococcal glomerulonephritis
membranoproliferative glomerulonephritis 
SLE (class III, IV)
bacterial endocarditis
cryoglobulinemia
158
Q

list the nephritic disorder with variable complement levels

A

rapidly progressive glomerulonephritis

159
Q

most common type of glomerulonephritis? what race is it rare in?

A

IgA nephropathy/Berger disease

blacks

160
Q

Pt presents with episodic hematuria with RBC casts, proteinuria of <3.5g/day, normal C3/C4, and has a history of viral respiratory illness. - Diagnosis? Prognosis? Common age group?

A

IgA nephropathy/Berger disease
usually prolonged benign course, 20% progress to ESRD (end stage renal disease)
15-30

161
Q

18 year old male presents with abdominal pain, pain in the joints, vasculitis and palpable purpura. Diagnosis? what changes will you see in his kidney?

A

Henoch-Schonlein Purpura (assoc with IgA nephropathy)

IgA deposition in the mesangium

162
Q

on biopsy of a kidney you see on LM segmental areas of increased mesangium and hypercellularity. On IF you see large patches of deposition. On EM you see mesangial and subendothelial deposits. Diagnosis?

A

IgA nephropathy/Berger disease

163
Q

characteristic subepithelial “humps” on EM

A

post-streptococcal glomerulonephritis

164
Q

8 year old child who had a skin rash a month ago presents with sudden onset proteinuria >2g/day with low complement levels and coca cola colored urine. LM shows proliferation of mesangium, endothelium, and epithelium. - Diagnosis? prognosis? What do characteristically expect to find in their serum?

A

post-streptococcal glomerulonephritis

good prognosis, only 1% of kids progress to renal failure, 25% of adults develop rapidly progressive glomerulonephritis. 10-40 years later can develop renal insufficiency

serum: anti-ASO Abs or anti-DNAase B

165
Q

IF shows granular deposits of IgG and C3 in mesangium and capillary walls. EM shows large deposits in subepithelium. Diagnosis?

A

post-streptococcal glomerulonephritis

166
Q

crescents in Bowman’s space - diagnosis? what are the crescents made of? what is the prognosis of the presence of crescents?

A

Rapidly Progressive Glomerulonephritis
fibrin and macrophages - not collagen!!
crescents are a very aggressive finding

167
Q

A pt. with Rapidly Progressive Glomerulonephritis shows a linear pattern on IF. Diagnosis? what is an important symptom for diagnosis? why is it a linear pattern?

A

Goodpasture’s syndrome
hemoptysis (LUNG involvement!)

linear due to anti-GBM Abs (anti-glomerular basement membrane)

168
Q

A pt. with Rapidly Progressive Glomerulonephritis shows a granular pattern on IF. Give 3 possible diagnoses. Which is most common? why is it granular?

A

post-streptococcal glomerulonephritis (most common)
SLE
IgA nephropathy

granular due to immune complex deposition

169
Q

A pt. with Rapidly Progressive Glomerulonephritis shows a non staining pattern on IF. Give 2 possible diagnoses. How do you differentiate? why don’t they stain?

A

Wegener’s (look for sinusitis!) c-ANCA
Churg-Strauss - p-ANCA

no staining due to no immune complexes, they are vasculitis diseases

170
Q

What is the outcome of Rapidly Progressive Glomerulonephritis? which types are most treatable? why?

A

75% die or are placed on dialysis within 2 years of diagnosis

better prognosis with those involving a treatable underlying disorder like SLE or one that resolves spontaneously like post-strep

171
Q

List of lupus symptoms - just go read them
need 4 or more for diagnosis
joints are most commonly affected: 90% cases, followed by rashes in 70% of cases

A 
malar rash
photosensitivity
oral ulcers
arthritis
pericarditis
renal disease
neurological disorder
(+) IF antinuclear antibody test
172
Q

anti-GBM Abs are seen in what disorder? What specifically is the Ab targeting?

A

Goodpasture’s syndrome

type IV collagen of GBM

173
Q

Pauci immune describes what kind of staining pattern?

A

minimal to no staining on IF

174
Q

you see a granular pattern on IF that tests positive for all immune complexes - diagnosis?

A

SLE

175
Q

to make the differential between class III and class IV lupus nephritis, what must you see on LM?

A

class III has < 50% of glomeruli involved, and class IV has >50% of glomeruli involved

176
Q

list the 6 classes of Lupus nephritis

which is most common? most severe?

A 
class I: minimal mesangial 
class II: mesangial proliferative
class III: focal segmental proliferative
class IV: diffuse proliferative
class V: membranous
class VI: advanced sclerosing

class IV is most common and most severe

*see page 38 in class notes

177
Q

List the 7 tubular and interstitial diseases

A 
acute tubular necrosis (ATN)
acute interstitial nephritis (tubulointerstitial)
acute pyelonephritis
chronic pyelonephritis
papillary necrosis
obstructive nephropathy
renal stones
178
Q

pt presents with dislocated lens, sensorineural hearing loss and hematuria - diagnosis? what is unique about this disease?

A

alport’s syndrome
only congenital/hereditary nephritic syndrome
80% X-linked

179
Q

“basket weave” appearance on EM

A

Alport’s syndrome

180
Q

a Mormon shows a mutation in the COL4A4 and COL4A5 genes - diagnosis? what do you see on EM?

A

Alport’s syndrome

thinning and splitting of the GBM

181
Q

patient presents with elevated BUN, metabolic acidosis, anemia, and hypotension. Brown, granular casts are seen in urine - Diagnosis? Give 2 etiologies and examples

A

Acute tubular necrosis
ischemic (decreased blood supply)
nephrotoxic (due to aminoglycosides or heavy metals like lead)

aminoglycosides are antibiotics

182
Q

describe the 3 phases of Acute tubular necrosis (ATN)

A

initiation: 36hrs - very low GFR, rapid inc in serum BUN
maintenance: days-3weeks - oliguria, fluid overload, metabolic acidosis

recovery phase: increasing GFR, function is restored

183
Q

pt presents with oliguria, muddy brown casts, epithelial cell casts, no pyuria and mild proteinuria - diagnosis?

A

Acute tubular necrosis

184
Q

pt presents with hyponatremia, metabolic acidosis, but no proteinuria or hematuria. Pt also has fever and rash. Eosinophils are seen in urine - diagnosis? cause? treatment? prognosis?

A

Acute interstitial nephritis

usually due to a drug-induced hypersensitivity like NSAIDs or penicillins

stop drug use

resolves with cessation of drug, but can progress to renal papillary necrosis

185
Q

Pt with sickle cell who has a long term history of aspirin use presents with gross hematuria and flank pain. Gross appearance of kidney shows necrosis of apical 2/3rds of the pyramids - diagnosis? give the 4 causes

A

Renal papillary necrosis

chronic analgesic abuse
diabetes mellitus
sickle cell trait
severe acute pyelonephritis

186
Q

Pt presents with fever, flank pain, WBC casts and leukocytosis - diagnosis? most common cause? more common in who? why?

A

acute pyelonephritis
ascending infection with E. coli
women, short urethra

187
Q

biopsy of kidney shows interstitial fibrosis and atrophy of tubules. you see progressive cortical scarring and blunted calyces - diagnosis? most common cause? second cause?

A 
chronic pyelonephritis 
reflux nephropathy (vesicoureteral reflux) most common
obstruction second cause: ex. kidney stones, BPH
188
Q

on microscopic exam of kidney biopsy you see eosinophilic proteinaceous material resembling colloid inside atrophic tubules - waxy casts are also seen in urine - diagnosis?

A

chronic pyelonephritis

189
Q

Pt presents with colicky pain, hematuria and unilateral flank tenderness. Kidney shows dilated renal pelvis and calyces. Diagnosis? prognosis? time frame for related damage?

A

nephrolithiasis - kidney stone
stone usually passed in hours, surgery may be required after that - resolves fully upon removal of stone

if left 2-3 weeks -> irreversible damage and renal failure

190
Q

composition of most common renal stone? list 3 other compositions

A

75% of stones are calcium oxalate or calcium phosphate

10-15% are struvite (Mg/ammonium phosphate)
5% uric acid
2% cystine

191
Q

3 methods to prevent kidney stones

A

increase fluid intake 2L/day
low sodium diet (decreases urinary calcium excretion)
alkalinization of urine to help inc solubility of uric acid

192
Q

which type of kidney stone is radiolucent?

A

uric acid

I can’t see U on x-ray

193
Q

these casts can be seen in normal people after exercise or fever due to dehydration

A

hyaline casts

194
Q

these muddy brown, cigar shaped granular casts are seen in what diseases?

A

acute tubular necrosis and chronic renal disease (most cases)

195
Q

these casts are seen with longstanding renal disease

A

waxy casts

196
Q

these casts are made of solidified tamm horsfall proteins

A

hyaline casts

197
Q

these casts are made of albumin or Ig light chains

A

granular casts

198
Q

these aggregates found in urine are in the shape of maltese crosses

A

oval fat bodies

NOT a cast! - below the level of the kidney

199
Q

the presence of RBCs and WBCs in urine tell you about about the problem?

A

that it is lower than the kidney… if it were a kidney problem, they would be in casts

200
Q

on kidney biopsy you see medial and intimal thickening, hyaline arteriolosclerosis and notice that the surface of the kidney is finely granular - diagnosis? who is most at risk (2: 1 disease 1 race) cause?

A

benign hypertensive nephrosclerosis
elderly diabetic pts and blacks (8x)

long standing hypertension

201
Q

flea bitten kidney with onion skinning of the arterioles - diagnosis? cause? course of disease? prognosis? who is at risk?

A 
malignant hypertensive nephrosclerosis
HTN with diastolic > 130
happens very quickly, hours or days
>50% mortality in 3 months
young black males
202
Q

you find flame-shaped retinal hemorrhages and AV nicking on fundoscopy - diagnosis?

A

malignant hypertension

203
Q

a 6 year old child eats a hamburger and 1 week later develops symptoms including purpuric rash, proteinuria, headache, and fever - diagnosis? cause?

A

hemolytic uremic syndrome (HUS)

usually E. coli O157:H7

204
Q

a patient with HIV develops purpuric rash, headache, confusion, seizures and acute renal failure. Schistocytes are seen on peripheral blood smear - diagnosis? prognosis?

A

Thrombotic thrombocytopenic purpura (TTP)

most recover but 25% progress to chronic renal failure

205
Q

how do you differentiate the two disorders that involve fibrin thrombi in glomeruli and small vessels, resulting in acute renal failure?

A

HUS and TTP

TTP has more pronounced CNS involvement

206
Q

25 year old female with fibromuscular dysplasia presents with suden onset HTN and intermittent pulmonary edema - ultrasound shows asymmetrical kidney size - diagnosis? describe the changes you would see in each kidney and why

A

renal artery stenosis

shrunken kidney (with stenosis) has no arteriolosclerosis due to low blood flow, but this lack of blood flow causes release of renin which leads to HTN - ischemic changes include crowded glomeruli, atrophic tubules, and interstitial fibrosis

HTN leads to hypertensive, hyaline arteriolosclerosis in the unaffected kidney

207
Q

associated with berry aneurysms and liver involvement

A

autosomal dominant polycystic kidney disease (AD for aDult)

208
Q

34 year old pt presents with bilateral enlargement of kidneys involving cortex and medulla and HTN. Kidneys are palpable - diagnosis? common cause of death?

A

autosomal dominant polycystic kidney disease

cerebral hemorrhage from rupture of associated berry aneurysm

209
Q

this disease involves a mutation in the APKD1 or APKD2 genes - diagnosis? what chromosomes are each of these genes found on and what do they code for?

A

autosomal dominant polycystic kidney disease

APKD1: ch16 - polycysteine II
APKD2: ch4 - polycysteine I

210
Q

baby is born with HTN, hypoplastic lungs, flat face, and limb malformations - what is the name of this condition? what disease is it associated with? outcome? why is the baby’s face flat?

A

Potter sequence
Childhood (autosomal recessive) polycystic kidney disease

death in infancy or childhood

oligohydramnios

211
Q

this disease involves a mutation in the PKHD1 gene - what disease? what chromosome? what does it code for?

A

Childhood (autosomal recessive) polycystic kidney disease

chromosome 6, codes for fibrocystin

212
Q

an infant’s kidneys have a smooth outer surface, but a sponge-like appearance in the cortex and medulla in a radial/spoke arrangement - diagnosis? what part of the kidney is involved? associated finding?

A

Childhood (autosomal recessive) polycystic kidney disease

collecting ducts (Children - Collecting ducts - Cs!)

hepatic fibrosis and cysts

213
Q

what can cause potter sequence in utero? what is characteristic of these fetuses?

A

bilateral renal agenesis -> oligohydramnios and lung hypoplasia

flat face, low set ears

214
Q

patients with autosomal dominant polycystic kidney disease have an increased risk fo what?

A

cancer

215
Q

list the 3 malignant tumors of the kidney

A

renal cell carcinoma (90%)
urothelial carcinoma
Wilm’s tumor in kids

216
Q

painless hematuria is associated with what?

A

renal tumor

217
Q

this renal tumor has sheets of cells and shows a central scar - name? malignancy?

A

renal oncocytoma

benign

218
Q

this tumor presents as a white spot on the outside of the kidney, no clear cells - name? malignancy?

A

renal adenoma

benign

219
Q

a 45 year old presents with flank pain, hematuria, and retroperitoneal hemorrhage. You find a mass in his kidney thats positive for CD117, HMB45, and actin. the tumor has a triphasic appearance. - name? malignancy?

A

angiomyolipoma (blood vessels, muscle, fat)

benign

220
Q

cancer of the renal tubular epithelial cells - diagnosis? more common in who?

A

renal cell carcinoma

males 2:1

221
Q

Male presents with hematuria, flank pain, and fever. He noticed a swelling in his left testicle that can be transilluminated. Should you be concerned?

A

Yes, left-sided varicocele can indicate renal cell carcinoma that has invaded the left renal vein

222
Q

on biopsy of a kidney mass you find lots of cells with clear cytoplasm - diagnosis? why is it clear?

A

renal cell carcinoma - clear cell type

filled with lipid, NOT mucin

223
Q

paraneoplastic syndromes of renal cell carcinoma - just read

A 
polycythemia (erythropoietin)
HTN (renin)
hypercalcemia (PTH)
cushings syndrome (ACTH)
leukemoid reaction
amyloidosis
224
Q

should you use urine cytology for diagnosis of renal cell carcinoma? why or why not?

A

no, its not a good marker, cells get degraded during passage along UT - good for bladder cancer though

225
Q

you find a single, unilateral tumor in the upper pole of a kidney in a 65 year old male - diagnosis? what is the biggest risk factor? how does it spread?

A

renal cell carcinoma (sporadic)
smoking
hematogenously (carcinoma exception!)

226
Q

30 year old presents with bilateral masses in their kidneys, you discover there has been inactivation of the VHL gene - name of this condition? disease? what chromosome is this gene on?increased risk for what associated factor?

A

Von Hippel-Lindau disease
Renal cell carcinoma
chromosome 3
hemangioblastoma of the cerebellum

227
Q

4 year old presents with large unilateral flank mass, hematuria, and HTN - you discover a triphasic tumor - diagnosis? what gene and chromosome is involved? what 3 cell types are involved?

A

wilm’s tumor
WT1 mutation on chromosome 11
blastema (immature mesenchyme), stroma, epithelium

228
Q

a 3 year old presents with aniridia and mental and motor retardation - what is the name of this syndrome? what disease does it predispose him to?

A

WAGR syndrome
Wilms tumor

W:wilms tumor
A: aniridia
G: genital abnormalities
R: retardation (mental and motor)

229
Q

a child is born with 1 sided muscle hypertrophy, hypoglycemia and a protruding tongue - name of syndrome? what does it predispose him to? what gene is involved? prognosis?

A

Beckwith-Wiedemann syndrome
Wilms tumor

WT2
90% 5 year survival

230
Q

baby presents with flank mass, how do you differentiate between the two differentials?

A

wilm’s tumor or adrenal neuroblastoma

wilm’s tumor has normal VMA levels

231
Q

cadmium increases your risk of what?

A

renal cell carcinoma

System Path II (3 decks)

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