Renal Path Review 4

Question 1

do we biopsy if suspecting diabetic nephropathy?

Answer 1

*NO, unless it will change management:
-concerned that symptoms cannot be accounted for by DN
-concerned for concurrent disease that warrants management

Question 2

indications for considering kidney biopsy in diabetic patients

Answer 2

*accelerated renal failure (rapid decline in renal function with minimal proteinuria)
*rapidly increasing protein excretion or acute onset nephrotic syndrome
*refractory hypertension
*macroscopic hematuria or active urine sediment
*signs/symptoms of another systemic disease

Question 3

biopsy findings of diabetic nephropathy

Answer 3

*diffuse collagen + mesangial expansion or focal nodular glomerulosclerosis + glomerular basement membrane thickening
*arteriolar hyalinosis of afferent & efferent arterioles
*nothing by immunofluorescence (negative)
*Kimmelstiel-Wilson Nodules

Question 4

in most cases, is pyelonephritis an ascending disease or a hematogenous disease?

Answer 4

*majority are ASCENDING diseases

Question 5

findings consistent with pyelonephritis

Answer 5

*sx: flank pain, systemic sx (fever), pain or burning on urination or dysuria
*UA: WBC casts + bacteriuria
*biopsy: pyelitis + nephritis

Question 6

ADPKD

Answer 6

*most common genetically transmitted cystic kidney disease
*genes: PKD1 or PKD2
*cysts develop in all segments of the nephron
*symptoms: hematuria, hypertension, bilateral massive kidney enlargement
*associations: cysts in other organs, especially Berry aneurysms (cerebral aneurysms)
*histology: cystic dilation of all segments of the nephron

Question 7

ARPKD

Answer 7

*congenital disease, often lethal in neonates
*gene: PCKD1 (fibrocystin/polyductin)
*cysts develop in COLLECTING DUCTS
*massively bilaterally enlarged diffusely cystic kidneys
*pulmonary hypoplasia, congenital hepatic fibrosis

Question 8

acquired cystic kidney disease

Answer 8

*associated with ESRD
*first cysts form in the proximal tubules

Question 9

renal cell carcinoma, clear cell type

Answer 9

*classic triad: flank pain, renal mass, and gross hematuria
*often presents with paraneoplastic symptoms
*pathogenesis: mutations in VHL gene on chromosome 3
*gross pathology: golden-yellow, due to increased lipid content
*microscopic pathology: POLYGONAL, CLEAR CELLS
*sporadic: unicentric, unilateral; hereditary: multicentric, bilateral

Question 10

angiomyolipoma - histology

Answer 10

*a benign tumor, consisting with:
1. atypical blood vessels
2. smooth muscle
3. fat

Question 11

Wilms Tumor - histology

Answer 11

*most common malignant renal tumor of childhood, consisting of 3 components:
1. BLASTEMA
2. epithelium
3. stroma

*due to loss of WT1 gene on chromosome 11
*most tumors are solitary and unilateral