Renal Pathology

Question 1

Compare the 4 cystic diseases of the kidney. (Don’t break down PKD on this one)

Answer 1

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

Question 2

Adult vs Childhood PKD

Answer 2

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.

Question 3

What are the three histological changes that may occur in glomerular disease?

Answer 3

• Thickening of the glomerular basement membrane
• Hypercellularity
• Hyalinosis/sclerosis

Question 4

What are the clinical characteristics of nephrotic syndrome?

Answer 4

Heavy proteinuria, hypoproteinemia, hyperlipidemia, anasarca

Question 5

What are the clinical characteristics of nephritic syndrome?

Answer 5

PHAROH
Proteinuria, hematuria, azotemia, RBC casts, oliguria, hypertension
Immune-mediated!

Question 6

What three diseases are characterized by nephrotic syndrome?

Answer 6

Lipoid nephrosis/minimal change disease
Membranous glomerulopathy
Focal-segmental glomerulosclerosis

Question 7

Lipoid nephrosis

• Is the MC…
• Proteinuria selective/nonselective
• Micro appearance

Answer 7

• MC cause of nephrotic syndrome in kids (peaks age 2-3)
• Selective proteinuria
• Nothing on histo, no immune complexes.

Question 8

Membranous glomerulopathy

• Is the MC…
• Etiology
• Micro appearance

Answer 8

• 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

Question 9

Focal-segmental glomerulosclerosis

• Is the MC…
• Micro appearance

Answer 9

• MC cause of nephrotic syndrome in African Americans

- Collagenous fibrous changes leading to loss of function, affects only part (segmental) of some glomeruli (focal)

Question 10

What is the most common cause of nephritic syndrome in the US?

Answer 10

Post-streptococcal glomerulonephritis

Question 11

What is the most common cause of nephritic syndrome worldwide?

Answer 11

IgA Nephropathy (Berger’s disease)

Question 12

Post-Strep glomerulonephritis

• Definition
• Micro appearance
• Labs

Answer 12

• Deposits of immune complexes trapped along basement membrane following GAS pharyngitis/impetigo
• Hypercellularity, neutrophils, poorly defined capillary loops
• High ASO titer

Question 13

Crescentic glomerulonephritis

• Definition
• Micro appearance

Answer 13

• Description of how some extremely acute diseases progress

- Capillary loop thickening, endothelial proliferation, crescentic figures, deposition of IgG along BM

Question 14

IgA Nephropathy

• Etiology
• Micro appearance

Answer 14

• Hypersecretion of IgA in response to infx

- Proliferation of mesangium

Question 15

MC cause of nephrotic syndrome in kids

Answer 15

Lipoid nephrosis/Minimal change disease

Question 16

MC cause of nephrotic syndrome in adults

Answer 16

Membranous glomerulopathy

Question 17

MC cause of nephrotic syndrome in African Americans

Answer 17

Focal-segmntal glomerulosclerosis

Question 18

MC cause of renal failure in US

Answer 18

Diabetic nephropathy

Question 19

Diabetic nephropathy

• Etiology
• Micro appearance

Answer 19

• Glomerular hyperfiltration –> BM & mesangial proliferation
• nodular glomerulosclerosis

Question 20

Nodular glomerulosclerosis assoc w/ DM (special name)

Answer 20

Kimmelstiel-Wilson Disease

Question 21

Amyloidosis nephropathy

• Etiology
• Micro appearance

Answer 21

• Amyloid accumulates in mesangium and capillary walls

- Amyloid is acellular, eosinophilic

Question 22

Goodpasture’s syndrome

• Etiology
• Micro appearance (late disease)
• Other organ involvement

Answer 22

• Circulating anti-basement membrane antibody
• Crescentic figures (RPGN)
• Respiratory

Question 23

Differentiate toxic vs ischemic acute tubular necrosis.

Answer 23

Toxic: proximal, acute, obliterated lumen
Ischemic: distal, mb acute, often dt chronic progressive atherosclerosis, skip lesions throughout tubule

Question 24

Characteristic UA finding of acute tubular necrosis (both toxic and ischemic)

Answer 24

Muddy brown casts

Question 25

Characteristic histo finding of malignant nephrosclerosis

Answer 25

Blood vessels that look like onion rings

Question 26

Gross finding of infarction vs histo finding of ischemia

Answer 26

Pale tissue, especially in a wedge | Poor uptake of vital stain

Question 27

Characteristic finding of chronic cystitis

Answer 27

Malakoplakia

Question 28

Characteristic histo finding of malakoplakia

Answer 28

Michaelis-Gutmann bodies

Question 29

Compare AIN and analgesic nephropathy

Answer 29

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)

Question 30

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

Answer 30

``` Calcium oxalate (MC 75%) Triple phosphate/staghorn (2MC 15%, assoc w/ Proteus UTI) Uric acid (3MC, pH ```

Question 31

Common cause of acute renal failure

Answer 31

Toxic ATN

Question 32

MC cause of HUS

Answer 32

E. coli O157:H7

Question 33

MC source of renal artery emboli

Answer 33

Heart

Question 34

MC renal malignancy

Answer 34

RCC

Question 35

MC primary renal tumor in kids

Answer 35

Wilm's tumor

Question 36

MC cell of origin for RCC

Answer 36

Proximal tubule epithelium

Question 37

MC and second MC bladder cancer

Answer 37

Transitional cell carcinoma | Squamous cell carcinoma

Question 38

Very common, small renal tumor with frond-like pattern on histology.

Answer 38

Renal papillary adenoma

Question 39

Renal tumor with uniform, large, polygonal cells and numerous prominent mitochondria with stacked appearance

Answer 39

Oncocytoma

Question 40

Pediatric renal tumor with nests of primitive, basophilic cells and primitive nephrons on histology.

Answer 40

Wilm's tumor

Question 41

Classic triad, major risk factors, and general age for RCC

Answer 41

- flank pain, hematuria, palpable abdominal mass - tobacco, toxic exposure, acquired cystic dz - old age

Question 42

Gross and micro appearance of malakoplakia

Answer 42

Gross: pale, raised mucosal plaques Micro: large, foamy M0 with Michaelis-Gutmann bodies, multinucleated giant cells

Question 43

Eosinophilic infiltrate in bladder

Answer 43

Eosinophilic cystitis

Question 44

Pathognomonic finding in interstitial cystitis

Answer 44

Hunner's ulcers

Question 45

Wegener's Granulomatosis | - Serology

Answer 45

C-ANCA

Question 46

What is the appearance of the crystals in the four main renal stones?

Answer 46

Calcium oxalate: rectangular, like envelopes Triple phosphate: rectangular, like coffin lids Uric acid: square, rhomboid, polygonal Cystine: hexagon