Renal Pathology Flashcards
Renal hypoplasia is …….
failure of the kidney to reach the normal weight
- Usually unilateral
- There is decreases number of calyces and lobules
Define Horseshoe kidney
The fusion of the two kidneys at the lower pole
* Normal function, but may cause calculi
Define childhood polycystic disease
- Autosomal recessive
- Progressive renal failure, with subsequent liver cirrhosis and portal hypertension
- Multiple cysts in the cortex and medulla
- There is dilatation of the tubules
- Liver cysts may also present
Define Adult polycystic disease
- Autosomal dominant
- Renal insufficiency in middle age, hematuria, hypertension
- Also, Berry aneurysm & liver cysts, colonic diverticula, mitral valve disease
- Cysts involve less than 10% of nephrons, but they expand later to interfere with function
What is the effect of T4, T3 and cortisol on blood pressure?
Increase BP
What is the effect of high BP on the kidney?
Atrophy and scarring of the glomeruli
In renal failure, ….. & …… can not be synthesized properly
Prostoglandins & Kinins
Malignant hypertension is …..
BP above 200/140 mm Hg, leads to acute end organ damage
* Usually in poorly controlled patient
What are the clinical features of malignant hypertension??
- Increased intracranial pressure: will cause, papilledema, headache, vomiting, scotoma (vision change), subarachnoid & intracerebral bleeding
- Left heart failure.
- Malignant nephrosclerosis: proteinuria, hematuria, acute renal failure
What are the forms of glomerular responses to injury?
- Cellular proliferation: of mesangial, endothelial & epithelial cells
2 Thickening of basement membrane - Leukocytic infilteration: of monocytes & neutrophils
- Sclerosis and hyalinization
Glomerulonephritis may result from anti bodies against :
- Basement membrane: example is Goodpasture syndrome
- Antibodies against any other glomerular antigen
- Ag-Ab complex may get trapped withing the glomeruli resulting in injury. The antigen could be exogenous (eg. serum sickness) or endogenous (eg. SLE with DNA-anti-DNA complex)
Nephrotic syndrome is a tetrad of …….
Proteinuria, edema, hypoalbuminemia, hyperlipidemia
What is the most common cause of nephrotic syndrome children & adults?
- Children: Lipoid nephrosis (minimal change disease)
2. Adults: Membranous glomerulonephritis (idiopathic)
Rapidly progressing glomerulonephritis is …..
rapidly deteriorating renal function accompanying glomerular injury
* Also called crescentic GN
Acute poststreptococcal GN is ……
immune related GN due to “skin” or throat infection. More in children
- Lab work show elevated antistreptolysin O (ASLO) titers and low complement
- The disease is probably related to immune complex deposition
Lipoid nephorsis is ……..
Nephrotic syndrome due to allergy, medications or hematologic malignancy
- Loss of visceral epithelial cells (podocyte) foot processes
- More in children, 2-3 years of age
- Complete recovery is expected
- Called minimal change disease
Membranoproliferative GN is ……
a mixed nephritic/nephrotic syndrome.
Antibodies against the glomerular basement membrane will cause ……..
rapidly progressing GN.
* Add pulmonary involvement and you get Goodpasture
The final stage of glomerular disease is ……..
chronic glomerulonephritis
* There is anemia, anorexia, hypertension, azotemia, nausea & vomiting, proteinuria
The most common cause for acute renal failure is ……
acute tubular necrosis
What are the types of acute tubular necrosis?
And what is the pathogenesis?
- Ischemic: most common, due to hypotension, renal vasoconstriction, shock
- Nephrotoxic: due to drugs (polymyxin, methicillin, sulfonamide), metals (mercury, lead, gold) etc…
* These lead to: vasoconstriction & decrease GFR, tubular obstruction, back leakage of fluid (into the interstitium), decrease glomerular permeability
* Prognosis is excellent
Tubulointerstitial disease is ………., it is cause by …….
Infection of everything but the glomerulus. Caused by G-ve bacilli (E. Coli, proteus, klebsiella, enterobacter) or Strep faecalis
- More common in females, since the urethra is shorter
- Infection ascends from urethra to the kidney
Chronic pyelonephritis may cause ……
renal failure due to parenchymal scarring
Toxic nephritis is ……
hypersensitivity reaction to infections or drugs (analgesics or antibiotics)
* Results in interstitial edema, mononuclear infiltrate, and renal necrosis
What are the clinical features for renal infarcts?
Asymptomatic, or may cause pain, hematuira, hypertension
What are the clinical features of diffuse cortical necrosis?
acute anuria and uremia
Renal vein thrombosis is associated with ……. . The clinical features are …….
The kidney looks ……
membranous glomerulonephritis (nephrotic syndrome)
- Flank pain, hematuria & renal failure
- The kidney looks enlarged
Urolithiasis formation has a family predisposition. T/F?
True
* Depends on the type of stone
What are the types of renal stones?
- Ca stones (80%): there is hypercalciuria without hypercalcemia. Also, there could be hyperuricosuria
- Magnesium ammonium (struvite) 15%: occur after infection with protease (splits urea)
- Uric acid (5%): seen in gout, leukemia, acidic urine
- Cystine (1%): due to cystinuria
* Ca stones are radio-opaque (the only that can be seen on xray)
Renal cell carcinoma is ……
adenocarcinoma arising from the PCT.
- They form 90% of all renal cancers in adults
- Associated with smoking & family history
- Prone to metastasis if larger than 3cm
What are the clinical features of renal cell carcinoma??
Hematuria, palpable mass, costovertebral pain
- May be asymptomatic until advanced
- May cause amyloidosis, leukemoid reaction, eosinophilia
What are the sites for metastasis of renal cancer?
opposite kidney, liver, lung, bone, adrenals, brain, lymph nodes
Hydroureter and hydronephrosis are caused by …….
ureter obstruction
- Obstruction could be due to:
1. Hematoma in the kidney
2. Renal caliculi
3. Stricture (post surgical/inflammatory)
4. Tumors
Bladder diverticula may cause …….
urinary stasis, and infection
Define bladder exstrophy
The presence of part of the bladder outside the body due to failure of downgrowth of mesoderm over the anterior bladder wall
Cystitis is caused by ……..
fecal flora (E. coli, Proteus, Klebsiella, Enterobacter, S. faecalis or Staphylococci) * Systemic signs are uncommon with lower UTI
Cystocele is ……
herniation of the fibrous barrier between the bladder and anterior vaginal wall during childbirth
* This may cause urine leakage or bladder obstruction
Most of the bladder tumors are …….
derived from the transitional epithelium, called “urothelium”
- Papilloma are uncommon, present with hematuria
- Carcinomas: due to Schistosoma haematobium, or smoking
What are the clinical features of bladder cancer?
Painless hematuria, dysuria, frequency, hydronephrosis, pyelonephritis
* High recurrence
Bladder sarcomas are ……..
large polypoid masses, usually leiomyosarcomas
Urithritis is two types, …… & ……
gonococcal & non gonococcal
* Non gonococcal are caused by Chlamydia, Mycoplasma & enteric bacteria
Urethral caruncle is …..
small red painful benign mass in the external urethral opening in the female
Urethral carcinoma are ……..
papillary growths composed of malignant squamous cells
* Rare. Cause by papillomavirus
