Renal Pathology Flashcards
The glomerulus is composed of what 3 things?
Endothelial cells, basement membrane and podocytes
What are the 4 main renal functions?
- Excrete metabolic wastes
* creatine, urea and certain drugs - Regulate acid-base balance
* balance of H+ and HCO3 - Regulate water-salt balance
* renin-angiotensin-aldosterone system - Secretes hormones
- erythropoietin
- conversion of vitamin D into D3
Discuss ADH:
- What are the steps in the release of ADH?
- What is another name for ADH?
- What does ADH insert into the collecting duct?
- Carotid baroreceptors signal hypothalamus to release ADH (vasopressin) which then inserts aquaporins into the wall of the collecting duct thus increasing water reabsorbtion without ion reabsorption
Which of the following is activated in response to low blood sodium?
A. Macula densa
B. J cells
A. Macula densa
Macula densa = low blood Na+
J cells = low blood pressure
A ______ in GFR is the most common cause of kidney failure.
A. increase
B. decrease
B. decrease
________ is characterized by damage to the glomerular membrane resulting in enlargement of the fenestrations between endothelial cells and/or slit pores of endothelial cells.
A. Nephrotic syndrome/ Nephrosis
B. Nephritic syndrome / Nephritis
A. Nephrotic syndrome/ Nephrosis
______ is inflammation of the glomerulus which is most commonly caused by immunologic abnormalities.
A. Nephrotic syndrome/ Nephrosis
B. Nephritic syndrome / Nephritis
B. Nephritic syndrome / Nephritis
Discuss Nephrotic syndrome / Nephrosis:
- What is damaged and what does the damage result in?
- Discuss fluid shifts and how hydrostatic and oncotic pressure contribute.
- What are the 2 clinical manifestations?
- What are the 3 types of Nephrosis?
Nephrotic syndrome / Nephrosis
- Damage to the glomerular membrane which results in enlargement of fenestrations allowing protein to make it through
- Oncotic pressure decreases as a result and protein is eliminated in the urine
- The loss of protein causes edema in the face/eyes and hypotension
- 3 types of nephrosis:
- Minimal change disease (usually in children; good prognosis)
- Focal segmental glomerulosclerosis (scarring of the glomerulus; poor prognosis)
- Membranous glomerulonephitis:
- Autoimmune activation
- deposition of antibodies in basement membrane
- increased membrane permeability and thickening
Which of the following types of nephrotic syndrome is characterized by scarring of the glomerulus?
A. Minimal change disease
B. Focal segmental glomerulosclerosis
C. Membranous glomerulonephritis
D. All of the above
B. Focal segmental glomerulosclerosis
Minimal change disease = children
Focal segmental glomerulosclerosis = scarring of glomerulus
Membranous = increased membrane permeability and thickening
Which of the following types of nephrotic syndrome is characterized by increased membrane permeability and thickening?
A. Minimal change disease
B. Focal segmental glomerulosclerosis
C. Membranous glomerulonephritis
D. All of the above
C. Membranous glomerulonephritis
Membranous glomerulonephritis:
- Autoimmune activation
- Deposition of antibodies in the basement membrane
- Increased membrane permeability and thickening
Which of the following types of nephrotic syndrome can be caused by the 3 H’s (HIV, heroin and hypertension)?
A. Minimal change disease
B. Focal segmental glomerulosclerosis
C. Membranous glomerulonephritis
D. All of the above
B. Focal segmental glomerulosclerosis
All of the following are characteristic of Membranous glomerulonephritis (a nephrotic syndrome) EXCEPT:
A. Deposition of antibodies in the basement membrane
B. Scarring of the glomerulus
C. Autoimmune activation
D. Increased permeability and thickening
B. Scarring of the glomerulus
What are the three causes of Nephrotic syndrome (nephrosis)?
- Hypertension
- Diabetes
- Type III immune disorders (lupus, rheumatoid arthritis)
Nephritic syndrome (nephritis) causes:
- Immunological abnormalities (most common)
- drugs or toxins
- vascular diseases
- systemic diseases
- viral causes
Nephrotic syndrome (nephrosis) is characterized by:
A. Excretion of 3.5 g or more of protein in urine per day
B. Excretion of less than 3.5 g or more of protein in urine per day
A. Excretion of 3.5 g or more of protein in urine per day
Nephrotic = 3.5 or more
Nephritic = less than 3.5 g of protein
What are the 4 clinical manifestations of nephritic syndrome (nephritis)?
- Slight proteinuria (<3.5 g/day)
- Hematuria (blood in urine)
- Azotemia
- Hypertension
Nephrotic syndrome (nephrosis):
- Edema in face/eyes
- Hypotension
All of the following are types of Nephritic syndrome (nephritis) EXCEPT:
A. Membranous glomerulonephritis
B. Acute post infectious glomerulonephritis
C. IgA nephropathy
D. Rapidly progressive glomerulonephritis (RPGN)
E. Chronic glomerulonephritis
A. Membranous glomerulonephritis
Which of the following types of Nephrotic syndrome (nephritis) typically occurs 2-3 weeks after a strep infection?
A. Membranous glomerulonephritis
B. Acute post infectious glomerulonephritis
C. IgA nephropathy
D. Rapidly progressive glomerulonephritis (RPGN)
E. Chronic glomerulonephritis
B. Acute post infectious glomerulonephritis
Acute post infectious glomerulonephritis = strep
IgA nephropathy (Berger disease) = URT or GI viral infection
RPGN = Ab form against basement membrane (good pasture syndrome)
Chronic glomerulonephritis = slow progressive loss of renal function
Which of the following types of Nephrotic syndrome (nephritis) is known as Goodpasture Syndrome?
A. Membranous glomerulonephritis
B. Acute post infectious glomerulonephritis
C. IgA nephropathy
D. Rapidly progressive glomerulonephritis (RPGN)
E. Chronic glomerulonephritis
D. Rapidly progressive glomerulonephritis (RPGN)
- Ab form against basement membrane
Which of the following types of Nephrotic syndrome (nephritis) seen 2-3 days after URT or GI viral infections?
A. Membranous glomerulonephritis
B. Acute post infectious glomerulonephritis
C. IgA nephropathy
D. Rapidly progressive glomerulonephritis (RPGN)
E. Chronic glomerulonephritis
C. IgA nephropathy
- IgA binds glomerular mesangial cells, inducing proliferation
Which of the following is characterized by a large collection of WBC?
A. Pyelonephritis
B. Drug-induced interstitial nephritis
A. Pyelonephritis
Which of the following is a disease of the proximal tubule associated with loss of reabsorption (glucose, amino acids and phosphate)?
A. Pyelonephritis
B. Drug-induced interstitial nephritis
C. Acute Tubular Necrosis
D. Fanconi Syndrome
D. Fanconi Syndrome
All of the following are characteristic of Benign Nephrosclerosis EXCEPT:
A. Found in patients with hypertension
B. Hyaline thickening of arterial walls
C. Leads to mild functional impairment
D. Renal ischemia
D. Renal ischemia (malignant nephrosclerosis)
All of the following are characteristic of adult polycystic kidney disease EXCEPT:
A. Many large cysts
B. Associated with brain aneurysms
C. Autosomal recessive
D. Autosomal dominant
C. Autosomal recessive
Adult polycystic kidney disease:
- Autosomal dominant
- Many large cysts
- Associated with brain aneurysms
Child polycystic kidney disease:
- Autosomal recessive
- Many small cysts
- Often accompanied by liver cysts
Which of the following is associated with childhood polycystic kidney disease?
(select all that apply)
A. Many large cysts
B. Associated with brain aneurysms
C. Autosomal recessive
D. Autosomal dominant
E. Many small cysts
C. Autosomal recessive
E. Many small cysts
All of the following are characteristic of Childhood polycystic kidney disease EXCEPT:
A. Autosomal recessive
B. Many small cysts
C. Associated with brain aneurysms
D. Often accompanied by liver cysts
C. Associated with brain aneurysms
Discuss Urolithiasis:
- What is the common name for urolithiasis?
- What is it?
- Who is typically affected? (M/F)
- What is the main component?
- What is the process of how its caused?
- What can it result in?
Urolithiasis
- Urolithiasis = kidney stones
- It is calculus (stone) formation in the urinary collection system
- Male > Female
- Main component = calcium oxalate
- Process:
- supersaturation of one or more salts
- precipitation of a salt from liquid to solid (caused by temperature and urinary pH)
- growth into a stone via crystallization or aggregation
- Can result in Hydronephrosis which is blockage leading to dilation of the renal pelvis and calyces
What is hydronephrosis and what may it be caused by?
Hydronephrosis: blockage leading to dilation of the renal pelvis and calyces
Can be caused by congenital atresia of ureter, calculi, tumors and inflammation
Which of the following is derived from tubular epithelium?
A. Renal carcinoma
B. Bladder carcinoma
A. Renal carcinoma
Renal carcinoma = tubular epithelium
Bladder carcinoma = transitional epithelium
Which of the following is derived from transitional epithelium?
A. Renal carcinoma
B. Bladder carcinoma
B. Bladder carcinoma
Renal carcinoma:
- tubular epithelium
- 5% survival rate (very lethal)
- Painful hematuria
Bladder carcinoma:
- transitional epithelium
- 50% survival rate
- Painless hematuria
_______ is fainting after or during urination.
Micturition syncope
