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CPR Final > Renal Pathology > Flashcards

Renal Pathology Flashcards

1
Q

RBC Casts

A
  • Glomerulonephritis
  • Ischemia
  • Malignant HTN
  • Indicates that hematuria is of renal origin
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2
Q

WBC casts

A
  • Tubulointerstitial inflammation
  • Acute pyelonephritis
  • Transplant rejection
  • Indicates pyuria is of renal origin
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3
Q

Granular casts

A
  • Muddy Brown casts

- Acute tubular necrosis

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4
Q

Waxy Casts

A
  • Advanced renal disease

- Chronic renal failure

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5
Q

Hyaline casts

A

Nonspecific

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6
Q

Nephritic Syndrome

A
  • Acute poststreptococcal glomerulonephritis
  • Rapidly progressive glomerulonephritis
  • Berger’s IgA glomerulonephropathy
  • Alport Syndrome
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7
Q

Nephrotic Syndrome

A
  • Focal segmental glomerulonephritis
  • Membraneous glomerulonephritis
  • Minimal Change disease
  • Amyloidosis
  • Diabetic glomerulonephropathy
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8
Q

Both Nephritic and Nephrotic

A
  • Diffuse proliferative glomerulonephritis

- Membrano-proliferative glomerulnephritis

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9
Q

Acute poststreptococcal Glomerulonephritis

A
  • Glomeruli are enlarged and hypocellular
  • Neutrophils
  • lumpy bumpy appearance
  • Subepithelial immune complex humps
  • Immunofluorescence shows granular appearance due to IgG, IgM and C3 deposition along GBM & mesangium
  • Most frequently in children
  • Peripheral & periorbiral edema
  • dark urine
  • Resolves spontaneously
  • Nephritic: Inflammatory process
    • In glomeruli: hematuria & RBC casts
    • Azotemia (elevated BUN)
    • Oliguria
    • HTN due to salt retention
    • Proteinuria <3.5g/day
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10
Q

Rapidly Progressive (Crescentic) Glomerulonephritis (RPGN)

A
  • Crescent moon shaped
  • Crescent consists of fibrin & plasma protiens (C3b)
    • Also glomerular parietal cells and macrophages
  • Caused by:
    • Goodpasture syndrome: type II hypersensitivity
      • antibodies GBM & alveolar basement membranes
      • Linear immunofluorescence
      • Hematuria and hemoptysis
    • Wegner’s granulomatosis
      • c-ANCA
    • Microscopic polyangiitis
      • p-ANCA
  • Poor prognosis
  • Rapidly deteriorating renal function
  • Nephritic: Inflammatory process
    • In glomeruli: hematuria & RBC casts
    • Azotemia (elevated BUN)
    • Oliguria
    • HTN due to salt retention
    • Proteinuria <3.5g/day
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11
Q

Diffuse Proliferative Glomerulonephritis

A
  • Due to SLE or MPGN
  • Wire looping of capillaries
  • Subendothelial & Intramembranous IgG immune complexes
    • Often w/ C3 deposits
  • Immunofluorescence: granular
  • Nephritic: Inflammatory process
    • In glomeruli: hematuria & RBC casts
    • Azotemia (elevated BUN)
    • Oliguria
    • HTN due to salt retention
    • Proteinuria <3.5g/day
  • Most common cause of death in SLE
    • Can present w/ nephritic and nephrotic
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12
Q

Berger’s Disease

A
  • IgA nephropathy
  • Related to Henoch-Schonlein (small vessel vasculitis w/ IgA)
  • Mesangial proliferation & immune complex deposits
  • IgA complex deposits in mesangium
  • Often presents/flares w/ URI or acute gastroenteritis
  • Nephritic: Inflammatory process
    • In glomeruli: hematuria & RBC casts
    • Azotemia (elevated BUN)
    • Oliguria
    • HTN due to salt retention
    • Proteinuria <3.5g/day
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13
Q

Focal Segmental glomerulosclerosis

A
  • Segmental sclerosis & hyalinosis
  • Most common glomerular disease in HIV patients
  • Nephrotic: massive proteinuria (>3.5 g/day)
    • Hyperlipidemia (low oncotic pressure triggers apoproteinB)
    • Fatty casts
    • Edema
    • Increased risk of infection b/c loss Ig
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14
Q

Membraneous glomerulonephritis

A
  • Diffuse membranous glomerulopathy
  • Diffuse capillary & GMB thickening
  • Spike & Dome appearance w/ subepithelial deposits
  • Granular immunofluorescence
    • SLE nephrotic presentation
  • Caused by:
    • Drugs
    • Infection
    • SLE
    • Solid tumors
  • Most common cause of adult nephrotic sydnrome
  • Nephritic: Inflammatory process
    • In glomeruli: hematuria & RBC casts
    • Azotemia (elevated BUN)
    • Oliguria
    • HTN due to salt retention
    • Proteinuria <3.5g/day
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15
Q

Minimal Change Disease

A
  • Lipoid nephrosis
  • Normal glomeruli
  • Foot process effacement
  • Selective loss of albumin
    • Not globins due to GBM polyanion loss
  • May be triggered by recent infection or immune stimulus
  • Most common in children
  • Responds to corticosteroids
  • Nephritic: Inflammatory process
    • In glomeruli: hematuria & RBC casts
    • Azotemia (elevated BUN)
    • Oliguria
    • HTN due to salt retention
    • Proteinuria <3.5g/day
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16
Q

Amyloidosis

A
  • Congo red stain w/ apple green bifiringence
  • Associated w/ chronic conditions
    • Multiple myeloma, TB, RA
  • Nephritic: Inflammatory process
    • In glomeruli: hematuria & RBC casts
    • Azotemia (elevated BUN)
    • Oliguria
    • HTN due to salt retention
    • Proteinuria <3.5g/day
17
Q

Membraneoproliferative glomerulonephritis

A

-Subendothelial immunocomplexes w/ granular IF
-Type 1: tram-track appearance due to GBM splitting from mesangial ingrowth
-HBV, HCV
-Type 2: dense deposits
-C3 nephritic factor
-

18
Q

Diabetic glomerulonephropathy

A
  • Nonenzymatic glycosylation of GBM
    • Increases permability and thickening
  • Nonenzymatic glycosylation of efferent arterioles
    • Increases GFR
    • Mesangial expansion
  • Mesangial expansion and GBM thickening
    • eosinophilic nodular granulosclerosis
    • Kimmelsteil-Wilson lesion
19
Q

Calcium Kidney Stones

A
  • Calcium: 75-85% (Ca oxalate or Ca phosphate)
  • precipitates at low or neutral pH
  • Radiopaque
  • Hypercalcemia (cancer or increased PTH)->hypercalciuria
  • Oxalate crystals from antifreeze or Vit C abuse
20
Q

Ammonium Magnesium Phosphate Kidney Stones

A
  • 15%
  • Precipitates at increased pH
  • Radiopaque
  • Caused by urease positive Mg or radiolucent bugs
    • Staphylococcus or phosphate Klebsiella
  • Can form staghorn calculi
    • huge stone in whole calyx
    • Can be nidus for UTI
  • WOrsened by alkaluria
21
Q

Uric Acid Kidney Stone

A
  • 5%
  • Precipitates at lower pH
  • Radiolucent
  • Strong association w/ hyperuricemia
  • Often seen in diseases w/ increased cell turnover (leukemia)
22
Q

Cystine Kidney Stones

A
  • 1%
  • Precipitates in decreased pH
  • Radiopaque
  • Most often secondary to cystinuria
  • Hexagonal
  • Treat w/ alkalinization of urine
23
Q

Renal Cell Carcinoma

A
  • Originates in renal tubular cells
  • Polygonal clear cells filled w/ lipid accumulations
  • Most common in men 50-70
  • Increased incidence in smoking and obesity
  • Clinical: hematuria, masses, flank pain, fever, wt loss
  • Invades IVC and spreads
  • Metastasizes to lungs and bone
  • Most common renal malignancy
  • Associate w/ von-Hippel-Lindau Syndrome
  • Associated w/ chromosome 3p deletion
  • Paraneoplastic syndrome
    • Ectopic EPO, ACTH, PTHrP, & prolactin
24
Q

Wilms’ Tumor

A
  • Most common renal malignancy of early childhood
  • Contains embryonic glomerular structures
  • Presents w/ huge palpable flank mass & hematuria
  • Deletion of tumor suppressor gene WT1 on chromosome 11p
  • WAGR complex
    • Wilm’s tumor
    • Aniridia (absent iris)
    • Genitourinary malformation
    • Retardation
25
Q

Transitional Cell Carcinoma

A
  • Most common tumor of the urinary tract
  • Can occur in renal calyces, renal pelvis, ureters, & bladder
  • Painless hematuria, no casts
  • Associated with:
    • Phenacetin
    • Smoking
    • Aniline dyes
    • Cyclophosphamide
26
Q

Acute Pyelonephritis

A
  • Affects cortex w/ relative sparing of glomeruli/vessels
  • Fever
  • CVA tenderness
  • Nausea and vomiting
  • Neutrophilic infiltration into renal interstitium
27
Q

Chronic pyelonephritis

A
  • Coarse asymmetric corticomedullary scarring
  • Blunted calyx
  • Tubules can contain eosinophilic casts
    • Thyroidization of kidney
  • White casts in urine are classic
  • Vesicoureteral reflux required
28
Q

Drug Induced interstitial nephritis

A
  • Acute interstitial renal inflammation
  • Pyuria (Typically eosinophils)
  • Azotemia 1-2 weeks after drugs
    • Diuretics, NSAIDs, penicillins, sulfonamides, rifampin
  • Drugs act as haptans and induce hypersensitivity
29
Q

Acute Tubular Necrosis

A
  • Most common cause of acute renal failure
  • Self-reversible but fatal if left untreated
  • Three stages:
    1. Inciting event
    2. Maintenance phase
    • oliguria: lasts 1-3 weeks
    • Risk of hyperkalemia
      1. Recovery phase:
    • Polyuric
    • BUN & creatinine fall
    • Risk of hypokalemia
  • Associated with:
    • renal ischemia: shock or sepsis
    • Crush injury: myoglobinuria
    • Toxins
  • Key finding: granular casts
30
Q

Renal Papillary Necrosis

A
  • Sloughing of renal papillae
  • Hematuria, proteinuria
  • May be triggered by recent infection or immune stimulation
  • Associated with:
    • Diabetes mellitus
    • Acute pyelonephritis
    • Chronic phenacetin use (acetaminophen)
    • Sickle cell anemia and trait
31
Q

Acute Renal Failure: Prerenal

A
  • Prerenal azotemia: due to decreased RBF (Hypotension)
    • decreased GFR
    • Na+/H2O and urea retained to conserve volume
      • BUN/Creatinine ratio increases
  • Urine osmolality: >500
  • Urine Na: 20
32
Q

Acute Renal Failure: Intrinsic

A
  • Abrut decline in renal function w/ increased creatine and BUN
  • ATN, ischemia/toxins, glomerulonephritis
  • Patchy necrosis: obstructs tubule
  • Fluid backflow across necrotic tubule
  • Decreased GFR
  • Urine has epithelial/granular casts
  • BUN reabsorption impaired: decreased BUN/creatinine ratio
  • Urine osmolality: 20
  • FeNa: >2%
  • BUN/Cr: <15
33
Q

Acute Renal Failure: Postrenal

A
  • outflow blockage
  • Stones, BPH, neoplasia, congenital anomalies
  • Develops only w/ bilateral obstruction
  • Urine osmolality: 40
  • FeNa: >4%
  • BUN/Cr: >15
34
Q

Consequences of Renal Failure

A
  • Inability to make urine and excrete nitrogenous wastes
  • Na+/H2O retention: CHF, pulmonary edema, HTN
  • Hyperkalemia
  • Metabolic acidosis
  • Uremia
    • Increased BUN & creatinine
    • Nausea/anorexia
    • Pericarditis
    • Asterixis
    • Encephalopathy
    • Platelet dysfunction
  • Anemia (failure of EPO production)
  • Renal osterodystrophy
  • Dyslipidemia
  • Growth retarded & developmental delay in children
35
Q

AD Polycystic Kidney Disease (ADPKD)

A
  • Multiple, large, bilateral cysts
  • Destroy kidney parenchyma
  • Presents with:
    • Flank pain
    • hematuria
    • HTN
    • Urinary infection
    • Progressive renal failure
  • Autosomal Dominant mutation in PKD1 or PKD2
  • Complications from chronic kidney disease and HTN
  • Associated with:
    • polycystic liver disease
    • berry aneurysm
    • mitral valve prolapse
36
Q

AR polycystic Kidney Disease (ARPKD)

A
  • Infantile presentation in the parenchyma
  • Autosomal recessive
  • Associated with:
    • congenital hepatic fibrosis
    • Significant renal failure can leads to Potter’s

CPR Final (29 decks)

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