Renal Pathology Flashcards
Hypoplasia with no scarring and a decrease in lobe number indicates?
Primary Hypoplasia (not due to any external factors)
ADPCKD chromosomes?
polycystin 1 or 2 (1 more common)
Non-kidney anomalies in ADPCKD?
Liver cysts (40%) Berry Aneurysms (DEATH) Mitral Valve Prolapse (25%)
Child with progressive polyuria and polydipsia. Pathology shows medullary cysts.
Nephronophthisis-Uremic Medullary Cystic Disease Complex
Nephritis Syndrome caused by and characteristics?
Inflammation of glomerulus with RBC casts, hematuria, BUN/Creatinine >15, HTN, Edema
Child with malaise, mild proteinuria, hematuria with smokey urine, HTN. Pathology shows:
Neutrophil infiltrate in glomerulus
Granular IF pattern
Subepithelial humps on EM
Post-Strep GN
Patient presents with progressive hematuria, edema. Pathology shows: Large pale petechial kidneys Crescent formation in glomerulus What are three possible causes?
Crescent Rapidly Progressing GN
- Anti GBM (linear IF)
- IC disease - granular IF
- P or C ANCA (Vasculitis)
Nephrotic Syndrome?
Cytokine induced podocyte effacement Massive Proteinuria Fatty Casts Edema (decreased albumin) Susceptibility to infection (Decreased Ig) Hypercoagulable (Decreased ATIII)
Patient with chronic proteinuria. Pathology shows: Normal cellularity diffuse thickening of capillaries Granular IF Subepithelial spikes on EM
Membranous GN
Causes of Membranous GN?
85% Idiopathic
- NSAIDs
- Malignancy
- IC
- DM
- HBV
Child with massive proteinuria, Normotensive, following URTI. Pathology shows:
Normal looking except Podocyte effacement and lipoid deposits
Minimal Change Disease
Cause of Minimal Change disease and treatment?
T-Cell mediated loss of GBM charge
TX = Steroids
Cancer associated with Minimal Change Disease?
Hodgkin’s Lymphoma
Adult with nephrotic syndrome, HTN. Pathology shows:
Focal changes
Collapsed GBM
Increased mesangial matrix hyalinization
Focal Segmental Glomerulosclerosis
Causes of FSGS?
HIV
Heroin
Compensatory hypertrophy
Prognosis of FSGS?
Bad
RAS can slow progression
50% with have end-stage renal disease in 10 years
Adult with nephrotic syndrome, HTN. Pathology shows: Focal changes Collapsed GBM Increased mesangial matrix hyalinization Cystic dialted tubules tubuloreticular inclusions
What disease does this person have?
HIV nephropathy
Type 1 membranoproliferative disease features?
Alternate and Classic SUBENDOTHELIAL complement deposition
Leukocyte infiltration
Very cellular
Type 2 membranoproliferate disease features?
Alternate complement deposition in the lamina densa
Leukocyte infiltration
(Dense deposit disease)
Recurrent hematuria
Pathology shows:
Mesangial deposits of IgA
Berger’s disease (IgA Nephropathy)
IgA nephropathy associated with which vasculitis?
Henoch-Schonlein
Genetic mutation in alpha-5-chain type VI collagen with irregular GBM
Alport Syndrome
Inheritance of Alport Syndrome
X-linked
Thin GBM due to genetic deficiency in collaged
Thin Membrane Disease
What can progress to Chronic GN
Rapidly progressing GN Focal Segmental Glomerulosclerosis Membranous GN Membranoproliferate GN Post-Strep IgA nephropathy
Decreased Urine output, increased BUN, oliguria, hyperkalemia, metabolic acidosis. Urine has hyaline and granular casts.
Acute Tubular Necrosis
Causes of ATN?
Ischemia
Toxicity (Aminoglycosides most common)
Polyuria, nocturia, and metabolic acidosis with normal looking tubules. PMN and eosinophil infiltrates
Tubulointerstitial Nephritis
Acute Drug-induced Interstital nephritis
- When?
- Pathology?
- Causes?
15 days after drugfs
Lymphocyte and macrophage granulomas
Type 1 and 4 immune response
What causes uric acid to precipitate and cause kidney damage?
Chemo or gout cause uric acid crystals to obstruct tubules
NSAID nephropathy mechanism of injury?
Inhibition of PGE vasodilation decreased perfusion causing both Interstitial nephritis and glomerulonephritis
Multiple Myeloma mechanism of kidney injury?
Ig chains directly toxic to tubules (Bence-Jones proteinuria)
Bruit on kidney ascultation?
Renal Artery Stenosis
Young black male with HTN, nausea, vomiting, hematuria and proteinurua. Pathology Shows:
Petechial kidney
Fibrinoid necrosis
Onion skinning hyperplastic arteriolitis
Malignant Nephrosclerosis
Sudden onset bleeding, oliguria, hematuria, MAHA?
Hemolytic Uremic Syndrome
Typical HUS cause?
Verycytotoxin E Coli
Atypical HUS cause?
Anti-Phospholipid
Pregnancy
Cyclosporine
Factor H Mutation
TTP Pentad?
Fever Hematuria Thrombocytopenia MAHA Renal Failure
TTP Cause?
ADAMTS-13 deficiency
Mahogany brown tumor with large eosinophilic cells in the collecting ducts?
Oncocytoma
Benign kidney tumors?
Angiomyolipoma
Oncocytoma
Most common RCC?
Clear Cell Carcinoma
Renal Cysts and hemangioblastomas due to what mutation?
VHL (autosomal dominant) angiogenesis
Von-Hippel-Lindau Syndrome
Bright Yellow tumor with solid cystic pattern. Cells have clear cytoplasm
Clear Cell carcinoma
Cuboidal cell cancer with papillary growth
Papillary Carcinoma
Vegtable-like cells
Chromophobe carcinoma
Renal Cell Carcinoma risk factors
Male
Elderly
Smoking = #1
Most common cause for acute kidney failure (disease state with many causes)?
Acute Tubular Necrosis
Ischemic vs. Nephrotoxic ATN patterns and causes
Ischemic: Patchy necrosis, due to volume loss, shock
Nephrotoxic: Mostly PCT damage due to drugs (aminoglycosides most common)
Nerve deafness, eye disorders, and nephritis = what syndrome?
Alport Syndrome
What nephrotic syndrome is associated with: Chronic IC disease Lipodystrophy Alpha-1-antitrypsin deficiency CLL, lymphomas, melanomas?
Membranoproliferative disease
RCC, renal cysts, hemangioblastomas of cerebellum and retina?
VHL (AD tumor supressor mutation)
Cartilage present in the kidneys indicates?
Cystic Renal Dysplasia
Tubulo-interstital nephritis with infiltrates IN the tubles?
Not in the tubules?
In = Pyelonephritis Out = Drug induced
Calyx damage?
NSAID tox or chronic pyelonephritis
