Renal - Pathology (1) Flashcards
1
Q
Casts in urine
- Presence of casts indicates that…
- Bladder cancer, kidney stones –>
- Acute cystitis –>
- RBC casts seen in…
- WBC casts seen in…
- Fatty casts seen in…
- Granular casts seen in…
- Waxy casts seen in…
- Hyaline casts seen in…
A
- Presence of casts indicates that…
- Hematuria/pyuria is of renal (vs. bladder) origin.
- Bladder cancer, kidney stones –>
- Hematuria, no casts.
- Acute cystitis –>
- Pyuria, no casts.
- RBC casts seen in…
- Glomerulonephritis, ischemia, or malignant hypertension.
- WBC casts seen in…
- Tubulointerstitial inflammation, acute pyelonephritis, transplant rejection.
- Fatty casts (“oval fat bodies”) seen in…
- Nephrotic syndrome.
- Granular (“muddy brown”) casts seen in…
- Acute tubular necrosis.
- Waxy casts seen in…
- Advanced renal disease/chronic renal failure.
- Hyaline casts seen in…
- Nonspecific, can be a normal finding, often seen in concentrated urine samples.
2
Q
Nomenclature of glomerular disorders
- For each
- Characteristics
- Example
- Focal
- Diffuse
- Proliferative
- Membranous
- 1° glomerular disease
- 2° glomerular disease
A
- Focal
- Characteristics: < 50% of glomeruli are involved
- Ex: Focal segmental glomerulosclerosis
- Diffuse
- Characteristics: > 50% of glomeruli are involved
- Ex: Diffuse proliferative glomerulonephritis
- Proliferative
- Characteristics: Hypercellular glomeruli
- Ex: Mesangial proliferative
- Membranous
- Characteristics: Thickening of glomerular basement membrane
- Ex: Membranous nephropathy
- 1° glomerular disease
- Characteristics: Involves only glomeruli, thus a 1° disease of the kidney
- Ex: Minimal change disease
- 2° glomerular disease
- Characteristics: Involves glomeruli and other organs, thus a disease of another organ system, or a systemic disease that has impact on the kidney
- Ex: SLE, diabetic nephropathy
3
Q
Glomerular diseases
- Nephritic syndrome
- Nephrotic syndrome
- Both
A
- Nephritic syndrome
- Acute poststreptococcal glomerulonephritis
- Rapidly progressive glomerulonephritis
- Berger disease (IgA glomerulonephropathy)
- Alport syndrome
- *Classic nephritic disorders can exhibit nephrotic features
- Nephrotic syndrome
- Focal segmental glomerulosclerosis
- Membranous nephropathy
- Minimal change disease
- Amyloidosis
- Diabetic glomerulonephropathy
- Both
- Diffuse proliferative glomerulonephritis
- Membranoproliferative glomerulonephritis
4
Q
Nephrotic vs. nephritic syndrome
- For each
- Presentation
- Associations
- Nephrotic syndrome
- Nephritic syndrome
A
- Nephrotic
- Presentation
- NephrOtic syndrome presents with massive prOteinuria (> 3.5 g/day, frothy urine), hyperlipidemia, fatty casts, edema.
- Associations
- Associated with thromboembolism (hypercoagulable state due to AT III loss in urine) and increased risk of infection (loss of immunoglobulins).
- Presentation
- Nephritic
- Presentation
- NephrItic syndrome = an Inflammatory process.
- When it involves glomeruli, it leads to hematuria and RBC casts in urine.
- Associations
- Associated with azotemia, oliguria, hypertension (due to salt retention), and proteinuria (< 3.5 g/day).
- Presentation
5
Q
Focal segmental glomerulosclerosis
- Type of disease
- LM
- IF
- EM
- Most common cause of…
- Due to…
- Treatment
A
- Type of disease
- Nephrotic syndrome
- LM
- Segmental sclerosis and hyalinosis [A].
- IF
- (-)
- EM
- Effacement of foot process similar to minimal change disease.
- Most common cause of…
- Nephrotic syndrome in African Americans and Hispanics.
- Due to…
- Can be idiopathic or associated with HIV infection, sickle cell disease, heroin abuse, massive obesity, interferon treatment, and chronic kidney disease due to congenital absence or surgical removal.
- Treatment
- Inconsistent response to steroid therapy and may progress to chronic renal disease.
![](https://s3.amazonaws.com/brainscape-prod/system/cm/125/170/534/a_image_thumb.png?1659443742)
6
Q
Membranous nephropathy
- Type of disease
- LM
- IF
- EM
- Most common cause of…
- Due to…
- Treatment
A
- Type of disease
- Nephrotic syndrome
- LM
- Diffuse capillary and GBM thickening [B].
- IF
- Granular as a result of immune complex deposition.
- Nephrotic presentation of SLE.
- EM
- “Spike and dome” appearance with subepithelial deposits.
- Most common cause of…
- 1° nephrotic syndrome in Caucasian adults.
- Due to…
- Can be idiopathic or associated with antibody to phospholipase A2 receptor, drugs (e.g., NSAIDs, penicillamine), infections (e.g., HBV, HCV), SLE, or solid tumors.
- Treatment
- Poor response to steroid therapy and may progress to chronic renal disease.
![](https://s3.amazonaws.com/brainscape-prod/system/cm/125/170/533/a_image_thumb.png?1659443742)
7
Q
Minimal change disease (lipoid nephrosis)
- Type of disease
- LM
- IF
- EM
- Most common in…
- Due to…
- Associations
- Treatment
A
- Type of disease
- Nephrotic syndrome
- LM
- Normal glomeruli (lipid may be seen in PCT cells).
- IF
- (-)
- EM
- Effacement of foot processes [C].
- Most common in…
- Children.
- Due to…
- May be triggered by recent infection, immunization, or immune stimulus.
- Associations
- May be associated with Hodgkin lymphoma (e.g., cytokine-mediated damage).
- Treatment
- Excellent response to corticosteroids.
![](https://s3.amazonaws.com/brainscape-prod/system/cm/125/171/955/a_image_thumb.png?1659443742)
8
Q
Amyloidosis
- Type of disease
- LM
- Most commonly involved organ
- Associations
A
- Type of disease
- Nephrotic syndrome
- LM
- Congo red stain shows apple-green birefringence under polarized light.
- Most commonly involved organ
- Kidney (systemic amyloidosis).
- Associations
- Associated with chronic conditions (e.g., multiple myeloma, TB, rheumatoid arthritis).
9
Q
Membranoproliferative glomerulonephritis
- Type of disease
- Type I
- Deposits
- Associations
- Type II
- Deposits
- Associations
A
- Type of disease
- Nephritic syndrome that can also present with nephrotic syndrome
- Type I
- Subendothelial immune complex (IC) deposits with granular IF
- “Tram-track” appearance due to GBM splitting caused by mesangial ingrowth [D].
- Associated with HBV, HCV.
- May also be idiopathic.
- Subendothelial immune complex (IC) deposits with granular IF
- Type II
- Intramembranous IC deposits
- “Dense deposits.”
- Associated with C3 nephritic factor (stabilizes C3 convertase –> decreased serum C3 levels).
- Intramembranous IC deposits
![](https://s3.amazonaws.com/brainscape-prod/system/cm/125/170/528/a_image_thumb.png?1659443741)
10
Q
Diabetic glomerulonephropathy
- Type of disease
- LM
- Nonenzymatic glycosylation of…
A
- Type of disease
- Nephrotic syndrome
- LM
- Mesangial expansion, GBM thickening, eosinophilic nodular glomerulosclerosis (Kimmelstiel-Wilson lesion) [E].
- Nonenzymatic glycosylation of…
- GBM –> increased permeability, thickening.
- Efferent arterioles –> increased GFR –> mesangial expansion.
![](https://s3.amazonaws.com/brainscape-prod/system/cm/125/170/497/a_image_thumb.png?1659443741)
11
Q
Acute poststreptococcal glomerulonephritis
- Type of disease
- LM
- IF
- EM
- Characteristics
- Findings
A
- Type of disease
- Nephritic syndrome
- LM
- Glomeruli enlarged and hypercellular.
- IF
- (“Starry sky”) granular appearance (“lumpy-bumpy”) due to IgG, IgM, and C3 deposition along GBM and mesangium.
- EM
- Subepithelial immune complex (IC) humps.
- Characteristics
- Most frequently seen in children.
- Occurs ~2 weeks after group A streptococcal infection of the pharynx or skin.
- Resolves spontaneously.
- Type III hypersensitivity reaction.
- Findings
- Presents with peripheral and periorbital edema, dark urine (cola-colored), and hypertension.
- Increased anti-DNase B titers and decreased complement levels.
12
Q
Rapidly progressive glomerulonephritis (RPGN)
- Type of disease
- LM and IF
- Several disease processes may result in this pattern, including:
- Prognosis
A
- Type of disease
- Nephritic syndrome
- AKA rapidly progressive (crescentic) glomerulonephritis (RPGN)
- LM and IF
- Crescent-moon shape [A].
- Crescents consist of fibrin and plasma proteins (e.g., C3b) with glomerular parietal cells, monocytes, and macrophages.
- Several disease processes may result in this pattern, including:
-
Goodpasture syndrome
- Type II hypersensitivity
- Antibodies to GBM and alveolar basement membrane –> linear IF
- Hematuria/hemoptysis.
- Granulomatosis with polyangiitis (Wegener)
- PR3-ANCA/c-ANCA.
- Microscopic polyangiitis
- MPO-ANCA/p-ANCA.
-
Goodpasture syndrome
- Prognosis
- Poor prognosis.
- Rapidly deteriorating renal function (days to weeks).
![](https://s3.amazonaws.com/brainscape-prod/system/cm/125/171/988/a_image_thumb.png?1659443743)
13
Q
Diffuse proliferative glomerulonephritis (DPGN)
- Type of disease
- LM
- IF
- EM
- Due to…
- Most common cause of…
A
- Type of disease
- Can present as nephrotic syndrome and nephritic syndrome concurrently.
- LM
- “Wire looping” of capillaries.
- IF
- Granular.
- EM
- Subendothelial and sometimes intramembranous IgG-based ICs often with C3 deposition.
- Due to…
- SLE or MPGN.
- Most common cause of…
- death in SLE.
14
Q
IgA nephropathy (Berger disease)
- Type of disease
- LM
- IF
- EM
- Presentation
A
- Type of disease
- Nephritic syndrome
- LM
- Mesangial proliferation.
- IF
- IgA-based IC deposits in mesangium.
- EM
- Mesangial IC deposits.
- Presentation
- Seen with Henoch-Schönlein purpura.
- Often presents/flares with a URI or acute gastroenteritis.
- Episodic hematuria with RBC casts.
15
Q
Alport syndrome
- Type of disease
- Due to…
- Findings
A
- Type of disease
- Nephritic syndrome
- Due to…
- Mutation in type IV collagen –> thinning and splitting of the glomerular basement membrane.
- Most commonly X-linked.
- Findings
- Glomerulonephritis, deafness, and, less commonly, eye problems.