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CRRAB 2 > Renal Pathology > Flashcards

Renal Pathology Flashcards

1
Q

Horseshoe kidney

A 
congential pathology
conjoined kidney (usually lower pole)
gets caught on inferior mesenteric artery --> abnormally located in lower abdomen
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2
Q

Renal Agenesis

A

Congenital pathology
Bilateral –> leads to oligohydraminos –> lung hypoplasia, flat face, low ears, extremity defects –> incompatible with life
Unilateral –> hypertrophy of existing kidney –> increased risk for renal failure later in life

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3
Q

Dysplastic Kidney

A

Noninherited congenital pathology
Unilateral or bilateral (if bilateral, distinguish from polycystic)
congential malformation of renal parenchyma with cysts and cartilage tissue

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4
Q

Polycystic Kidney Disease (PKD)

A

inherited defect leading to bilateral enlarged kidneys with cysts in renal cortex and medulla

  1. Autosomal recessive - infants with Potter sequence and hepatic fibrosis
  2. Autosomal dominant - young adults with HTN, hematuria, renal failure (cysts develop over time)
    - associated with berry aneurysm, hepatic cysts, mitral valve prolapse
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5
Q

Medullary Cystic Kidney Disease

A

inherited defect leading to cysts in medullary collecting duct

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6
Q

Acute Renal Failure

A

Acute, severe decrease in renal function
Azotemia with oliguria
3 Types

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7
Q

Prerenal Azotemia

A

due to decreased blood flow (CHF, hemorrhage)
decreased GFR, azotemia, oliguria
increased BUN/Cr ratio
tubular function normal = FENa <1%

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8
Q

Postrenal Azotemia

A

due to obstruction in urinary tract
decreased GFR, azotemia, oliguria
EARLY - increased BUN/Cr ratio, FENa 2% because of tubular damage

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9
Q

Acute Tubular Necrosis

A

Injury and necrosis of tubular epithelial cells
Necrotic cells plug up tubule –> obstruction
decreased GFR, azotemia, oliguria, brown casts in urine
decreased BUN/Cr ratio, FENa >2%
Can be ischemic or nephrotoxic etiology

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10
Q

Acute Interstitial Nephritis

A

Drug-induced hypersensitivity involving interstitium and tubules
NSAIDs, penicillin, diuretics
Oliguria, fever, rash, eosinophilia

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11
Q

Renal Papillary Necrosis

A

Necrosis of renal papilla
Gross hematuria and flank pain
Causes:
- chronic analgesic use, DM, sickle cell, acute pyelonephritis

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12
Q

Nephrotic Syndrome

A

glomerular disorder with proteinuria (>3.5 g/day)

- hypoalbuminemia, hypogammaglobulinemia, hypercoaguable (AT III), hyperlipidemia

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13
Q

Minimal Change Disease

A

Idiopathic, some association with Hodgkin lymphoma (massive overproduction of cytokines)
Normal glomeruli on H&E
Effacement of foot processes on EM (HALLMARK)
No immune complex deposition
Selective proteinuria (albumin)
Excellent response to steroids

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14
Q

Focal Segmental Glomerulosclerosis

A 
Idiopathic, some association with HIV, heroin, sickle cell
Focal, segmental sclerosis on H&E
Effacement of foot processes on EM
No immune complex
Poor response to steroids
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15
Q

Membranous Nephropathy

A

Idiopathic, some association with Hep B/C, SLE, drugs
Thick glomerular BM on H&E
Immune complex deposition (subepithelial) –> spike and dome appearance
Poor response to steroids

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16
Q

Membranoproliferative glomerulonephritis

A

Thick glomerular BM on H&E, ‘tram-track’ appearance
Immune complex deposition
Type 1 - subendothelial (Hep B, C)
Type 2 - intramembranous –> C3 nephritic factor (stabilizes C3 convertase)
Poor response to steroids

17
Q

Diabetes Mellitus

A

high serum glucose –> nonenzymatic glycosylation of vascular BM –> leaky –> hyaline arteriolosclerosis
Stenosis of efferent arteriole –> high glomerular filtration pressure
Sclerosis of mesangium
ACE inhibitors slow progression

18
Q

Systemic Amyloidosis

A

Kidney is most commonly involved organ of systemic amyloidosis
Deposits in mesangium –> Congo Red stain

19
Q

Nephritic Sydnrome

A

Glomerular disease with glomerular inflammation and bleeding
Limited proteinuria
Oliguria and azotemia
Periorbital edema and HTN
Immune complex deposition activates complement –> C5 attracts neutrophils –> damage

20
Q

Poststreptococcal Glomerulonephritis

A

Arises after group A strep infection –> M-protein
Hematuria, oliguria, HTN, periorbital edema
Hypercellular, inflamed glomeruli
Immune-complex deposition

21
Q

Rapidly Progressive Glomerulonephritis

A

progresses to renal failure in weeks/months

Crescents in Bowmans space on H&E (composed of fibrin and macrophages)

22
Q

IgA Nephropathy

A

IgA immune complex deposition in mesangium following mucosal infection (IgA)

23
Q

Alport Syndrome

A

Inherited defect in type IV collagen (X-linked)
Results in thinning and splitting of glomerular BM
Presents as isolated hematuria, sensory hearing loss, and ocular disturbances

24
Q

UTIs

A

infection of urethra, bladder, kidney
most commonly –> ascending infection
more likely in females (50x)
risk factors: sex, urinary stasis, catheters

25
Q

Cystitis

A

bladder infection
presents as dysuria, urinary frequency and urgency, suprapubic pain (systemic symptoms absent)
Positive urine culture (gold standard)
E. Coli (80%)
Staph saprophyticus (young sexually active females)
Klebsiella and proteus (gram + urease -)

26
Q

Pyelonephritis

A

kidney infection
ascending infection, increased risk with vesicoureteral reflux
Fever, flank pain and WBC casts (systemic symptoms)
E. Coli (90%)
Enterococcus, Klebsiella

27
Q

Chronic Pyelonephritis

A

interstitial fibrosis and atrophy of tubules
vesicoureteral reflux or obstruction
leads to scarring and blunted calyces (thyroidization of kindeys)

28
Q

Nephrolithiasis

A

precipitation of urinary solute as stone
Risk factors: urinary stasis, high solute [ ]
presents as colicky flank pain, hematuria

29
Q

Chornic Renal Failure

A

Results from glomerlular, tubular, inflammatory or vascular insults
Common causes: DM, HTN, glomerular disease
Features: uremia, salt and water retention –> HTN, Hyperkalemia, anemia, hypocalcemia, renal osteodystrophy

30
Q

Angiomyolipoma

A

hamartoma comprised of blood vessels, smooth muscle, and adipose tissue
- increased frequency with tuberous sclerosis

31
Q

Renal Cell Carcinoma

A

malignant epithelial tumor from kidney tubules
Classic triad = hematuria, palpable mass, flank pain (rarely see triad)
Sx: fever, weight loss, paraneoplastic syndrome
Left-sided varicocele (right spermatic veins drains directly into IVC so no R)
Pathogenesis: loss of VHL (tumor suppressor gene)

32
Q

Wilms Tumor

A

malignant kidney tumor comprised of blastema (common in kids deletion of WT1 gene (Wilms tumor, Aniridia, Genital abnormalities, Retardation)
Beckwith-Wiedemann syndrome –> mutation in WT2 gene

33
Q

Urothelial Carcinoma

A

malignant tumor or urothelial lining (transitional epithelium)
involves ureter, renal pelvis, bladder, urethra
Major risk factor = SMOKING, long term cyclophosphamide use
Seen in older adults with painless hematuria
2 distinct pathways
1. Flat - high grade flat tumor that invades
2. Papillary - low grade papillary tumor –> high grade –> invades

34
Q

Squamous Cell Carcinoma

A

malignant proliferation of squamous cells (bladder)
Arises from squamous cell metaplasia from chronic inflammation
Risk factors = chronic cystitis, Schistosoma hematobium, long-standing nephrolithiasis

35
Q

Adenocarcinoma

A

malignant proliferation of glands (bladder)
Arises from urachal remnany (tumor develops at dome of bladder)
Metaplasia from chronic inflammation

36
Q

Nomenclature of glomerular disorders

A

Focal - 50% of glomeruli
Proliferative - hypercellular glomeruli
Membranous - thickening of GBM
Primary glomerular disease - only involves glomeruli
Secondary glomerular disease - involves other organs as well

CRRAB 2 (21 decks)

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