Renal Path Quiz 2- part 3

Question 1

acute tubular necrosis (ATN) is characterized by what?

Answer 1

proximal tubular involvement
either toxicity or ischemia of the epithelium
results in epithelium necrosis of the proximal tubules

Question 2

In toxic ATN what is the characteristic appearance?

Answer 2

anuclear and homogenous cytoplasm that stains darkly eosinophilic
maintains normal shape

Question 3

toxin related ATN usu causes what?

Answer 3

acute renal failure

Question 4

what’s pathognomonic for acute tubular necrosis (ATN)?

Answer 4

presence of “muddy brown casts” of epithelial cells in urine
also epithelial casts that obliterate the lumen

Question 5

Ischemic ATN specifically causes

Answer 5

skip lesions through the tubules due to differences in perfusion within the kidney

Question 6

Acute interstitial nephritis (AIN) is the result of

Answer 6

an allergic response to a drug or following infxn

Question 7

where does acute interstitial nephritis (AIN) occur

Answer 7

renal parenchyma

Question 8

which of these cases would most likely present with marked eosinophils in urine?

Answer 8

acute interstitial nephritis (makes sense because it’s an allergic response)

Question 9

AIN patients will present with acute renal failure in

Answer 9

40-50% of cases

with discontinuation of medication there is generally full recovery

Question 10

what if you have acute interstitial nephritis, discontinue medication and don’t recover?

Answer 10

then you have chronic interstitial nephritis

no cure exists

Question 11

microscopically, how does chronic interstitial nephritis appear?

Answer 11

The interstitial area is expanded by fibrosis with distortion of tubules and peri-glomerular fibrosis. Glomeruli do not show pathologic changes

Question 12

Fanconi’s syndrome falls under what classification of conditions?

Answer 12

Renal tubular acidosis (RTA)
RTA involves the accumulation of acid in the body due to a failure of the kidneys to appropriately acidify the urine

it’s type 2 or proximal tubule involvement

Question 13

In light microscopy, fanconi’s syndrome reveals

Answer 13

atrophic and hyalinized glomeruli typical of end-stage kidney disease.

Question 14

analgesic nephropathy occurs after

Answer 14

ingestion of large amnts of analgesics OVER A LONG PERIOD OF TIME (in contrast to AIN which can occur with a single dose)

Question 15

analgesic nephropathy damages what part of the kidney?

Answer 15

papillary necrosis

dark hemorrhagic areas are renal papillae that are necrotic

Question 16

whats the disease where you have atherosclerotic changes in renal blood vessels?

Answer 16

benign nephrosclerosis

Question 17

benign nephrosclerosis is a sequelae to which common condition?

Answer 17

HTN

Question 18

the gross appearance of benign nephrosclerosis is what?

Answer 18

the surface of the kidney looks granular

due to focal loos of parenchyma from ischemia

Question 19

what conditions is a consequence of sever hypertension?

Answer 19

malignant nephrosclerosis

more severe changes in renal architecture

Question 20

what is the characteristic changes seen in arterioles in malignant nephrosclerosis?

Answer 20

onion ring appearance (hyperplastic arterioles)

Question 21

most common cause of secondary hypertension

Answer 21

renal artery stenosis

Question 22

renal artery stenosis (narrowing or blockage of the renal artery) is due to

Answer 22

atherosclerosis
fibromuscular dysplasia of the renal artery
atheroembolic renal disease
scar formation in the renal artery

Question 23

Hemolytic uremic syndrome (HUS) is a condition that presents with a clinical triad of:
(HUS is widespread formation of hyaline thrombi in the microcirculation)

Answer 23

acute renal failure
microangiopathic hemolytic anemia
thrombocytopenia

Question 24

what is the most common bacteria to cause HUS?

Answer 24

E. coli

Question 25

most common cause of acute renal failure in children and is

Answer 25

hemolytic uremic syndrome

Question 26

childhood HUS is most frequently associated with intestinal infection by which Shiga-like toxin

Answer 26

verocytotoxin

Question 27

HUS is characterized by sudden onset of sx that follow a

Answer 27

gastrointestinal infection or flu like illness

Question 28

_______ develops in ~ half of all childhood HUS patients

Answer 28

HTN

Question 29

Microscopically HUS appears as

Answer 29

fibrin thrombi and packed red blood cells are visible in the lumina

Question 30

if adults get HUS, they are likely to have which other condition

Answer 30

TTP (thrombotic thrombocytopenic purpura)

Question 31

which adult population is most at risk for HUS/TTP?

Answer 31

pregnant or postpartum women

Question 32

renal artery emboli usually come from a

Answer 32

cardiac source such as atrial fibrillation

Question 33

the most important non-cardiac source of renal emboli comes from

Answer 33

ruptured aortic atheromatous plaques

rupture may occur spontaneously or as a result of surgery