Renal-Pathology Flashcards

Question

What is another name for a wilms tumor? Epid? Cellular make up? Presentation? Mtation? What are two syndromes that it can be part of?

Answer 1

Nephroblastoma Most common renal malignancy of ages 2-4 Embryonic glomerular structures Large palpable, unilateral flank mass and/or hematuria Loss of function mutations of TSGs WT1 or WT2 on chrom. 11 Beckwith-Wiedemann WAGR

Answer 2

Wilms tumor macroglossia organomegaly hemihypertrophy Wilms tumor aniridia genitourinary malformation mental retardation

Answer 3

Most common tumor of urinary tract system Renal calyces, pelvis, ureters, and bladder Painless hematuria (no casts) suggests bladder cancer Pee SAC Phenacetin Smoking Aniline Dyes cyclophosphamide papillary growth lined by transitional epithelium with mild nuclear atypia and pleomorphism

Answer 4

Chronic irritation of urinary bladder leading to squamous metaplasia to dysplasia and squamous cell CA Schistosoma haematobium, chronic cystitis, smoking, chornic nephrolithiasis Painless hematuria

Answer 5

UTI=inflammation of urinary bladder Suprapubic pain, dysuria, urinary frequency, urgency Systemic signs absent Female, sexual intercourse, indwelling catheter, diabetes mellitus, impaired bladder emptying E. Coli (most common) Sapro Klebsiella proteus mirabilis (ammonia scent of urine) Positive leukocyte esterase Positive nitrites for gram neg. organisms N. gonorrhoeae or chlamydia

Answer 6

Neutrophils infiltrate renal interstitium Cortex w/ relative sparing of glomeruli/vessels Fevers, flank pain Acending UTI Hematogenous spread to kidney WBCs in urine, possibly with casts Striated parenchymal enhancement ``` Indwelling urinary catheter Urinary tract obstruction vesicoureteral reflux DM pregnancy ``` Chronic pyelo renal papillary necrosis perinephric abscess urosepsis Antibiotics

Answer 7

recurrent episodies of acute pyelo Vesicoureteral reflux or chronically obstructing kidney stones (a chronic predisposition) Course, asymmetric corticomedullary scarring, blunted calyx. tubules contain eosino cats resembling thyroid tissue (thyroidization of kidney)

Answer 8

tubulointerstitial nephritis Acute interstitial renal inflammation Pyuria (classically eosinophils) Azotemia Associated w/ fever, rash, hematuria, and flank tenderness, but can be asymptomatic Drugs act as haptens, induce HSR leading to inflammation. 1-2 weeks after most drugs Could be months after NSAIDs Diuretics, penicillin derivatives, PPIs, sulfonamides, rifampin

Answer 9

Acute generalized cortical infarction of both kidneys Due to combination of vasospasm and DIC Obstetric catastrophies Septic shock

Answer 10

Most common cause of acute kidney injury in hospitalized patients. Often spontaneously resolves Can be fatal, especially during initial oliguric phase Incr. FENa (fractional excretion of sodium) Granular (muddybrown) casts Inciting event Maintenance phase=oliguric; 1-3 weeks; risk of hyperkalemia, metabolic acidosis, uremia Recovery phase=polyuric; BUN and serum creatinine fall; risk of hypokalemia Ischemic: Secondary to decr. RBF (hypotension, shock, sepsis, hemorrhage, HF). Death of tubular cells that may slough into tubular lumen (PCT and thick ascending limb are highly susceptible) Nephrotoxic: Secondary to injury resulting from toxic substances (Aminoglycosides, radiocontrast agents, lead, cisplatin), crush injury (myoglobinuria), hemoglobinuria. PCT is particularly susc. to injury Sloughed tubular cells w/i tubular lumen

Answer 11

Sloughing of necrotic renal papillae leading to gross hematuria and proteinuria. Recent infection or immune stimulus ``` SAAD papa Sickle cell disease or trait Acute pyelonephritis Analgesics (NSAIDS) Diabetes Mellitus ```

Answer 12

Acute renal failure Abruput decline in renal funciton as measured by incr. Cr and BUN PRERENAL Decr. RBF leads to decr. GFR Na/H20 and BUN are retained by kidney to conserve V Incr. BUN/Cr ratio Decr. FENa INTRINSIC Due to ATN or ischemia/toxins; less commonly due acute glomerulonephritis Patchy necrosis leads t debris obstructing tubule and fluid backflow acrss necrotic tubule leading to decr. GFR. BUN is impaired Decr. BUN/Cr ratio POSTRENAL ``` Outflow obstruction (stones, BPH, neoplasia, cong. anom) Only with bilateral obstruction ```

Answer 13

PRERENAL Urine Osmol: >500 Urine Na: 20 INTRINSIC ``` Urine Osmol: 40 FENa: >2% Serum BUN/Cr: 40 FENa: >1%=mild; >2%=severe Serum BUN/Cr: Varies ```

Answer 14

Acute (ATN, prerenal, postrenal) Chronic (hypertension, DM, congenital anomalies MAD HUNGER ``` Meta Acid Dyslipidemia (incr. TGs) Hyperkalemia Uremia (Incr. BUN=Nausea and anorexia, pericarditis, asterixis, encephalopathy, platelet dysfunction) Na/H20 retention Growth retardation and devel. delay EPO failure (anemia) Renal Osteodystrophy ```

Answer 15

Failure of Vit D Hydroxylation (decr. Ca absorption) Failure to preserve Calcium (hypocalcemia) Failure to excrete Phosphate (tissue calcifications leads to decr. Ca) All this leads to Secondary hyperparathyroidism which causes: Subperiosteal thinning of bones.

Answer 16

Numerous cysts causing bilateral enlarged kidneys ultimately destroying kidney parenchyma Flank pain, hematuria, hypertension, urinary infection, progressive renal failure. PKD1 (16) PKD2 (4) complications of chronic kidney disease or hypertension (Incr. renin production) Berry aneurysms, mitral valve prolapse, benign hepatic cysts

Answer 17

In infancy: systemic hypertension, progressive renal insufficiency and portal hypertension Potters sequence in Utero Congenital hepatic fibrosis

Answer 18

Tubulointerstitial fibrosis and progressive renal insufficiency with inability to concentrate urine Medullary cysts nt visualized Shrunken kidneys on U/S Poor prognosis

Answer 19

Ultrafiltrate (Anechoic on U/S). Very common; most of all renal masses. Incidental finding, asymp Complex Cysts: Septated, enhanced, or have solid components. Follow up or removal due to risk of RCC.