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Cell Pathology II > Renal Pathology > Flashcards

Renal Pathology Flashcards

1
Q

What are the three main types of microscopy/technical methods used histopathologically?

A
  • Light microscopy
  • Immunofluorescence microscopy/IHC
  • Electron microscopy
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2
Q

What type of capillaries are evident in renal pathology?

A

Fenestrated capillaries

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3
Q

What are the three difference cells of the glomerulus?

A

Visceral epithelial cell/podocyte
endothelial cell
Mesangial cell

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4
Q

What are the three components of the kidney which can be affected by kidney disease?

A
  • glomeruli
  • tubules
  • interstitium
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5
Q

What are the two types of renal biopsies?

A

Native biopsy - taken for the investigation of chronic or systemic disease
Transplant biopsy - to investigate graft dysfunction

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6
Q

What are the 3 stages of the dissection of the tissue?

A

LM
EM
IF

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7
Q

What is the primary step for LM?

A

Fix the portion in 10% buffered formalin

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8
Q

What is the primary step for electron microscopy?

A

EM in 2.5% glutaraldehyde

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9
Q

What is the primary step for IF?

A

Snap freeze the portion in liquid nitrogen

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10
Q

What does fixing in formaldehyde do to the antigenic sites of the tissues?

A

Formaldehyde fixing gives good fixation but alters the antigenic sites in tissue.
Followed by paraffin processing, dehydration through graded alcohols, clearing with xylene and infiltration/embedding in paraffin wax

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11
Q

The PAS stain highlights which areas of the glomerulus?

A

The focal areas of sclerosis?

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12
Q

Which stain is used to highlight the presence of amyloid protein in the renal biopsy?

A

Congo Red
Apple Green Biofringence when under polarized light

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13
Q

What stain could be used for the demonstration of connective tissue?

A

Masson Trichrome Stain

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14
Q

Histologically what is the difference between the proximal and convoluted tubules?

A

Proximal have a brush border while distal tubules have no brush border.

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15
Q

What type of casts can be seen in the tubule ?

A

casts - red cells, light chains (myeloma casts), protein casts

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16
Q

What is the main disadvantage to DIF?

A

Low sensitivity due to the lack of signal amplification

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17
Q

What is the main conjugation for DIF used?

A

Fluorescein conjugated antibody

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18
Q

What are the specimen requirements for IF?

A
  • tissue snap frozen in N2
  • 4 micron unfixed sections cut on cryostat
  • multiwell slides
    FITC conjugated panel of primary antibodies, applied for 30min
    slides washed after incubation, cover-slipped and examined under fluorescent microscope
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19
Q

What are the main types of antisera used in DIF?

A
  • IgA, IgM, IgG
  • C1q, C3
  • Kappa and Lambda light chains
  • fibrinogen
    0 - 4+
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20
Q

What is used for the primary and secondary fixation in electron microscopy?

A

1st - glutaraldehyde
2nd - osmium tetroxide

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21
Q

What is the initial staining in EM for semi-thin sections?

A

Toluidine blue

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22
Q

What is the initial staining in EM for ultra-thin sections?

A

Uranyl acetate and lead citrate

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23
Q

EM in renal pathology can be useful in renal pathology as it?

A
  • confirms presence/location of immune complexes (electron dense)
  • defines the degree of injury to the glomerular cell, BM and GBM
  • detects protein fibrils such as amyloid
  • provides ultrastructure information (podocyte effacement and flattening etxc)
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24
Q

What are two reasons for early renal insufficiency?

A
  1. Injection
  2. Rejection
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25
Q

What are the two reasons for late onset renal insufficiency?

A
  1. Transplant glomerulopathy
  2. Recurrence of original disease
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26
Q

What is Banff?

A

The international classification of Renal Allograft Rejection

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27
Q

What are reasons for renal rejection?

A
  • antibody/humoral mediated rejection
  • cellular rejection
  • polyoma virus, CMV infection
  • chronic glomerulopathy
  • de-novo and recurrent renal disease
28
Q

Positive incidence of which antibody in the tubular capillaries is indicative of humoral rejection?

A

Positive C4d staining
IF

29
Q

Acute kidney injury is caused by and what is the clinical definition attached to this morphological characteristic?

A

Damage to the tubular epithelium and an acute decline in renal function with casts and tubular epithelial cells observed in the urine. Evident via dipstick analysis.

30
Q

What are the four main causes of acute kidney injury?

A
  • tubular necrosis (leading cause)
  • glomerular disease
  • vascular disease
  • acute drug induced allergic interstitial nephritis
31
Q

Chronic renal failure is indicated by what?

A

A build up of fluid and waste products in the body including increased of serum creatinine and urea in the urine.
Eventually leading to ESKD

32
Q

What are the 4 causes of chronic renal failure?

A
  • hypertension
  • vascular disease
  • glomerular disease
  • tubular and interstitial disease
33
Q

Is chronic renal failure reversible?

A

No it is generally irreversible

34
Q

What is glomerulonephritis?

A

This is a glomerular injury, caused by a group of underlying diseases generally characterized by inflammatory changes in the glomerulus.

35
Q

Primary renal glomerular disease is limited to where?

A

It is a renal limited injury

36
Q

Secondary renal disease is limited to where?

A

It is systemic disease which involves the kidney

37
Q

What are the four characteristics of nephrotic syndrome?

A
  • proteinuria >3.5g/24hr
  • oedema
  • hyperlipidaemia
  • hyperlipiduria
38
Q

What are the four primary disorders of nephrotic syndrome?

A
  • minimal change
  • FSGS
  • Membranous
  • MPGN
39
Q

What are the three secondary disorders of nephrotic syndrome?

A
  • diabetes
  • amyloidosis/light chain deposition disease
40
Q

What is the morphological evidence of Minimal Change (primary) nephrotic syndrome?

A

effacement of foot processes

41
Q

In membranous glomerulopathy (primary), what is visible under light microscopy?

A
  • normal cellular population in glomerulus
  • thickened GBM
  • spikes and rings seen on Jones Silver Stain
42
Q

Membranous GN is caused by the GBM becoming stuffed with?

A

Immune complexes

43
Q

What are the clinical features of diabetic nephropathy? (secondary)

A
  • ten years of diabetes mellitus
  • microalbuminuria (proteinuria) is an early clinical feature.
  • hypertension is common
44
Q

What is evident under light microscopy with diabetic nephropathy?

A
  • increase in mesangial matrix
  • sclerotic mesangial nodules ‘wilson bodies’
45
Q

What is evident under electron microscopy with diabetic nephropathy?

A
  • podocytes; show effacement
  • thick glomerular basement membrane up to 1000nm in thickness
46
Q

What is a normal thickness of the basement membrane in electron microscopy?

A

male 370+/- 50nm
female 320 +/- 50nm

47
Q

What is amyloidosis?

A

It is an accumulation of abnormally folded protein in the tissue.

48
Q

AL Amyloid is associated with which disease? (light chain)

A

Multiple myeloma

49
Q

What stain is used for highlighting amyloid deposits in the kidney?

A

Congo Red

50
Q

AA amyloid is associated with which chronic inflammatory conditions? (serum amyloid A protein)

A
  • Rheumatoid arthritis
  • TB infections
51
Q

What are the 5 main clinical findings of nephritic syndrome?

A
  • haematuria
  • proteinuria
  • increased serum creatinine
  • oliguria (low urine output)
  • hypertension
52
Q

What are the three primary disorders of nephritic syndrome?

A
  • crescentic (rapidly progressive GN)
  • IgA nephropathy
  • post infectious GN
52
Q

What are the three primary disorders of nephritic syndrome?

A
  • crescentic (rapidly progressive GN)
  • IgA nephropathy
  • post infectious GN
53
Q

What are the three secondary disorders of nephritic syndrome?

A
  • SLE
  • Vasculitis
  • HSP
54
Q

What is the most common glomerular disease worldwide?

A

IgA nephropathy

55
Q

What are the clinical features of IgA nephropathy?

A
  • haematuria
  • proteinuria
  • HSP
56
Q

What is IgA nephropathy caused by ?

A

Inadequate clearance of an abnormal IgA molecule from tissues

57
Q

What is seen under light microscopy with IgA nephropathy?

A
  • mesangial proliferation
  • immune deposits of IgA in the mesangial and paramesangial areas, electron dense deposits
58
Q

What is prognosis of IgA nephropathy?

A
  • slow progression to ESRD
  • HSP in children –> complete resolution
59
Q

What is rapidly progressive glomerulonephritis characterized by?

A

nephritic syndrome which progresses rapidly to renal failure within weeks to months.
Focal rupture of the capillary walls (LM and EM)

60
Q

What are the three classifications of RPGN underlying causes?

A
  • anti GBM antibody
  • immune complex disease
  • pauci-immune disease
61
Q

If RPGN is due to pauci immune disease what is the ANCA result?

A

Positive

62
Q

How are creasents formed?

A

By the proliferation of the epithelial cells of the bowman’s capsule
Migration of monocytes and macrophages into the glomerular space

63
Q

How is PIGN visible under LM?

A
  • hypercellular
  • leukocytes
  • proliferation of mesangial and endothelial cells
  • polymorphs (multi-lobed, dark-staining nuclei)
64
Q

Post Infectious GN has evident deposition of which immune cells under IF?

A

C3
IgG
‘starry night’ pattern

65
Q

What morphological feature is evident in Post infectious GN under EM?

A

Hump like deposits on the epithelial side of the GBM

66
Q

What are the three main diseases of the tubules and interstitium?

A
  1. pyelonephritis
  2. tubular injury
  3. drug induced interstitial nephritis

Cell Pathology II (6 decks)

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