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PATHPROS > RENAL PATHOLOGY -3 > Flashcards

RENAL PATHOLOGY -3 Flashcards

This deck covers Congenital and cystic kidney disorders + Urinary tract Obstruction + Chronic kidney disease.

1
Q

Name one condition associated with formation of the characteristic crystals shown in the attached image.

A

Hyperuricemia- Gout, Leukemia

The uric acid crystals are described as Diamond/ rhombic/ rosette forms

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2
Q

What is the underlying reason for the typical physical appearance and assoc pulmonary hypoplasia in Potter sequence?

A

Oligohydramnios and compression while in utero

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3
Q

Identify the type of crystal seen on microscopic exam of a urinalysis specimen

A

Calcium oxalate crystals: colorless octahedral or “envelope”- shaped crystals which look like small squares crossed by intersecting diagonal lines . Appears dumbbell shaped when viewed from the side.

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4
Q

Define hydronephrosis

A

dilation of the renal pelvis and calyces associated with progressive atrophy of the kidney due to obstruction to the outflow of urine

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5
Q

What are some ways in which urinary tract obstruction can compromise renal function?

A
  1. High pressure in the renal pelvis-→ decreased renal blood flow-→increased renin-→hypertension
  2. elevated intratubular pressure-→tubular dysfunction-→polyuria, nocturia
  3. complete obstruction-→elevation in BUN, creatinine, oliguria, anuria i.e post renal azotemia
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6
Q

electrolyte abnormalities associated with chronic kidney disease

A

hypervolemic hyponatremia

hyperkalemia - due to transcellular shift in acidosis and decreased renal excretion

hypocalcemia- due to decreased synthesis of 1-α-hydroxylase and binding of excess phosphorus with calcium

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7
Q

Two important consequences of a posterior urethral valve abnormality

A

A. Chronic kidney disease

B. VUR

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8
Q

Staghorn calculi are associated with infection with which specific group of micro-organisms?

A

Infections by urea-splitting bacteria that Convert urea to ammonia, alkalinizing urine e.g., Proteus

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9
Q

One consequence of hydronephrosis on morphology of renal parenchyma

A
  1. Cortical atrophy
  2. decreased medullary blood flow
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10
Q

Acid base abnormality associated with CKD

A

Metabolic acidosis

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11
Q

Read the scenario below and deduce whether it would result in unilateral/ bilateral hydronephrosis:

Obstruction is above the level of the bladder

A

Unilateral hydronephrosis

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12
Q

How does CKD lead to osteomalacia?

A

Hypovitaminosis D →hypocalcemia →decreased mineralization of osteoid

[bone biopsy shows exaggeration of osteoid seams]

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13
Q

most common etiology of urinary tract obstruction in the newborn male.

A

Posterior Urethral Valve

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14
Q

Top 3 causes of prevalence of end stage renal disease in the United States

A
  1. Diabetes Mellitus
  2. Hypertension
  3. Glomerulonephritis
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15
Q

Mineral disorders in chronic kidney disease

A

diminished production of 1,25-(OH)2D3 (calcitriol, the activated form of vitamin D),

decreased serum calcium

increased serum phosphorus.

increased PTH (secondary hyperparathyroidism)

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16
Q

Simple or complex renal cyst?

Incidentally discovered

Asymptomatic

USG: Well defined, sharp margins, thin walls, anechoic

A

Simple renal cyst

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17
Q

What is the genetic mutation associated with the condition described below?

Autosomal dominant

Bilateral enlarged kidneys

C/F: Proteinuria, polyuria, CKD

A

Condition described: Autosomal polycystic kidney disease

Every cell carries a germline mutant allele of either PKD1 or PKD2

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18
Q

Identify the condition being described

congenital absence or shortening of the intravesical portion of the ureter→ ureter enters the bladder at right angles→reflux of urine into ureters during micturition

A

Vesicoureteral reflux

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19
Q

Why does hypertension occur in chronic kidney disease?

A

Chronic injury→ nephron loss → decreased perfusion pressure→ release of renin→ increased Angiotensin II→ glomerular hypertension and hyperfiltration

20
Q

One consequence of hydronephrosis on tubular function

A

impaired concentrating ability

[obstruction to outflow-→high pressure in renal pelvis-→elevated intratubular pressure-→ tubular dysfunction]

21
Q

See the attached image. What’s your diagnosis?

A

Autosomal Dominant (Adult) Polycystic Kidney Disease

22
Q

List 2 key CVS abnormalities in CKD

A
  1. Hypertension\Heart failure and pulmonary edema
  2. Pericarditis
23
Q

Read the scenario described. Is it likely to result in a spastic/ flaccid neurogenic bladder?

Spinal lesions at/above T12 (traumatic spinal cord injuries, multiple sclerosis).

A

Spastic neurogenic Bladder

24
Q

Which malignancy in women is associated with bilateral hydronephrosis and subsequent renal failure?

A

Invasive cervical cancer

25
Q

Identify the congenital anomaly shown in the attached image

A

Horseshoe kidneys

26
Q

Give one term that describes the gross morphology shown in the attached image

A

Hydronephrosis

27
Q

What would be the morphology of urine crystals associated with a condition wherein there is a genetic defect in the renal reabsorption of amino acids, including cystine?

A

colorless, refractile, hexagonal plates

28
Q

Most likely etiologic factor for development of calcium oxalate stones

A

Hypercalcemia, hypercalciuria

29
Q

Name one marker of renal dysfunction that is less dependent on age, sex, race, and muscle mass than serum creatinine

A

Serum cystatin C - Cysteine protease inhibitor that is produced by all nucleated cells. Filtered by the glomerulus but is not secreted.

30
Q

List 2 radiopaque renal calculi

A

Calcium oxalate

Magnesium ammonium phosphate (Triple phosphate)

31
Q

Identify the type of crystal see on microscopic exam of a urinalysis specimen

A

Magnesium ammonium phosphate stones - coffin lid appearance

colorless prisms with from three to six sides that frequently have oblique ends

32
Q

Name this pathologic lesion

Mimics a renal neoplasm when unilateral

Composed of islands of undifferentiated mesenchyme, often with cartilage, and immature collecting ducts

A

Multicystic renal dysplasia

33
Q

Diagnostic method of choice to identify a VUR

A

Voiding cystourethrography

34
Q

Read the scenario below and deduce whether it would result in unilateral/ bilateral hydronephrosis:

Obstructive lesions at /below the level of the bladder

A

Bilateral hydronephrosis

35
Q

Morphology of Bone change due to secondary hyperparathyroidism in CKD

A

Osteitis fibrosa cystica

[increased bone cell activity + peritrabecular fibrosis + cystic brown tumors]

36
Q

Most common type of renal calculi

A

Calcium oxalate stones

37
Q

Most common extra renal congenital anomaly associated with ADPKD

A

Liver cysts

38
Q

Type of casts seen on urinalysis in CKD

A

Waxy casts

39
Q

Type of anemia seen in CKD and why?

A

§Normochromic and normocytic anemia- due to decreased production of erythropoietin

40
Q

List 3 possible causes of death in patients with ADPKD?

A
  1. 40%-coronary or hypertensive heart disease
  2. 25% - infection
  3. 15% - ruptured berry aneurysm or hypertensive intracerebral hemorrhage
41
Q

List 2 radiologic hallmarks of CKD

A

Rugger jersey spine - sclerosis of the vertebral endplates at multiple contiguous levels, producing an alternating dense-lucent-dense appearance , resembling bands of a rugby jersey

Pepper pot skull- multiple tiny well-defined lucencies in the calvaria caused by resorption of trabecular bone in hyperparathyroidism

42
Q

Mutation in the PKHD1 gene

Gross appearance of kidney: Smooth surface, Cysts with dilated elongated channels present at right angles to the cortical surface

What protein is coded for by this gene?

A

This is ARPKD. It is assoc with mutations in the PKHD1 gene which codes for fibrocystin

43
Q

Most common extra renal congenital anomaly associated with ADPKD

A

Liver cysts

44
Q

3 common causes of death in ADPKD

A
  1. Coronary or hypertensive heart disease
  2. Infection
  3. Ruptured berry aneurysm or hypertensive intracerebral hemorrhage
45
Q

What is the diagnosis?

Mutation in the PKHD1 gene

Gross: Smooth surface, Cysts with dilated elongated channels present at right angles to the cortical surface

A

Autosomal Recessive Polycystic Kidney Disease

46
Q

Most likely effect on hydrostatic pressure in outflow obstruction due to BPH

A

Increased hydrostatic pressure proximal to obstruction

Decreased GFR

PATHPROS (36 decks)

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