Renal Path Quiz 2- part 3 Flashcards
acute tubular necrosis (ATN) is characterized by what?
proximal tubular involvement
either toxicity or ischemia of the epithelium
results in epithelium necrosis of the proximal tubules
In toxic ATN what is the characteristic appearance?
anuclear and homogenous cytoplasm that stains darkly eosinophilic
maintains normal shape
toxin related ATN usu causes what?
acute renal failure
what’s pathognomonic for acute tubular necrosis (ATN)?
presence of “muddy brown casts” of epithelial cells in urine
also epithelial casts that obliterate the lumen
Ischemic ATN specifically causes
skip lesions through the tubules due to differences in perfusion within the kidney
Acute interstitial nephritis (AIN) is the result of
an allergic response to a drug or following infxn
where does acute interstitial nephritis (AIN) occur
renal parenchyma
which of these cases would most likely present with marked eosinophils in urine?
acute interstitial nephritis (makes sense because it’s an allergic response)
AIN patients will present with acute renal failure in
40-50% of cases
with discontinuation of medication there is generally full recovery
what if you have acute interstitial nephritis, discontinue medication and don’t recover?
then you have chronic interstitial nephritis
no cure exists
microscopically, how does chronic interstitial nephritis appear?
The interstitial area is expanded by fibrosis with distortion of tubules and peri-glomerular fibrosis. Glomeruli do not show pathologic changes
Fanconi’s syndrome falls under what classification of conditions?
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
In light microscopy, fanconi’s syndrome reveals
atrophic and hyalinized glomeruli typical of end-stage kidney disease.
analgesic nephropathy occurs after
ingestion of large amnts of analgesics OVER A LONG PERIOD OF TIME (in contrast to AIN which can occur with a single dose)
analgesic nephropathy damages what part of the kidney?
papillary necrosis
dark hemorrhagic areas are renal papillae that are necrotic
whats the disease where you have atherosclerotic changes in renal blood vessels?
benign nephrosclerosis
benign nephrosclerosis is a sequelae to which common condition?
HTN
the gross appearance of benign nephrosclerosis is what?
the surface of the kidney looks granular
due to focal loos of parenchyma from ischemia
what conditions is a consequence of sever hypertension?
malignant nephrosclerosis
more severe changes in renal architecture
what is the characteristic changes seen in arterioles in malignant nephrosclerosis?
onion ring appearance (hyperplastic arterioles)
most common cause of secondary hypertension
renal artery stenosis
renal artery stenosis (narrowing or blockage of the renal artery) is due to
atherosclerosis
fibromuscular dysplasia of the renal artery
atheroembolic renal disease
scar formation in the renal artery
Hemolytic uremic syndrome (HUS) is a condition that presents with a clinical triad of:
(HUS is widespread formation of hyaline thrombi in the microcirculation)
acute renal failure
microangiopathic hemolytic anemia
thrombocytopenia
what is the most common bacteria to cause HUS?
E. coli
most common cause of acute renal failure in children and is
hemolytic uremic syndrome
childhood HUS is most frequently associated with intestinal infection by which Shiga-like toxin
verocytotoxin
HUS is characterized by sudden onset of sx that follow a
gastrointestinal infection or flu like illness
_______ develops in ~ half of all childhood HUS patients
HTN
Microscopically HUS appears as
fibrin thrombi and packed red blood cells are visible in the lumina
if adults get HUS, they are likely to have which other condition
TTP (thrombotic thrombocytopenic purpura)
which adult population is most at risk for HUS/TTP?
pregnant or postpartum women
renal artery emboli usually come from a
cardiac source such as atrial fibrillation
the most important non-cardiac source of renal emboli comes from
ruptured aortic atheromatous plaques
rupture may occur spontaneously or as a result of surgery
