Renal Pathology 2 Flashcards
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Normal adult kidney
Capsule has been removed & pattern of fetal lobulations still persists (sometimes does). Hilum has some adipose tissue. There is a simple renal cyst (smooth surface, small, clear fluid) - not uncommon in adults.
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Normal Kidney
Cut surface of the kidney with good cortical-medullary demarcation and pelvic adipose tissue
Light outer cortex & darker medulla with renal pyramids into which the collecting ducts coalesce and rains into calyces and central pelvis
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Normal kidney
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Acute pyelonephritis
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Acute Pyelonephritis
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Acute Pyelonephritis
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Acute Pyelonephritis
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Acute Pyelonephritis
Ascending bacterial infection leading to acute pyelonephritis. Numerous PMNs seen filling renal tubules across center/right of this pic. These leukocytes may form into a cast within the tubule. Casts appearing in the urine orginate in the distal renal tubules and collecting ducts.
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Acute Pyelonephritis
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Acute Pyelonephritis
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Acute Pyelonephritis
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Renal Papillary Necrosis
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Sloughed renal papillary in Renal Papillary Necrosis
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Sloughed renal papilla in renal papillary necrosis
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Distended calyx & ureter in hydronephrosis
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Atrophy of renal parenchyma = non-functional in hydronephrosis
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Hydronephrosis
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Hydronephrosis
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Hydronephrosis
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Nephrolithiasis
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Staghorn Calculus
Urolithiasis
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Staghorn Calculus
Struvite stone, usually forms in alkaline urine
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Uric acid calculi
Form in acidic urine, radiolucent
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Urolithiasis
Calcium oxalate stones
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Urolithiasis
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Urolithiasis
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Urolithiasis
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Nephrosclerosis
Granular surface due to tiny infarcts throughout renal cortex
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Hyaline arteriosclerosis in nephrosclerosis
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Hyaline arteriosclerosis in nephrosclerosis
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Nephrosclerosis
Small red dot petechiae hemorrhage (Flea bitten kidney)
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Nephrosclerosis (fibrinoid necrosis)
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Nephrosclerosis
Onion-skinning hyperplastic arteriolitis
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Nephrosclerosis
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Autosomal dominant PKD
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Autosomal Dominant PKD
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AD PKD
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AD PKD
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AD PKD
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AD PKD
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AR PKD
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AR PKD
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AR PKD
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AR PKD
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AR PKD
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AR PKD
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AR PKD
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Acquired Dialysis-associated cystic kidney disease
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Acquired Dialysis-associated cystic kidney disease
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Renal Cell Carcinoma
Bright yellow/orange because tumor cells have lipid in cytoplasm
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Renal Cell Carcinoma
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Renal Cell Carcinoma
Propensity to spread to renal vein & hematogenously
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Renal Cell Carcinoma
Adipocytes with empty cytoplasm
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Renal Cell Carcinoma
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Transitional Cell Carcinoma
| (In renal pelvis, not yellow)
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Transitional Cell Carcinoma
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Transitional Cell Carcinoma of Ureter
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Transitional Cell Carcinoma of Bladder
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Transitional Cell Carcinoma
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Transitional Cell Carcinoma
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Transitional Cell Carcinoma
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Transitional Cell Carcinoma
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Wilm's Tumor (Nephroblastoma)
Usually large by the time diagnosis occurs
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Wilm's Tumor (Nephroblastoma)
Left side has cells that are mostly nucleus with less cytoplasm
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Wilm's Tumor (Nephroblastoma)
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Wilm's Tumor (Nephroblastoma)
Left: primitive; Right: glandular structure
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Wilm's Tumor (Nephroblastoma)
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What are the clinical features of acute pyelonephritis?
Fever, malaise, flank pain, urinary frequency, dysuria
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What is found in the lab work of someone with acute pyelonephritis?
Pyuria, bacteruria, sometimes hematuria, WBC casts
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What are 2 common agents that cause acute pyelonephritis via hematogenous spread?
Staphylococcus
E. coli
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What are some common organisms that cause acute pyelonephritis via ascending infection?
E. coli
Proteus
Enterobacter
Klebsiella
Enterococcus
Pseudomonas
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What are some risk factors/causes (besides bacteria) of acute pyelonephritis?
1. Short urethra (females)
2. Stasis of urine (any cause)
3. Structural abnormalities of urinary tract (causes obstruction)
4. VUR
5. Catheterization of bladder
6. Diabetes mellitus
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What are some complications of acute pyelonephritis?
Perinephric abscess
Pyonephrosis
Renal papillary necrosis
Sepsis
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What are some causes of papillary necrosis?
Acute pyelonephritis with obstruction
Excessive intake of analgesics, esp. phenacitin
DM
Sickle cell disease
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What are some clinical hallmarks of papillary necrosis?
Inability to concentrate urine
Gross hematuria
Proteinuria
Colicky flank pain
Sloughing of renal papilla
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What is hydronephrosis?
Dilation of renal pelvis and calyces associated with progressive atrophy of kidneys due to obstruction of urine outflow
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What are some causes of hydronephrosis?
Transitional cell carcinoma of renal pelvis/ureter
Carcinoma of cervix
Blood clot
Ureteral stone
Retroperitoneal fibrosis
Pregnancy/endometriosis
BPH
Uretheral stricture
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What is a main clinical finding of hydronephrosis?
Postrenal azotemia
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What are the clinical findings of urolithiasis?
Flank pain radiating toward groin
Hematuria
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What are the 4 main types of urinary tract calculi?
Calcium oxalate & calcium phosphate (70%)
Magnesium ammonion phosphate (struvite/staghorn calculus (15-20%)
Uric acid (5-10%)
Cystine (1-2%)
81
What is the difference betwen benign and accelerated nephrosclerosis?
Benign: normal/small kidney with finely granular cortical surface. Hyaline arteriolosclerosis, tubular atrophy, interstitial fibrosis, glomerular sclerosis
Accelerated: (malignant HTN), vascular injury to arterioles & small arteries (vasculopathy)
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What are the clinical findings in nephrosclerosis?
Acute renal failure
Hematuria, proteinuria
Rapid increased in BP (\>200/120)
Encephalopathy
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What are the gross and microscopic findings in nephrosclerosis?
Gross: swollen kidneys with petechial hemorrage (flea bitten kidney)
Microscopic: fibrinoid necrosis of arterioles, hyperplastic arteriolitis (onion skinning)
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What is the incidence of AD PKD?
What is the mutation and its frequency?
1/400-1/1,000 in US
PKD1 (85%) - polycystin 1 (chromosome 16p)
PKD2 (15%) - polycystin 2 (chromosome 4q)
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What is the chronologic sequence of events of AD PKD?
Bilateral cysts develop by 3rd decade (many also have liver/pancreas cysts)
Chronic renal failure by 40-60
Intracranial berry aneurysms (15-20% of patients)
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What is the incidence of AR PKD?
1:10,000 - 1:50,000
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Who does AR PKD affect?
Neonates, infants, and young children
75% of children die in perinatal period
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What is AR PKD associated with?
Congenital hepatic fibrosis -\> portal hypertension
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How is AR PKD different from AD?
AR PKD has numerous elongated cysts arranged at right angles to cortex w/ cylindrical enlargement of collecting tubules
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How common is Acquired Dialysis-associated cystic kidney disease?
Found in ~35% of patients treated with long-term dialysis
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What is Acquired Dialysis-associated cystic kidney disease?
Cystic disease superimposed on other types of kidney pathology
Probably due to obstruction of tubules by interstitial fibrosis or crystals
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What are the gross and microscopic findings of Acquired Dialysis-associated cystic kidney disease?
Gross: Numerous 0.5-0.2 cm cysts containing clear fluid
Microscopic: Cysts lined by hyperplastic or flattened tubular epithelium, sometimes contain Ca2+ oxalate crystals
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What are some complications of Acquired Dialysis-associated cystic kidney disease?
Hemorrhage into cysts or retroperitoneum
Renal cell carcinoma (7%)
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What is the most common primary malignancy of the kidney?
Renal cell carcinoma (80% of renal cancers)
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What syndromes are renal cell carcinoma associated with?
von-Hippel Lindau Syndrome
Paraneoplastic sydnrome: EPO, PTH, etc.
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What are the clinical findings of renal cell carcinoma?
Classic triad: Hematuria, CV angle pain, flank mass (but only seen in 10%)
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What are the histological findings of renal cell carcinoma?
Epithelioid cells arranged in nests, often with clear cytoplasm (clear cell carcinoma) due to intracellular lipid/glycogen
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Where does renal cell carcinoma have a tendency to invade and metastasize?
Tendency to invade renal vein and metastasize to bone, lung, CNS (late metastasis)
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What are some of the genetic associations of renal cell carcinoma?
Translocation, deletion on chromosome 3 --\> sporadic clear cell
Loss of VHL, inactivated/hypermethylated VHL --\> hereditary clear cell
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Urothelial (transitional cell) carcinomas represent \_\_% of primary renal tumors?
5-10%
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Where do Urothelial (transitional cell) carcinomas occur?
anywhere in the urinary tract, including renal pelvis
Patients may have multiple tumors in different locations
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Describe a Urothelial (transitional cell) carcinoma histologically & grossly
Composed of tumor cells resembling normal transitional epithelium (urothelium)
Gross: firm, white, sometimes papillary white cauliflower mass
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What is the most common childhood tumor of the kidney?
Wilm's tumor
most common from 1-7 y.o.
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What are the clinical findings of Wilm's tumor?
Palpable mass in abdomen or flank
HTN (due to renin secretion)
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Describe the gross and microscopic findings of Wilm's tumor?
Large, solid, circumscribed tumor
Resembles renal blastema (primitive mesodermal tissue) but may have "differentiation" in form of primitive tubular structures, glomeruli, or other mesenchymal tissue
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What is the treatment for Wilm's tumor?
Combined surgery, chemo, radiation
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What is the overall long-term survival of Wilm's tumor?
\>90%
