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Path (AJC) > Renal pathology > Flashcards

Renal pathology Flashcards

1
Q

Types of renal carcinoma

A

Clear cell - well differentiated
Papillary (15%) - dialysis-associated cystic disease, >5mm;
Chromophobe - pale eosinophilic cells.
Also Wilms’ - children, small round blue cells, RUQ mass.

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2
Q

RF for renal carcinoma

A

Smoking, obesity, hypertension, unopposed oestrogen, heavy metals, CKD.

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3
Q

Features of renal carcinoma

A

Haematuria, palpable mass, costovertebral pain.

Paraneoplastic syndrome: polycythaemia, ^Ca, HTN, Cushing’s, amyloid.

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4
Q

Classification of (non-neoplastic) renal pathogy

A
  1. Glomerulus:
    - Nephritic
    - Nephrotic
    1. Tubules and interstitium
      • Acute tubular necrosis (acute tubular injury)
      • Pyelonephritis
      • Interstitial nephritis
    2. Blood vessels
      • HUS
      • TTP
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5
Q

Nephrotic syndrome features

A

Proteinuria (3g/24h), hypoalbuminaemia, oedema.
“Swelling” (facial in children), “frothy urine”.
Due to loss of foot processes (only seen on EM).

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6
Q

Primary causes of nephrotic syndrome

A
  1. Minimal Change Disease
  2. Membranous glomerular disease
  3. Focal segmental glomerulosclerosis
    All show loss of foot processes on EM.
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7
Q

Minimal change disease

A

Chidren.
No change on microscopy, no immune deposits, (loss of foot processes on EM).
90% respond to steroids. 5% get ESRF.

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8
Q

Membranous glomerular disease

A

Adults.
Diffuse thickening of basement membrane.
EM: lose foot processes, subepithelial deposits.
Immunofluorescence: Ig and complement all along BM.
Poor response to steroids. 40% get ESRF eventually.
Can be 2o to SLE, infection, drugs, cancer.

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9
Q

Focal segmental glomulerosclerosis

A

Adults, AC.
Bits of glomerular scarring, with hyalinosis.
Immunofluorescence shows Ig and complement in scarred areas.
50% respond to steroids, but 50% get ESRF.
Can be 2o to obesity or HIV nephropathy.

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10
Q

Seondary causes of nephrotic syndrome

A
  1. Diabetes (Kimmelstiel Wilson nodules);

2. Amyloidosis (chronic inflam, Ig light chains, macroglossia, heart failure, big liver).

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11
Q

Nephritic syndrome features

A

Haematuria,
dysmorphic RBCs and red cell casts in urine.
?: hyertension, oliguria, proteinuria, ^urea and Cr.

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12
Q

Causes of nephritic syndrome (5)

A
  1. Acute post-infectious GN (after strep)
  2. Rapidly progressive / crescentic GN
  3. IgA nephropathy (Berger disease)
  4. Hereditary nephritis (Alport syndrome)
  5. Thin basement membrane disease (benign familial haematuria)
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13
Q

Acute post-infectious glomerulonephritis

A

1-3 weeks after strep throat or impetigo (Staph aureus or Strep pyogenes (group A beta haemolytic));
Immune complexes damage BM;
Raised ASO titre, low C3;
Biopsy:
LM: ^ cellularity,
FM: granular deposits of Ig and C3 in GBM,
EM: subendothelial humps.

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14
Q

Rapidly progressive / crescentic glomerulonephritis

A

Most aggressive: ESRF in weeks. Pronounced oliguria and renal failure.
All show crescents on LM. Classified by immunological findings.

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15
Q

Type 1 Rapidly progressive (crescentic) GN

A 
Anti-GBM Ab, because Goodpasture 
Ab to COL4-A3. HLA-DRB1. 
LM: Obviously crescents. 
FM: Linear IgG deposits in GBM. 
Also lungs (pulmonary haemorrhage).
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16
Q

Type 2 Rapidly progressive (crescentic) GN

A

Immune complexes.
Due to SLE / IgA nephropathy / Acute post-infectious GN.
LM: Obviously crescents.
FM: Granular (lumpy bumpy) IgG immune complexes.

17
Q

Type 3 Rapidly progressive (crescentic) GN

A

Pauci-immune / ANCA associated,
ie. no anti-GBM or immune complexes.
Due to c-ANCA (Wegener’s) or p-ANCA (microscopic polyangiitis).
Vasculitis elsewhere - rashes and pulmonary haemorrhage.

18
Q

IgA nephropathy

A

= Berger disease.
Frank haematuria 1-2 days after upper RTI. Recurrent.
Commonest GN worldwide.
IgA immune complexes deposited in glomeruli.

19
Q

Hereditary nephritis

A

= Alport’s syndrome
X-linked mutn in type IV collagen alpha 5 chain.
Nephritic syndrome + sensorineural deafness + eye problems (lens & cataracts).
5-20yo. Progresses to ESRF.

20
Q

Thin basement membrane disease

A

= benign familial haematuria
ie. usually doesn’t cause nephritic syndrome, renal function usually normal.
AD, type IV collagen alpha 4 chain.
Prevalence 5%.

21
Q

Causes of asymptomatic haematuria

A

Thin basement membrane disease,
IgA nephropathy (Berger),
Alport’s.

22
Q

Acute pyelonephritis

A

Bacterial infection of kidney, usually ascending E. coli.
Fever, flank pain, leukocytes, ?urinary Sx.
Leukocytic casts in urine.
Ciprofloxacin or co-amox.

23
Q

Chronic pyelonephritis

A

Chronic bacteria, inflam, scarring.
Due to
- obstruction: calculi, posterior urethral valves
- vesico-ureteric reflux = reflux nephropathy

24
Q

Acute interstitial nephritis

A

Hypersensitivity reaction to drug,
days after exposure,
fever, rash, haematuria, proteinuria, eosinophilia.

25
Q

Chronic interstitial nephritis

A

= Analgesic nephropathy
ie. old people on lots of NSAIDs.
Sx = late.

26
Q

Acute tubular injury

A

= Acute tubular necrosis.
Damage, blockage by casts, ischaemia, ARF.
Commonest cause of ARF.
Caused by:
- ischaemia (burns, septicaemia),
- nephrotoxins: drugs, contrast, myoglobin (rhabdomyolysis), heavy metals.
Necrosis of short segments of tubules.

27
Q

Thrombotic microangiopathies affecting kidneys

A

HUS + TTP.
Fibrin deposits cause thrombi, Plt and RBC damaged as they pass, and destroyed.
ie. thrombocytopaenia (petechiae and other bleeding) and MAHA (pallor and jaundice).

28
Q

Haemolytic uraemic syndrome

A

Children.
Diarrhoea by E. coli 0157:H7 (pettng zoos).
Thrombi in kidneys only.
Renal failure.

29
Q

Thrombotic thrombocytopaenic purpura

A

Thrombi all around, incl CNS, so neuro Sx.

Can give renal failure, but not often.

30
Q

Acute kidney injury (ARF)

A

^Cr, ^urea.

? -> metabolic acidosis, ^K, fluid overload, hypo-Ca.

31
Q

Pre-renal AKI

A 
Most common AKI. 
Renal hypo-perfusion: 
 - Hypovolaemia 
 - Sepsis 
 - Burns 
 - Acute pancreatitis / other causes of SIRS 
 - Renal artery stenosis
32
Q

Renal causes of AKI (3)

A
  • Acute tubular necrosis (commonest renal cause of AKI)
  • Acute glomerulonephritis
  • MAHA
33
Q

Chronic kidney disease: (=CRF)

Sx, causes, staging.

A 
Progressive irreversible loss of renal function, 
Uraemia Sx: fatigue, itching, anorexia, confusion. 
Due to: 
 - DM 
 - Glomerulonephritis 
 - Hypertension / vascular disease 
 - Chronic pyelo (reflux) 
 - PCKD 
5 stages based on GFR of 90, 60, 30, 15.
34
Q

Adult polycystic kidney disease

A

10% of PCKD
AD:
85% PKD1 for polycystin 1 on Chr16;
rest PKD2 on Chr4.
Haematuria, flank pain, UTI. Cysts can infect, rupture and haemorrhage.
Also berry aenurysms (and liver cysts in PKD1).

35
Q

Lupus nephritis

A

SLE damages kidneys.

Path (AJC) (22 decks)

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