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USLME Kiss my ass and pray > Renal - Pathology > Flashcards

Renal - Pathology Flashcards

1
Q

inferior mesenteric artery root implicated in this congenital problem

A

horseshoe kidney

most common congenital renal anomaly

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2
Q

Bilateral renal agenesis 1 problem w/3 complications

Also known as

A

oligohydraminos

  • > lung hypoplasia, flat face w/ low set ears, developmental extremity problems
  • potters syndrome
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3
Q

Unilateral renal agenesis complication

A

hypertrophy and later hyperfiltation later on leading to renal failure risk

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4
Q

Noninherited congenital renal malformation characterized by cysts

what histology seen

A

dysplastic kidney (usually unilateral)

Collagen adjacent to cysts

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5
Q

inherited defect w/ cysts in the renal cortex and medulla

A

Polycystic kidney disease

infantile and adults

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6
Q

inherited defect w/ cysts in the medullary collecting duct

Seen grossly

A

Medullary cystic disease (Auto Dom)

shrunken kidneys

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7
Q 
ADPCK
presents as (3)

associated w/(3)

A

Adults w/ HTN, hematuria and worsening renal failure

berry aneurisms
hepatic cysts
mitral valve prolapse

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8
Q

Infantile PCKD presents as

A

Auto recessive

presents as renal failure and infantile HTN

also have hepatic fibrosis w/ hepatic cyst formation

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9
Q

Acute renal failure seen as

A

Azotemia and oliguria seen w/in days

Divided into pre renal, post renal and infrarenal

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10
Q

Azotemia def

A

increased BUN and Creatinine in serum

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11
Q

Prerenal azotemia due to?

See:(3)

BUN:Creatinine
FENa ?
Osm?

A

decreased blood flow

See decreased GFR, azotremia and oliguria

BUN:Creatinine >15, low flow means BUN can resorb, renin aldosterone working to increase BUN level
FENa 500 mOSM/kg - tubes are fine

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12
Q

Postrenal azotremia ude to

See (3)

BUN:Creatinine
FENa
Osm

A

obstruction downstream

See low GFR, azotemia and oliguria

Depends:
Early
- BUN:Cr >15, BUN forced into serum w/ backpressur
-FENa 500 mOsm, tubes fine

Late - tubular damage - Can’t resorb as well
-BUN:Cr 1%
Osm <500mOsm

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13
Q

Intrarenal Tubular necrosis is

Types(2)?

A

Problem w/in the kidney(block) usually resulting in BUN:Cr < 15 ( overall increase in BUN and creatinine)
FENa >1%
Osm <500 mOSM

Acute Tubular Necrosis - tubes
Acute interstitial nephritis - surrounding tissue

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14
Q

Causes of Acute tubular necrosis (2)

A

Ischemia
- low blood supply, preceded by pre renal azotemia

Nephrotoxic
-aminoglycosides, heavy metals. myoglobinuria(crush injury), ethylene glycol, radio contrast die, urate (tumor lysis syndrome(

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15
Q

Brown granular cases in urine seen in

A

necrotic cells plugging the tubule in acute tubular necrosis

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16
Q

Tumor lysis syndrome

What is it and prevention?

A

acute leukemia treated w/ chemo -> increased nuclear material in the blood

Rx w/ hydration and allopurinol

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17
Q

Acute interstitial nephritis Due and causes (3)

A

Drug induced hypersensitivity of surrounding tissue

NSAIDs, penicillin and diuretics

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18
Q

Clinical features of acute tubular necrosis (3)

A

oliguria w/ brown granular casts
elevated BUN and Creatine
Hyperkalemia(reduced excretion) w/ metabolic acidosis (decreased organic acid excretion)

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19
Q

eosinophils seen in urine?

A

acute interstitial nephritis

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20
Q

Renal papillary necrosis

Presentation(2) and causes (4)

A

gross hematuria and flank pain w/ necrotic renal papillae

Due to:
chronic analgesic use, 
DM, 
Sickle cell
severe acute pyelonephritis
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21
Q

Nephrotic syndrome = what seen

4 complications

A

> 3.5 g.day filtered

leading to
hypoalbuminemia -edema
hypogammaglobinemia - infection risk
hypercoaguable - loss of anti thrombin III
Hyperlipidemai and hypercholesterolemia - fatty casts in urine (liver wants to thicken blood)

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22
Q

Most common syndrome in kids

Associated w/

A

minimal change disease

Hodgekin lymphoma - due to cytokine release leading the change

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23
Q

effacement of foot processes on electron microscopy (2)

Rx?

A

minimal change disease or focal glomerulosclerosis

Steroids, great response in KIDS,
not adults w/ FSGS -> renal failure

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24
Q

HIV, heroin and sickle cell associated nephrotic syndrome

A

Focal semental glomeulosclerosis

Usually idiopathic

MOST COMMON - hispanic and African americans

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25
Q

Membranous nephopathy is associated w/ (5)

A

used to be most common - usually idiopathic

HepB
HepC
solid tumors
SLE - (diffuse prolifererative glomerulinephritis more common)
Drugs (NSAIDs and penicillamine)
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26
Q

Thick glomeruli basement membrane on H and E w/ immune complex deposits (granular) (2)

A

Membranous nephropathy

Membranoproliferative glomerulonephritis
(can be nephritis too)

Deposits go to all 3 areas

  • subepithelial - membranous nephropathy
  • subendothelial - Type I membranoproliferative gom
  • BM - type II membranoproliferative glom
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27
Q

Spike and dome appearance EM

A

Membranous nephropathy -

Podocytes like to be on BM and will lay down BL over subepithelial deposits

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28
Q

Tram Track appearance on Em

Associated w/

A

Membranoproliferative Glomerulonephritis Type 1

(HBV and HCV)

Mesangial cells adjacent proliferate w/ sub endothelial deposits and tries to split deposit w/ increased cytoplasm -> tram track

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29
Q

Associated w/ C3 nephritic factor

What is It?

A

membranoproliferative glomerulonephritis Type II

intramembranous deposit (BM)

Antibodies stabilize C3 convertase instead of destroying it -> hyperactive complement activation inflammation and decreased C

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30
Q

nonenzymatic glycosylation of vascular BM -> hyaline arteriolosclerosis

A

Diabetes mellatis nephrotic syndrome

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31
Q

Kimmelstiel Wilson nodules

A

Sclerosis of the mesangium seen in DM nephrotic syndrome

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32
Q

Protective agent in DM nephrotic syndrome

A

ACE inhibitors

Prevents further clamping of the efferent arteriole and associated hyper filtration (selected in the disease progression)

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33
Q

Nephrotic syndrome w/ apple green birefringence

deposits are what type and where?

A

Systemic Amyloidosis involves kidney most commonly

deposits in the mesangium

AL seen from original cause multiple myeloma

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34
Q

6 types of nephrotic syndrome

A

Minimal change disease
Focal segmental glomerulosclerosis

Membranous Nephropathy
Membranoproliferative Glomerulonephritis (nephritic as well)

Diabetes Mellitus
Systemic Amyloidosis

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35
Q

Nephritic syndrome characterized by(2)

Also see

A

glomerular inflammation(hyper cellular) and bleeding

limited proteinuria periorbital edema and HTN
RBC casts

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36
Q

Hypercellularity in nephritic syndrome is due to

A

Immune complex deposition and activation of complement -> C5a recruitment of PMNs

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37
Q

Types of nephritic syndrome(5)

A 
Membranoproliferatve glomerulonephritis
poststreptococcal glomerulonephritis
rapidly progressive glomerulonephritis
- Linear
-Granular
- Negative IF
IgA nephopathy - Berger disease
Alport Syndrome
38
Q

sub epithelial humps seen on EM post sore throat

More common in?

A

Poststreptococcal glomerulonephritis
2-3 weeks post sore throat or impetigo infection

(group A beta hemolytic strep pharynges)

More common in kids, mote dangerous in adults -> rapidly progressive glomerulonephritis

Sub endo -> sub epi (humps)-> goes away- passes (supportive Rx)

39
Q

Crescents in Bowmans space are made of what?

Pathology called?

A

Made of fibrin and macrophages

Nephritic syndrome - Rapidly Progressive Glomerulonephritis

40
Q

3 immunofloresent patterns seen in Rapidly progressive glomerulinephritis

A

Linear - Anti BN
Granular - Immune complex deposit
Negative IF - no immune showing

41
Q

SLE associated nephritic syndrome

A

diffuse proliferative glomerulonephritis

a nephritic syndrome (rapidly progressive glomerulonephritis) w/ granular deposition

42
Q

Ab against collagen in the glomerular and alveolar BM

A

Goodpasture Syndrome

Hematuria and hemoptysis

43
Q

sub endothelial deposition of immune complexes in adults that does not get better

A

poststroptococcal glomerulonphritis (granular)

44
Q

negative IF and C-ANCA nephritic syndrome

3 targets

A

Wegeners

lung, kidney, nasopharynx

45
Q

2 p- ANCA disease w/ negative IF nephritic syndromes

A

Churg Strauss

Microscopic polyangiitis

46
Q

Churg Struass has 3 differences from microscopic polyangiitis

A

granulomatous inflammation
eosinophilia
asthma

47
Q

Most common nephropathy world wide w/ deposition in the mesangium post mucosal infection

A

IgA nephropathy

episodic gross or microscopic hematuria post illness progressing to renal failure

48
Q

sensory hearing loss, ocular disturbance and isolated hematuria

All due to

A

Alport syndrome

Inherited defect in type Iv collagen
X linked

49
Q

gold standard in cystitis

Other labs

A

> 100,000 colony forming units

positive leukocyte esterase and nitrites (from bacteria converting nitrates)

Cloudy urine

50
Q

Presentation of Cystitis(4) and notable absence

A

dysuria
frequency
urgency and suprapubic pain

absence of systemic signs

51
Q

Etiology of cystitis (top 5)

A 
E coli
Staph saprophyticus - esp if sexually active
Klebsiella pneumoniae
Proteus miabilis - alkaline urine
Enterococcus faecalis
52
Q

Sterile urine w/ symptoms of cystitis/urethritis suggestive of

have pyuria

A

Chlamydia tachomatis or Nesseria gonorrhoea

53
Q

Pyelonephritis noteable addition in presentation over cystitis (4)

A

fever
flank pain
WBC casts
lekocytosis

54
Q

Chronic pyelonephritis risk increases w/(2)

A

vesicoureteral reflux - kids

obstruction (BPH/cervical carcinoma) - adults

55
Q

Interstitial fibrosis and atrophy of the tubules -> cortical scarring w. blunted calyces called?

A

multiple bouts of pyelonephritis -> chronic pyelonephritis

56
Q

Charactersitically scarred in vesicoureteral reflux chronic pyelonephritis

A

upper and lower poles

57
Q

esosinophilic proteinaceous material resembling thyroid follicles

A

Atrophic tubules in chronic pyelonephritis

Waxy casts also

58
Q

Presentation of nephrolithiasis(3)

A

Colicky pain
Hematuria
unilateral flank tenderness

59
Q

Common causes of chronic renal failure(3)

A

DM
HTN
Glomerular disease

60
Q

Uremia in chronic renal failure see (7)

A

increased nitrogenous waste products in the blood->

nausea
anorexia
pericarditis
platelet dysfunction - low adhesion and aggregation
encephalopathy w/ asterixis
deposition of urea crystals in skin
61
Q

Clinical Features of Chronic renal disease (6)

A 
Uremia
Na and water retention
Hyperkalemia and Metabolic alkalosis
Anemia - low EPO
Hypocalcemia - 
Renal osteodystophy
62
Q

Erythropoeitin made by?

A

renal peritubular interstitial cells

63
Q

Hypocalcemia in chronic renal failure due to ?

A

decreased 1 alpha hydroxylation of VIt D by proximal renal tubule cells

and hyperphosphatemia

64
Q

Bone destruction in chronic renal failure is called what and due to what 3 things?

A

Renal ostrodystrophy

osteritis fibrosis cystica -> hypocalcemia and secondary hyperparathyroidism

osteomalacia - low Vit D function

osteoperosis - Ca leached from bone to buffer metabolic acidosis

65
Q

Crohn’s has this renal association?

Due to?

A

Calcium oxalate stones

Due to increased reabsorbtion of oxalate and precipitation in the

66
Q

Rx for most common cause of stones in kidneys

A

hydrochlorothiazide

Ca sparing dieuretic for Ca oxalate stones

67
Q

Alkaline urine and infection -> this?

Major complication

A

Ammonium magnesium phosphate stones and urease positive organisms (Proteus or Klebsiella)

Staghorn calculi

68
Q

Only radiolucent stone

Due to?

A

Uric acid

Seen in gout patients and hyperuricemia - > leukemia or myeloproliferative

69
Q

Risk factors for Uric acid stone (3)

A

hot arid climate
low urine volume
acidic pH

(Rx w/ hydration and alkalination w/ bicarb)

70
Q

Inherited renal stone risk?

A

Cystein stones

w/ cystinuria - defect of tubules and decreased reabsorption of cysteine

Also staghorn calculi

71
Q

Harmatoma w/ blood vessels, smooth muscle and adipose tissue - renal neoplasia

Increased in?

A

Angiomyolipoma

Tuberous sclerosis

72
Q

Classic triad of renal cell carcinoma

A

Hematuria
palpable mass
flank pain

  • rare, usually hematuria
73
Q

See a patient w/ reactive polycythemia or cushing syndrome or hypercalcemia or HTN w. hematuria?

A

Renal cell carcinoma

Has a lot of paraneoplastic potential

74
Q

Left sided varicocele w/ hematuria

A

renal cell carcinoma

75
Q

Most common subtype of renal cell carcinoma

A

clear cell

Grossly see a yello mass

76
Q

Loss of VHL(3p)

A

Renal cell Carcinoma

A tumor suppressor gene

increased IGF-1 and HIF as a result

77
Q

2 pathogenesis of renal cell carcinoma and associated epidemiology

A

Sporadic - seen in adult (>60) smokers unilaterally

Hereditary seen in younger adults bilaterally

78
Q

Von hoppel Lindau disease - due to

Risks(2)

A

AD disease w/ inactivation of VHL gene

hemangioblastoma of cerebellum and renal cell carcinoma

79
Q

METS of renal cell Carcinoma (2)

Nodes located?

A

Lungs and bone
w/ renal vein involvement

retroperitoneal

80
Q

Blastema implicated in

what is it

A

Wilms Tumor

immature kidney mesenchyme

81
Q

3 year old kid w/ hematuria, HTN an large unilateral flank mass

A

Wilms tumor

HTN w/ renin

most common malignant

82
Q

WT1 gene

A

Tumor suppressor gene implicated in Wilms tumor

90% sporadic

83
Q

WAGR syndrome(4)

due to?

A

wilms tumor
Aniridia
genital abnormalities
mental and motor retardation

-deletion of WT1 (llp13)

84
Q

Denys Drash syndrome(3)

  • due to ?
A

Wilms tumor
progressive renal disease
male pseudohemaphroditism

mutations in WT1

85
Q

Beckwith Wiedmann Syndrome(4)

-due to?

A

Wilms tumor
neonatal hypoglycemia
muscular hemihypertrophy
organomegaly - tongue

WT2 gene cluster mutation

86
Q

Risk factors of Urothelial (transitional cell) carcinoma (5)

A 
Cigarette smoke - main
naphthalyamine
Azo dye
cyclophosphamide long use
phenacetin long use
87
Q

Older adult presents w/ painless hematuria, what must be ruled out

A

urothelial (transitional cell) carcinoma

88
Q

Field effect ?

A

Bladder cancer

multifocal and recur w/ chronic bath of carcinogen

89
Q

2 types of urothelial carcinoma

  • 2 major differences
A

Flat - starts high grade w/ p53 mutations - Progression

Papillary - starts low grade w/out p53 -> progression

90
Q

background of squamous metaplasia in the bladder?

3 causes

A
  • predisposes for squamous cell carcinoma

Chronic irritation

  • chronic cystitis (old women)
  • Schistosoma hematobium (middle east)
  • nephrolithiasis
91
Q

Cancer presents at the dome of the bladder

due to ?

A

Adenocarcinoma bladder
- malignant prolif of gland cells

often due to Urachal remnant

Other causes cystitis glandularis or extrophy (bladder outside)

92
Q

string of beads on angiography leading to HTN

A

fibromuscular dysplasia

seen in middle age women, renal vascular sclerosis

bruits on auscultation

USLME Kiss my ass and pray (33 decks)

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