Renal Pathology Flashcards
Compare the 4 cystic diseases of the kidney. (Don’t break down PKD on this one)
Simple cyst: thin walled w/ clear fluid, single or multiple, common with age. Benign.
Medullary sponge kidney: many small cysts throughout the kidney medulla. Benign.
PKD: genetic, lots of large cysts, leads to kidney failure.
Chronic dialysis cysts: pts on dialysis, smaller cysts, assoc w/ RCC
Adult vs Childhood PKD
Adult: AD, dz develops in adulthood, chronic renal failure in middle age, assoc w/ liver cysts.
Childhood: AR, dz congenital, renal failure early in life, assoc w/ fetal demise.
What are the three histological changes that may occur in glomerular disease?
- Thickening of the glomerular basement membrane
- Hypercellularity
- Hyalinosis/sclerosis
What are the clinical characteristics of nephrotic syndrome?
Heavy proteinuria, hypoproteinemia, hyperlipidemia, anasarca
What are the clinical characteristics of nephritic syndrome?
PHAROH
Proteinuria, hematuria, azotemia, RBC casts, oliguria, hypertension
Immune-mediated!
What three diseases are characterized by nephrotic syndrome?
Lipoid nephrosis/minimal change disease
Membranous glomerulopathy
Focal-segmental glomerulosclerosis
Lipoid nephrosis
- Is the MC…
- Proteinuria selective/nonselective
- Micro appearance
- MC cause of nephrotic syndrome in kids (peaks age 2-3)
- Selective proteinuria
- Nothing on histo, no immune complexes.
Membranous glomerulopathy
- Is the MC…
- Etiology
- Micro appearance
- MC cause of nephrotic syndrome in adults
- Immunologically mediated (Ab bind Ag in GBM –> local damage and inc permeability)
- Thickening of capillary loops, BM may appear spiked
Focal-segmental glomerulosclerosis
- Is the MC…
- Micro appearance
- MC cause of nephrotic syndrome in African Americans
- Collagenous fibrous changes leading to loss of function, affects only part (segmental) of some glomeruli (focal)
What is the most common cause of nephritic syndrome in the US?
Post-streptococcal glomerulonephritis
What is the most common cause of nephritic syndrome worldwide?
IgA Nephropathy (Berger’s disease)
Post-Strep glomerulonephritis
- Definition
- Micro appearance
- Labs
- Deposits of immune complexes trapped along basement membrane following GAS pharyngitis/impetigo
- Hypercellularity, neutrophils, poorly defined capillary loops
- High ASO titer
Crescentic glomerulonephritis
- Definition
- Micro appearance
- Description of how some extremely acute diseases progress
- Capillary loop thickening, endothelial proliferation, crescentic figures, deposition of IgG along BM
IgA Nephropathy
- Etiology
- Micro appearance
- Hypersecretion of IgA in response to infx
- Proliferation of mesangium
MC cause of nephrotic syndrome in kids
Lipoid nephrosis/Minimal change disease
MC cause of nephrotic syndrome in adults
Membranous glomerulopathy
MC cause of nephrotic syndrome in African Americans
Focal-segmntal glomerulosclerosis
MC cause of renal failure in US
Diabetic nephropathy
Diabetic nephropathy
- Etiology
- Micro appearance
- Glomerular hyperfiltration –> BM & mesangial proliferation
- nodular glomerulosclerosis
Nodular glomerulosclerosis assoc w/ DM (special name)
Kimmelstiel-Wilson Disease
Amyloidosis nephropathy
- Etiology
- Micro appearance
- Amyloid accumulates in mesangium and capillary walls
- Amyloid is acellular, eosinophilic
Goodpasture’s syndrome
- Etiology
- Micro appearance (late disease)
- Other organ involvement
- Circulating anti-basement membrane antibody
- Crescentic figures (RPGN)
- Respiratory
Differentiate toxic vs ischemic acute tubular necrosis.
Toxic: proximal, acute, obliterated lumen
Ischemic: distal, mb acute, often dt chronic progressive atherosclerosis, skip lesions throughout tubule
Characteristic UA finding of acute tubular necrosis (both toxic and ischemic)
Muddy brown casts
Characteristic histo finding of malignant nephrosclerosis
Blood vessels that look like onion rings
Gross finding of infarction vs histo finding of ischemia
Pale tissue, especially in a wedge
Poor uptake of vital stain
Characteristic finding of chronic cystitis
Malakoplakia
Characteristic histo finding of malakoplakia
Michaelis-Gutmann bodies
Compare AIN and analgesic nephropathy
Both are drug-induced damage to interstitium
AIN is an allergic rxn to a single dose (edema, inflammatory infiltrate, thickening of BM)
Analgesic nephropathy is the result of analgesic abuse (ischemic injury)
Give the types of renal stones.
- Which is MC
- Which is assoc w/ UTI
- Which is assoc low urine pH
- Which is MC in kids
Calcium oxalate (MC 75%) Triple phosphate/staghorn (2MC 15%, assoc w/ Proteus UTI) Uric acid (3MC, pH
Common cause of acute renal failure
Toxic ATN
MC cause of HUS
E. coli O157:H7
MC source of renal artery emboli
Heart
MC renal malignancy
RCC
MC primary renal tumor in kids
Wilm’s tumor
MC cell of origin for RCC
Proximal tubule epithelium
MC and second MC bladder cancer
Transitional cell carcinoma
Squamous cell carcinoma
Very common, small renal tumor with frond-like pattern on histology.
Renal papillary adenoma
Renal tumor with uniform, large, polygonal cells and numerous prominent mitochondria with stacked appearance
Oncocytoma
Pediatric renal tumor with nests of primitive, basophilic cells and primitive nephrons on histology.
Wilm’s tumor
Classic triad, major risk factors, and general age for RCC
- flank pain, hematuria, palpable abdominal mass
- tobacco, toxic exposure, acquired cystic dz
- old age
Gross and micro appearance of malakoplakia
Gross: pale, raised mucosal plaques
Micro: large, foamy M0 with Michaelis-Gutmann bodies, multinucleated giant cells
Eosinophilic infiltrate in bladder
Eosinophilic cystitis
Pathognomonic finding in interstitial cystitis
Hunner’s ulcers
Wegener’s Granulomatosis
- Serology
C-ANCA
What is the appearance of the crystals in the four main renal stones?
Calcium oxalate: rectangular, like envelopes
Triple phosphate: rectangular, like coffin lids
Uric acid: square, rhomboid, polygonal
Cystine: hexagon
