RENAL PATHOLOGY Flashcards by Iseoluwa Ojo

Kidney

_______-shaped paired organs.

Weight: ____gm and ____gm in the adult male and female respectively.

Hilium of kidney: _____ of ______ aspect where the artery, vein, lymphatics and ureter are located.

Bean

150; 135

midpoint of medial

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Kidney

Surrounded by a (thin or thick?) fibrous capsule adherent at the ______.

Cut surface of kidney made up of a well-demarcated peripheral ______ and inner ______.

Thin ; hilium

cortex; medulla

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Kidney

Cortex: ___ to ____ cm in thickness.

Medulla: composed of several _____-shaped renal _______.

The apex of each pyramid called the ______ is related to a ______.

1.2 to 1.5

cone; pyramids

papilla; calyx

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Kidney

Septa of Bertin: ______ tissue that extends ________________________

Pelvis:_______-shaped (proximal or distal?) part of the _________ formed by the union of _______________________.

cortical

into the space between adjacent pyramids.

funnel; proximal; ureter

2 to 3 major calyces

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NORMAL STRUCTURE - HISTOLOGY

Parenchyma of each kidney is composed of approx. _______ microstructures called ____________.

one million

nephrons

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NORMAL STRUCTURE - HISTOLOGY

Nephrons consist of _____ major parts having a functional role in urine formation;

The glomerular capsule ( ______ and ————-).

The ___________________

The __________________

The ______________________

_______________

Glomerulus and Bowman’s capsule

proximal convoluted tubule (PCT).

loop of Henle.

distal convoluted tubule (DCT).
I

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NORMAL STRUCTURE - HISTOLOGY

Four components of renal parenchyma from point of view of kidney diseases;

_________
__________
________
___________

Renal vasculature
Glomeruli
Tubules
Interstitium

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Renal vasculature

Each kidney is supplied with blood by a renal artery, arising from the aorta at ____.

It usually divides into _____ and ______ divisions at the hilium, sometimes they arise _______________

L2; anterior and posterior

directly from the aorta.

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Renal vasculature

The anterior and posterior divisions divide into _______ branches from which the ___________ arteries arise which course within the lobes.
These arteries along their course, they give off the ________ arteries which arch between the ___________________________

These arteries in turn, give off _________ arteries which lie in the ______ , (parallel or perpendicular ?) to the capsular surface in the part overlying the pyramids and are called ______ arteries.

segmental

interlobar

arcuate; cortex and medulla.

interlobular; cortex; perpendicular

Straight

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Renal vasculature

Afferent arterioles take their origin from _______ arteries each supplying ________________.

Efferent arterioles emerge from the _______. The arteries and arterioles are _______________

interlobular; a single glomerulus

glomerulus; end vessels.

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Renal vasculature

Efferent arterioles leaving the glomerulus supply ________________ plexus which anastomoses with the ________ of another nephron.

The _______________, give off a series of parallel vessels called ________ which descend to the inner medulla supplying the __________ and _________ and anastomose at all levels throughout the medulla with the _______________

peritubular capillary

capillary plexus

juxtamedullary glomeruli

Vasa recta ; loop of Henle and collecting ducts

ascending vasa recta.

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Renal vasculature
Theses drain into arcuate veins and finally through veins that accompany corresponding arteries and finally a _________ vein into the ____________.

single renal ; inferior vena cava

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Renal vasculature cont’d

Lymphatic drainage occurs likewise through lymphatics associated intrarenal vasculature leaving the kidney hilum and draining to _______ lymph nodes.

The renal cortex receives about ______% of the total renal blood supply, so the pressure in the capillaries are (low or high?) .

lateral aortic

90; high

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the renal _______ is more prone to the effects of hypertension.

cortex

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The renal medulla is (well or poorly?) perfused and any interference in blood supply results in ____________

poorly

Medullary necrosis.

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Renal vasculature

The divisions and subdivisions of the renal artery up to arterioles are __________ and have _________, therefore occlusion of any of the branches will result in ______________________________________.

end arteries; no anastomoses

infarction of the renal parenchyma supplied by it

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Renal vasculature

The tubular capillary beds are derived from the _________ arterioles leaving the _______, thus dieases affecting the ________ tuft affect the tubules significantly.

efferent arterioles

glomeruli

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Glomerulus

The glomerulus consists of invagination of the _____ end of the _______ and contains a ___________ fed from the afferent arteriole and drained by the efferent arteriole.

The capillary tuft is covered by ____________(_________) which are continuous with those of the _________ epithelium at the vascular pole.

The transition of proximal tubular cells occurs at the __________________________

blind

proximal tubule ; capillary tuft

visceral epithelial cells (podocytes)

parietal

urinary pole of the glomerulus.

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The visceral and parietal epithelial cells are separated by the ___________ or ___________

urinary space or Bowman’s capsule.

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Glomerulus

The capillaries from the afferent arterioles form lobules of which there are not more than ____ in the glomerulus.

Each lobule of a glomerular tuft consists of __________________ stalk composed of ————- containing ______ cells and ___________ matrix.

centrilobular supporting

mesangium; mesangial

mesangial matrix

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Glomerulus

The mesangium is continuous at the _____ with the ______ of the _____________.

hilum; lacis cells

juxtaglomerular apparatus

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The mesangial cells produce _________ and __________

mesangial matrix and glomerular basement membrane.

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The mesangial cells produce mesangial matrix and glomerular basement membrane.

They function in __________ of leaked _______ and probably control ___________________ through contractile elements in their cells.

endocytosis

macromolecules

glomerular blood flow

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Glomerulus

Main function of the glomerulus is ____________ from the _______ to the ___________

complex filtration

capillaries

urinary space.

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Glomerulus The barrier of the glomerulus consists of 3 components: •__________ ————— cells lining the capillary loops. •Glomerular _____________ on which the _________ rest •___________________ between the ______________ of the _________________ external to ______.

Fenestrated endothelial basement membrane ; endothelial cells Filtration slit pores; foot processes visceral epithelial cells (podocytes) GBM

Glomerulus Glomerular basement membrane consists of 3 layers –central _________, bounded by ____________ and ____________\

lamina densa lamina rara interna lamina rara externa.

Glomerulus The barrier to filtration of macromolecules of the size and molecular weight of albumin and larger depends upon : A normal ___________, maintenance of ____________ on both lamina rarae, a healthy glomerular __________ covering.

lamina densa negative charge epithelial cells

Juxtaglomerular Apparatus (JGA) Situated at the vascular pole of the glomerulus and is made up of 3 parts; The ___________ cells The __________ The ________ cells or _________ cells

juxtaglomerular macula densa lacis; non-granular

Juxtaglomerular Apparatus (JGA) The juxtaglomerular cells: are modified __________________ cells in the media of the ___________ and contain the hormone, _________

granular smoot muscle afferent arteriole; renin

Juxtaglomerular Apparatus (JGA) The macula densa: comprised by specialized region of the ________ when it returns to the ________ of its parent glomerulus.

distal tubule vascular pole

Juxtaglomerular Apparatus (JGA) The lacis cells or non-granular cells: occupy the space between the _________ and _________ and merge with the _________________

macula densa and the arterioles glomerular mesangium.

__________ account for the amount of the renal parenchyma.

Tubules

Tubules 1. Proximal convoluted tubule (PCT): This is the _______ part arising from the glomerulus. It is lined by _______ cells with a _______ composed of ___________. Contains numerous _________,__________ and ______________ The major functions are (passive or active?) reabsorption of filtered _____,_____,_____,_____,_____,_____,_____,______ and (active or passive?) reabsorption of ___% of filtered water.

first cuboidal; brush border; microvilli mitochondria, Golgi apparatus and endoplasmic reticulum. Active ; sodium, potassium, glucose, amino acids, proteins, phosphate, calcium and uric acid Passive ; 80

The structure of the renal tubular epithelium varies in different parts of the nephron and is correlated with the __________ of that part of the tubule.

functional capacity

Tubules Loop of Henle. The PCT drains into the ______ part of loop of Henle that consists of thin , descending and ascending limbs and the actual loop, all of which are found in the ________. They are lined by a _______ type of epithelium The thin ascending limb continues as _____________ in the ___________. The major function is (passive or active?) reabsorption of _______ and ______ and (active or passive?) diffusion of _____ resulting in urinary concentration.

straight; medulla flattened; thick ascending limb medullary rays; active ; sodium and chloride Passive ; water

Tubules Distal convoluted tubule (DCT) Represents a transition from ________________ from the point where the ascending limb meets the vascular pole of the glomerulus of its origin to the ___________ The lining cells are ________ which are (lower or higher?) than those of PCT. The epithelial cells at the point of beginning of DCT are (shorter or taller?), (narrower or wider?) and more closely packed to form the ________ of JGA. Further contributes to urinary _______ and ______ while the ______ of JGA is the source of ______ and has a role in ______ metabolism.

thick ascending limb ; early collecting ducts. cuboidal; lower ; taller; narrower macula densa ; concentration and acidification renin; sodium

Tubules Collecting ducts The system of collecting ducts is the final pathway by which urine reaches the tip of ____________ The cells lining the collecting ducts are ________ but ______________

renal papilla. cuboidal lack the brush border.

Interstitium In health, the renal cortical interstitium is _______ and consists of a (small or large ?) number of __________-like cells. The medullary interstitium is more ______ and contains ______ cells, which are considered to produce ____________ agents and are involved in the metabolism of _______. • •

scanty; small; fibroblasts plentiful; stellate anti-hypertensive prostaglandins

RENAL FUNCTION TESTS VITAL FUNCTIONS THE KIDNEY PERFORMS ARE; Excretion of ___________ Regulation of _____________ Regulation of _________ Formation of _______ and _________

waste products acid-base balance salt-water balance renin and erythropoietin

Urine Analysis The ______ examination The _________ tests The ____________ examination Urine _________

physical chemical bacteriologic microscopy

Concentration and Dilution Tests In ________ test In ___________ test,

concentration dilution

Renal Clearance Tests In _______ or _______ clearance tests, In _________ clearance test, In ______ clearance test, ________________ clearance test

inulin or mannitol creatinine urea Para-aminohippuric acid (PAH)

CLINICOPATHOLOGIC FEATURES OF KIDNEY DISEASES GLOMERULAR DISEASES Most often ___________-mediated May be ______ or _____ TUBULAR DISEASES Likely to be caused by ______ or _______ agents May be _______ or _____

immunologically acute or chronic toxic or infectious acute or chronic

CLINICOPATHOLOGIC FEATURES OF KIDNEY DISEASES INTERSTITIAL DISEASES Commonly due to ______ or _____ agents Quite often involve _______ and ______ (___________ diseases). VASCULAR DISEASES Include changes in the nephron as a consequence of ________________ such as in hypertension or impaired blood flow. Other diseases are congenital anomalies, obstructive uropathy, and tumours of the kidneys.

toxic or infectious interstitium and tubules; tubulo- interstitial increased intra-glomerular pressure

CLINICOPATHOLOGIC FEATURES OF KIDNEY DISEASES Major morphologic involvements of the kidneys in the initial stage is confined to ______ component (glomeruli, tubules, interstitium or blood vessels). Eventually, ____ components are affected leading to _____ kidneys.

one all; end-stage

Renal disease usually results in the evolution of one of the 2 major pathological syndromes; ___________ and ________

acute renal failure and chronic renal failure.

Azotaemia: elevation of the ___________ and _______ levels Uraemia: association of _______ abnormalities with clinical signs and symptoms.

blood urea nitrogen (BUN) and creatinine biochemical

CLINICAL MANIFESTATIONS OF RENAL DISEASES Clinical manifestations of renal disease can be grouped into the syndromes below: Nephritic syndrome  Due to ________ disease.  Dominated by the acute onset of ____________, ——— to ______ and _________.

glomerular grossly visible hematuria mild to moderate proteinuria hypertension

CLINICAL MANIFESTATIONS OF RENAL DISEASES Clinical manifestations of renal disease can be grouped into the syndromes below: Rapidly progressive glomerulonephritis  Characterized as a ____________ with ___________ (hours to days) in. ______.

nephritic syndrome rapid decline; GFR

CLINICAL MANIFESTATIONS OF RENAL DISEASES Clinical manifestations of renal disease can be grouped into the syndromes below: The nephrotic syndrome  Due to ________ disease.  Characterized by _______,________,_________,________,_________

glomerular heavy proteinuria, hypoalbuminemia, severe edema, hyperlipidemia and lipiduria.

CLINICAL MANIFESTATIONS OF RENAL DISEASES Asymptomatic hematuria or proteinuria or a combination of both Usually a combination of _______ or _____ ———————————

subtle or mild glomerular abnormalities,

CLINICAL MANIFESTATIONS OF RENAL DISEASES Acute renal failure Dominated by ____uria or ___uria and recent onset of ________. Can result from ______,______,________ injury or ________ injury.

olig; an azotemia glomerular, interstitial or vascular acute tubular

CLINICAL MANIFESTATIONS OF RENAL DISEASES Chronic renal failure Characterized by prolonged symptoms and signs of _________. It is the end result of all ___________________

uremia chronic renal parenchymal diseases.

CLINICAL MANIFESTATIONS OF RENAL DISEASES Renal tubular defects Dominated by _____uria, _______ and electrolyte disorders. They are the result of diseases that either ______________ or cause defects in ____________

poly; nocturia directly affect tubular structure specific tubular functions.

CLINICAL MANIFESTATIONS OF RENAL DISEASES Urinary tract infection Characterized by _________ and _______ The infection may be symptomatic or asymptomatic May affect the ______ or ________

bacteriuria and pyuria. kidney or the bladder.

CLINICAL MANIFESTATIONS OF RENAL DISEASES Nephrolithiasis (renal ______) Manifested by severe ______ and ______, often with recurrent ————

stones spasms of pain and hematuria stone formation.

CLINICAL MANIFESTATIONS OF RENAL DISEASES Urinary tract obstruction and renal tumours Have varied clinical manifestations based on the specific anatomic location and nature of the lesion. T/F

Renal Failure Acute renal failure implies a (slow or rapid?) and frequently (reversible or irreversible?) deterioration of renal function. The evolution from normal renal function to _________________ broadly progresses through a series of 4 stages that merge into one another: Diminished _______ GFR is about __________ Serum BUN and creatinine values are _______ Patients are _______, however they are more susceptible to developing ________________

Rapid ; reversible symptomatic chronic renal failure renal reserve; 50% of normal.; normal; asymptomatic azotemia with additional renal insult.

Renal Failure The evolution from normal renal function to symptomatic chronic renal failure broadly progresses through a series of 4 stages that merge into one another: Renal sufficiency GFR IS ______________ __________ appears, usually associated with _______ and _________ ______uria and _____uria can occur as a result of decreased concentrating ability ________ may precipitate uremia.

20% to 50% of normal. Azotemia anemia and hypertension. Poly; noct Sudden stress

Renal Failure The evolution from normal renal function to symptomatic chronic renal failure broadly progresses through a series of 4 stages that merge into one another: Chronic renal failure GFR is _____________\\ Kidneys cannot regulate volume and solute composition Patients develop _______,________, and __________ Overt ______ may ensue with neurologic, gastrointestinal and cardiovascular complications.

less than 20% to 25% of normal. edema, metabolic acidosis and hyperkalemia. uremia

Renal Failure The evolution from normal renal function to symptomatic chronic renal failure broadly progresses through a series of 4 stages that merge into one another: End-stage renal disease GFR is ______________ This is the terminal stage of _________

less than 5% of normal uremia

Congenital Malformations Approximately _____% of all persons are born with potentially significant malformations of the urinary system.

Congenital Malformations About half of all patients with malformations of the kidneys have coexistent anomalies either elsewhere in the urinary tract or in other organs. T/F

Congenital Malformations Malformations of the kidneys are classified into 3 broad groups: Abnormalities in ______________ Anomalies of _______,_______, and ________ Anomalies of ___________

amount of renal tissue position, form and orientation differentiation

Congenital Malformations Anomalies of position, form and orientation: These are renal ectopia (______kidney), renal fusion (______ kidney) and _______________

pelvic horseshoe persistent foetal lobation.

Cystic Diseases of the Kidney They are a _____genous group comprising hereditary, developmental but nonhereditary and acquired disorders.

hetero

Cystic Diseases of the Kidney As a group, they are important for several reasons: •They are reasonably (common or rare?) and often represent __________ for clinicians, radiologists and pathologists. •Some forms such as ____________ disease are major causes of chronic renal failure. •They can occasionally be confused with _______________

Common; diagnostic problems adult polycystic malignant tumours.

Classification of Renal Cysts Cystic renal _________ _______kidney disease ________ cystic disease _______(dialysis-associated) cystic disease ________ (simple) renal cysts Renal cysts in __________ syndromes __________ disease ________________ renal cysts

dysplasia Polycystic Medullary Acquired Localized hereditary malformation Glomerulocystic Extraparenchymal

Polycystic kidney disease Autosomal-__________(_____) polycystic disease Autosomal- __________(________) polycystic disease

dominant; adult recessive; childhood

Renal Cystic Dysplasia Is used for defective renal ________ with __________________ in the kidney not represented in normal ___________ such as presence of ________________ containing smooth muscle or cartilage and immature collecting ducts.

differentiation persistence of structures nephrogenesis; undifferentiated mesenchyme

Renal Cystic Dysplasia It is diagnosed on the basis of _________________ The condition is fairly common in the ________ and _________. The pathogenesis of renal dysplasia is ________.

histologic features. newborn and infants unknown

Renal Cystic Dysplasia Pathologic Changes  Renal dysplasia may be _________ or _______  The dysplastic process may involve the ____________ or __________

unilateral or bilateral entire renal mass or a part of it.

Renal Cystic Dysplasia Grossly,  The dysplastic kidney is almost always __________.  The kidney is replaced by disorderly mass of _________ that is not uniform but resembles ___________.  No normal renal parenchyma is recognizable, and ______ and ______ are not present.  The _______ is invariably abnormal , being either absent or atretic.

cystic; multiple cysts; a bunch of grapes calyces and pelvis ureter

Renal Cystic Dysplasia Histologically, The characteristic feature is the presence of _______________ that contains _________ or _____________ The cysts are __________ lined by _____ epithelium surrounded by concentric layers of connective tissue. Glomeruli are _________ or _______

undifferentiated mesenchyme smooth muscle or cartilage. dilated tubules; flattened scanty or absent.

Renal Cystic Dysplasia Clinical Features Is frequently discovered in newborn or infants as a ___________ Often, it is associated with other congenital malformations and syndromes such as ventricular septa defect, trachea-esophageal fistula, lumbosacral meningomyelocele and Down’s syndrome. The progress of unilateral renal dysplasia following removal of the abnormal kidney is ______ while bilateral renal dysplasia results in _________

flank mass. excellent death in infancy.

Autosomal-Dominant (Adult) Polycystic Kidney Disease Relatively (common or rare?) and is the cause of end-stage renal failure in approximately 10% of _________ patients The pattern of inheritance is autosomal dominant having (low or high?) penetrance with ______ expressivity. Family history of renal disease may be present. The condition occurs due to mutation in chromosome ______. Though the kidneys are ______ at birth, renal function is ______ and symptoms appear in adult life, mostly between the age of _____ and _____ years.

Common; haemodialysis High; variable; 16 abnormal; retained 30 and 50

Autosomal-Dominant (Adult) Polycystic Kidney Disease Grossly,  Kidneys are always bilaterally _____, usually symmetrically, ______ and ______. The cut surface shows ______ throughout the renal parenchyma varying in size from tiny cysts to 4-5cm in diameter. The content of the cysts vary from __________ fluid to ________ material. The renal pelvis and calyces are present but are ______ by the cysts, however, do not communicate with the pelvis of the kidney - a feature that helps to distinguish polycystic kidney from _________ kidney.

enlarged; heavy and cystic cysts clear straw-yellow ; reddish brown greatly distorted hyderonephrotic

Autosomal-Dominant (Adult) Polycystic Kidney Disease Histologically, The cysts arise from ______ of nephron. It is possible to find some cysts containing recognizable ________ reflecting their origin from ________, while others have epithelial lining like that of distal or proximal tubules or collecting ducts. The intervening tissue between the cysts shows ________________ With ______________ of ______ of the patient, acquired lesions such as pyelonephritis, nephrosclerosis, fibrosis and chronic inflammation are increasingly seen.

all parts; glomerular tufts ; Bowman’s capsule some normal renal parenchyma. advancement of age

Autosomal-Dominant (Adult) Polycystic Kidney Disease Clinical Features  The condition may become clinically apparent at any age but most commonly manifests in ________ decades of life.  The most frequent and earliest presenting feature is a _________ in the ________ regions.  In others, the presenting complaints are ________ or passage of _______ in urine, renal colic, hypertension, urinary tract infections and progressive CRF with polyuria and proteinuria.

3rd to 5th dull-ache ; lumbar haematuria; blood clots

Autosomal-Dominant (Adult) Polycystic Kidney Disease Clinical Features  About a third of patients with adult polycystic kidney disease have __________  Other associated congenital anomalies seen less frequently are cysts in the pancreas, spleen, lungs and other organs.  Approximately 15% of patients have one or more _____________________________  Any acquired renal disease is more prone to occur in polycystic kidneys.

cysts of the liver. intracranial berry aneurysms of the circle of Willis.

Autosomal-Recessive (Childhood) Polycystic Kidney Disease It is transmitted as an autosomal recessive trait and the family history of similar disease is usually (present or not present?) The condition occurs due to a mutation in chromosome ____ It is invariably (unilateral or bilateral?) . The age at presentation may be perinatal, neonatal, infantile or juvenile. Frequently serious manifestations are present at ____ and result in death from _________ in early childhood.

not present. 6.; bilateral birth; renal failure

Autosomal-Recessive (Childhood) Polycystic Kidney Disease Grossly, The kidneys are bilaterally ________ with (smooth or rough?) external surface and retained normal shape. Cut surface reveals (small or large?) , fusiform or cylindrical cysts formed from dilation of ______ which extend _____ to the ______________ This gives the sectioned surface of the kidney a _______-like appearance. __________ renal parenchyma is grossly recognized. Pelvis, calyces and ureters are (normal or abnormal?) .

enlarged; smooth Small; collecting tubules; radially; outer cortex. sponge; No normal Normal

Autosomal-Recessive (Childhood) Polycystic Kidney Disease Histologically,  The total number of nephrons is ______ but all the ______ show cylindrical or saccular dilatations and are lined by cuboidal to low columnar epithelium.  Many of the glomeruli are also ____________.

normal; collecting tubules cystically dilated

Autosomal-Recessive (Childhood) Polycystic Kidney Disease Clinical Features The clinical manifestations depend on _____________ In severe form, the gross bilateral cystic renal enlargement may interfere with ________ In infancy, _________ may manifest early.

age of the child. delivery. renal failure

Autosomal-Recessive (Childhood) Polycystic Kidney Disease Clinical Features Almost all the cases of infantile polycystic kidney disease have associated multiple epithelium-lined cysts in the liver or proliferation of portal bile ductules. In older children, these associated hepatic changes develop into what is termed ______________ which may lead to ____________ and ____________

congenital hepatic fibrosis portal hypertension and splenomegaly.

Simple Renal Cysts Are very (common or rare?) postmortem finding. Are seen in about ____ of all persons above the age of 50 years. Since cysts are rare in _____ and ________, they appear to be ______ rather than _______ lesions. Simple cysts of the kidneys are (frequently or rarely?) responsible for symptoms. However, symptoms may result from _______,______, or ________ The association between simple cysts and _________ is common.

Common; half; infants and children acquired; congenital Rarely ; rupture, haemorrhage or infection. hypertension

Simple Renal Cysts Grossly,  Simple renal cysts are usually ______ but may be ________.  They are commonly located in the _______.  Their size vary from a _______ to _______ in diameter.  The wall of cyst is characteristically __________ and ________  The cyst usually contain _______-coloured fluid which may become _____-coloured due to _______.

solitary; multiple cortex few millimeters to 10cm yellowish-white and translucent. clear straw; rust haemorrhage

Simple Renal Cysts Microscopically,  The lining of the cyst is by ______ epithelium.  The cyst wall contains variable amount of ________ tissue which may occasionally have deposits of ________ or ________

flattened collagenised fibrous haemosiderin or calcium salts.