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Renal Pathology Flashcards

1
Q

Infectious aetiology of nephritic types of glomerular disease?

A

Post streptococcal GN-MC

IgA nephropathy

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2
Q

Autoimmune aetiology of nephritic type of glomerular disease?

A

Good pastures syndrome, wegeners granulomatosis, microscopic polyarteritis-rapidly progressive crescentic GN

SLE- diffuse proliferative GN

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3
Q

Circulating immunocomplex deposition mechanism producing nephritic glomerular disease?

A

IgA nephropathy-mesangium
Post strep GN-sub epithelial
Diffuse proliferative-sub endothelial

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4
Q

Antibodies directed against GBM antigens mechanism in nephritic type of glomerular diseases?

A

Good pastures-rapidly progressive GN

Anti-BM ab against collagen in lungs and kidneys

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5
Q

Granular IF finding seen in which nephritic type of glomerular diseases?

A

IgA glomerulopathy-mesangium
Post strep-sub epithelial
Diffuse proliferative-sub endothelial
[wire looping of capillaries]

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6
Q

Specific test to confirm post streptococcal GN?

A

Anti-DNAse B titres -+ streptozyme test

ASO - degraded by oil in skin

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7
Q

Specific test to confirm diffuse proliferative GN?

A

Serum ANA test-rim pattern-confirms anti-dsDNA antibodies

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8
Q

Specific test to confirm good pastures-rapidly progressive GN?

A

HLA-DR2 +

Hemoptysis–>CRF

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9
Q

Nephritic type of glomerular diseases that progress to CRF?

A

All but post streptococcal GN which usually resolves in children

Highest incidence in rapidly progressive glomerulonephritis

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10
Q

Infectious aetiology of nephrotic syndrome type glomerular diseases?

A

Focal segmental glomerulosclerosis
Diffuse membranous glomerulopathy-HBV/syphilis/plasmodium malariae
Type 1MPGN- HCV/HBV

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11
Q

Malignancy aetiology of nephrotic type of glomerular diseases?

A

Focal segmental glomerulosclerosis- Hodgkin’s lymphoma

Diffuse membranous glomerulopathy-HL, carcinoma

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12
Q

T cell production of cytokines mechanism in nephrotic types of glomerular diseases?

A

Minimal change disease

Cytokines-loss of negative charge on GBM

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13
Q

Immune complex deposition mechanism in nephrotic type of glomerular diseases?

A

Diffuse membranous glomerulopathy-sub epithelial
Type 1 MPGN-sub endothelial
Type 2 MPGN-intra membranous

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14
Q

Autoimmune aetiology of nephrotic type of glomerular diseases?

A

Diffuse membranous glomerulopathy

Type 2 MPGN- C3 nephritic factor autoantibodies bind to C3 convertase-constant stimulation-deplete levels

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15
Q

Tram tracks on EM in nephrotic type of glomerular diseases?

A

Type 1 MPGN and type 2 MPGN caused by splitting of GBM by in growth of mesangium

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16
Q

Specific test for minimal change disease?

A

Positive fat stains in glomerulus and tubules

Fusion of podocytes in EM

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17
Q

Specific clinical features seen in minimal change disease but not other types of nephrotic type of glomerular disease?

A 
Selective proteinuria (only albumin not globulin) 
Normotensive
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18
Q

Drugs that cause diffuse membranous glomerulopathy?

A

Captopril, gold therapy

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19
Q

Specific test for diffuse membranous glomerulopathy?

A

Silver stain-spike and some pattern

Diffuse thickening of membranes

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20
Q

Which is the only type of nephrotic type of glomerular disease that does not progress to CRF?

A

Minimal change disease

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21
Q

Nephritic type of glomerular diseases?

A

Based on site of IC deposition:

  1. Sub endothelial- diffuse proliferative GN
  2. Basement membrane- rapidly progressive cresentric GN
  3. Sub epithelial- Post strep GN
  4. Mesangium- IgA glomerulopathy
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22
Q

Hereditary glomerular diseases?

A

Alport syndrome and thin basement membrane disease

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23
Q

Type of inheritance in hereditary glomerular diseases?

A

Alport syndrome- X linked recessive and autosomal dominant/recessive
Thin basement membrane disease-AD

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24
Q

Clinical features in alport syndrome vs. thin basement membrane disease?

A

Sensorineural hearing loss and ocular findings in alport syndrome; hematuria and mild proteinuria in both

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25
Diagnosis of alport syndrome vs. thin basement membrane disease?
Alport syndrome-EM/monoclonal ab to detect GBM defects Thin basement membrane disease-extremely thin BM
26
Gross and microscopic findings in chronic glomerulonephritis?
Shrunken kidneys | Glomerular sclerosis and tubular atrophy
27
Most common cause of nephrotic syndrome in adults?
Focal segmental glomerulosclerosis followed by diffuse membranous glomerulopathy
28
Cause of acute renal failure following haemorrhage?
Hypovolemia-> pre renal azotemia-> most common cause of acute tubular necrosis
29
Drug most commonly responsible for acute tubular necrosis?
Gentamicin; amino glycosides
30
In which subtype of acute tubular necrosis can acute renal failure be reversed?
Nephrotoxic- tubular basement membrane not disrupted- tubular cell regeneration possible Ischemic-bm disrupted
31
Lab findings in acute tubular necrosis?
Oliguria (~400ml/day) Pigmented renal tubular casts Hyperkalemia, increased anion gap metabolic acidosis Hypokalemia (diuresis phase) and infection
32
Reason for administration of dopamine low dose in ATN?
Increases renal blood flow
33
Distinguishing conditions of oliguria with good tubular function?
Pre renal azotemia and acute glomerulonephritis Urine sedimentation- RBC casts and hematuria in acute glomerulonephritis
34
Distinguish between conditions producing oliguria with bad tubular function?
Post renal azotemia and acute tubular necrosis Urine sedimentation: Acute tubular necrosis-pigmented tubular casts
35
Conditions with good tubular function and oliguria?
Prerenal azotemia | Acute glomerulonephritis
36
Conditions with bad tubular function and oliguria?
Post renal azotemia and acute tubular necrosis
37
Common causes of tubulointerstial nephritis?
Acute pyelonephritis Lead poisoning Urate nephropathy Multiple myeloma
38
Aetiology of acute pyelonephritis?
E.coli most common cause | Enterococcus 2ndMC
39
Mechanism of TIN in cancer patients receiving aggressive therapy?
Urate nephropathy with deposition of urate crystals in tubules and interstitium
40
Mechanism of TIN in persons with chronic pain?
Aspirin- decreases renal blood flow by blocking prostaglandin release Acetaminophen-free radical damage
41
Mechanism of TIN with patients on rifampin/penicillin?
Drug induced nephropathy-type 1 and 4 hypersensitivity reaction
42
Mechanism of TIN in young girls?
Acute/chronic pyelonephritis-short urethra Vesicoureteral reflux with ascending infection
43
Mechanism of TIN in elderly | Male?
BPH- lower urinary tract obstruction-chronic pyelonephritis
44
Mechanism of TIN in chronic lead poisoning?
Decreases renal excretion of uric acid-urate nephropathy Direct toxicity
45
Mechanism of TIN in multiple myeloma patients?
Bence Jones proteinuria-foreign body giant cell reaction in tubular lumen in PT Nephrocalcinosis- calcification of collecting duct 2 to hypercalcemia due to lytic lesions Primary amyloidosis-light chains to amyloid
46
Clinical findings in acute pyelonephritis vs. chronic pyelonephritis?
Acute: Spiking fever, flank pain Increased frequency of urination Painful urination Chronic: history Reflux nephropathy->HTN in children CRF
47
Gross and microscopy findings in acute pyelonephritis vs. chronic?
Acute- abscess in cortex and medulla; micro abscess in tubules Chronic-reflux: U shaped scars overlying blunt calyx Obstructive: dilation of calyx with diffuse thinning of cortical tissue Thyroidisation (eosinophilic material) of tubules with atrophy
48
Specific diagnosis of acute vs chronic pyelonephritis?
Acute- WBC casts, pyuria/bacteruria and hematuria Chronic-IV pyelogram-U shaped scars overlying blunt calyx
49
Causes of renal papillary necrosis?
APN, analgesic nephropathy, DM and sickle cell disease/trait
50
Lab diagnosis of renal papillary necrosis?
Sloughing of renal papillae- hematuria, proteinuria, flank pain IVP- ring defect
51
Most common cause of chronic renal failure?
DM
51
Mechanism for normocytic anaemia in chronic renal failure?
Decreased erythropoietin
51
Mechanism of osteomalacia vs. osteoporosis in chronic renal failure?
Osteomalacia- loss of mineralised bone due to hypovitaminosis D-hypocalcemia Osteoporosis-metabolic acidosis-excess H+ buffered by bone
52
Mechanism of cystic lesions in jaw/ osteitis fibrosa cystica in chronic renal failure?
Hypovitaminosis D->hypocalcemia->+ PTH-> secondary hyperparathyroidism->increases bone resorption
53
Mechanism of HTN and CCF in chronic renal failure?
Salt retention and volume overload
54
Mechanism of hyperkalemia and hyponatremia in chronic renal failure?
Volume overload- dilution hyponatremia/Na loss Hyperkalemia- very low GFR and metabolic acidosis shifts K+ from ICF to ECF
55
Mechanism of hypocalcemia in chronic renal failure?
Hypovitaminosis D-decreased synthesis of 1-alpha hydroxylase in PT Hyperphosphatemia- drives Ca into bones and soft tissues [metastatic calcification]
56
Mechanism of free water clearance =0 in chronic renal failure?
Tubular dysfunction- loss of concentration and dilution
57
Specific test to diagnose chronic renal failure?
Increased serum cystatin C(>1.3mg/flow) | Only filtered not secreted; cysteine protease inhibitor produced by all nucleated cells
58
Mechanism of prolonged bleeding time in chronic renal failure?
Platelet aggregation defect [qualitative]
59
Pathogenesis of benign nephrosclerosis vs. malignant HTN?
Benign nephrosclerosis-hyaline arteriolosclerosis in arterioles of renal cortex Malignant HTN-vascular damage to arterioles and small arteries->hyperplastic arteriolosclerosis and fibrinoid necrosis
60
Risk factors for malignant HTN?
BNS Haemolytic uremic syndrome Thrombotic thrombocytopenic purpura Systemic sclerosis
61
Features of hypertensive encephalopathy in malignant HTN?
Cerebral edema Papilledema Retinopathy-exudates, flame hemorrhages Potential for intracerebral bleed
62
Morphology of kidney in benign nephrosclerosis?
Small kidney; granular cortical surface
63
Aetiology of renal infarction?
Embolisation from L. Heart Atheroembolic disease Vasculitis; polyarteritis nodosa
64
Diagnosis of anuria in a pregnant woman followed by ARF?
DIC limited to renal cortex 2 to abruptio placentae, preeclampsia--> bilateral pale renal infarcts
65
Aetiology of hydronephrosis in children vs. adults?
Children-congenital bladder neck obstruction/urethral valve defect Adult-renal stones, BPH
66
Dilated ureter and renal pelvis; compression atrophy of renal medulla and cortex with post renal azotemia. Diagnosis?
Hydronephrosis
67
Most common metabolic abnormality producing stones?
Hypercalciuria w/o hypercalcemia- increased GI absorption of Ca
68
Factors that promote formation of calcium renal stones?
Hypercalciuria; decreased urine volume Reduced urine citrate-citrate chelates ca; Urinary pH alteration-alkaline pH favours ca and Po4 stones; Dairy products-rich in oxalate/phosphate; primary HPTH
69
Most common type of stone in adults and its aetiology?
Calcium oxalate stone-->pure vegan diet, vitamin C deficiency and Crohn's disease
70
Most common type of renal stones in children?
Calcium phosphate stones--> dairy products and distal renal tubular acidosis
71
Uncommon types of renal stones?
Uric acid and cystine
72
Stones associated with proteus infection? [urine is alkaline and smells of ammonium]
Magnesium ammonium phosphate stone
73
Rationale behind treatment of calcium stones with hydrocholothiazide and cellulose phosphate?
Hydrochlorothiazide- causes hypercalcemia; decreases urine ca Cellulose phosphate binds to ca in intestine
74
Rationale behind treatment of Uric acid stones with alkaline pH and allopurinol?
Allopurinol-decreases synthesis of Uric acid | Alkaline pH-makes Uric acid soluble in urine
75
Rationale behind using antibiotic and surgical removal in struvite stones?
Antibiotic-eliminates urease producer | Surgical removal-size of struvite stone
76
Colicky pain radiating to ipsilateral groin and gross hematuria. Diagnosis?
Renal stones
77
Best test to diagnose renal stones?
SpiralCT scan (unenhanced)
78
Bilateral renal cell carcinoma, hemangioblastoma of cerebellum and retina. Diagnosis with inheritance pattern?
Von hippel-Lindau disease. Autosomal dominant associated with chromosome 3
79
Gross and microscopy of most common type of renal cell carcinoma?
Gross: yellow tumour on upper pole >3cm Microscopy: clear cells with lipid and glycogen
80
Triad of renal cell carcinoma?
Hematuria-abdominal mass-flank pain
81
Mechanism of left sided and variocele and extension to heart in renal cell carcinoma?
Predisposition to invasion of renal vein; renal vein-IVC-heart Renal vein blocked-drainage of spermatic vein blocked-variocele
82
Mechanism of secondary polycythemia and hypercalcemia in RCC?
Ectopic production of hormones: EPO- 2 polycythemia Vera PTH related protein-hypercalcemia
83
Most common site of metastasis of RCC?
Lung- cannon ball appearance on radiograph
84
Most common cause of renal pelvis cancer and RCC?
Smoking
85
Renal stones and chronic infection predispose to what type of cancer?
SCC of renal pelvis
86
Most common primary renal tumour in children? [2-5 years]
Wilms tumour
87
Syndromes associated with Wilms tumour?
WAGR | Beckwith-wiesemann syndrome
88
Clinical features of WAGR syndrome?
Wilms tumour-aniridia-genitourinary-retardation (mental)
89
Clinical features of beckwith-wiedemann syndrome?
Wilms tumour, macroglossia, enlarged body organs (liver adrenal pancreas) and hemihypertrophy of extremities
90
Child with unilateral flank mass and HTN. Diagnosis?
Wilms tumour; HTN due to renin secretion
91
Bilateral renal cell carcinoma, hemangioblastoma of cerebellum and retina. Diagnosis with inheritance pattern?
Von hippel-Lindau disease. Autosomal dominant associated with chromosome 3
92
Gross and microscopy of most common type of renal cell carcinoma?
Gross: yellow tumour on upper pole >3cm Microscopy: clear cells with lipid and glycogen
93
Triad of renal cell carcinoma?
Hematuria-abdominal mass-flank pain
94
Mechanism of left sided and variocele and extension to heart in renal cell carcinoma?
Predisposition to invasion of renal vein; renal vein-IVC-heart Renal vein blocked-drainage of spermatic vein blocked-variocele
95
Mechanism of secondary polycythemia and hypercalcemia in RCC?
Ectopic production of hormones: EPO- 2 polycythemia Vera PTH related protein-hypercalcemia
96
Most common site of metastasis of RCC?
Lung- cannon ball appearance on radiograph
97
Most common cause of renal pelvis cancer and RCC?
Smoking
98
Renal stones and chronic infection predispose to what type of cancer?
SCC of renal pelvis
99
Most common primary renal tumour in children? [2-5 years]
Wilms tumour
100
Syndromes associated with Wilms tumour?
WAGR | Beckwith-wiesemann syndrome
101
Clinical features of WAGR syndrome?
Wilms tumour-aniridia-genitourinary-retardation (mental)
102
Clinical features of beckwith-wiedemann syndrome?
Wilms tumour, macroglossia, enlarged body organs (liver adrenal pancreas) and hemihypertrophy of extremities
103
Child with unilateral flank mass and HTN. Diagnosis?
Wilms tumour; HTN due to renin secretion

pathology (6 decks)

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