Renal pathology Flashcards
What is nephritis?
Inflammation of the kidney
Can be infective (pyelonephritis) or non-infective (glomerulonephritis)
What is the pathogenesis of goodpasture’s disease/
IgG antibodies against alpha 3 subunit of collagen 4
Present in glomeruli and alveoli
What antibody is present in goodpasture’s disease?
Anti-GBM
What vasculitis can cause glomerulonephritis?
GPA - cANCA
MPA - pANCA
What is nephritic syndrome?
Haematuria, hypertension
What is nephrotic syndrome?
Heavy proteinuria
Non-dependent oedema, hyperlipidaemia
Protein loss - antibodies, complement, and proteins in clotting cascade
Can predispose to immunosuppression and renal vein thrombosis
What are crescents associated with?
BAD
Rapidly progressive GMN
What conditions can cause granuloma formation in the glomerulus?
GPA
Sarcoidosis
What is light microscopy used for?
Hypercellularity - inflammatory cells and reactive proliferations
Sclerosis
Crescents
Vasculitis
What condition will show linear IgG on immunofluorescence?
Goodpasture’s
Describe minimal change disease?
Nephrotic syndrome
Children get it
Resolves with steroids
Can only be diagnosed from EM
What can cause FSGS?
Obesity
HIV
Sickle cell
PWID
What syndrome will FSGS cause?
Nephrotic syndrome
What can cause membranous glomerulonephritis?
Infection - streptococcus
Hepatitis
Malaria
Syphilis
Drugs: penicillamine, NSAIDs, catopril, gold
Malignancy: lung, colon, melanoma
Immunological: SLE, RA, sarcoid, sjogrens
What syndrome will membranous glomerulonephritis cause?
Nephrotic
What is the histological appearance of membranous glomerulonephritis?
Thick membranes
Sub-epithelial immune deposits
Spikes seen on silver stain
What antibodies will membranous glomerulonephritis show?
Anti-phospholipase A2 receptors
Who is likely to get IgA glomerulonephritis?
Genetic
Acquired
Coeliac
Post infectious
What syndrome will IgA glomerulonephritis cause?
Nephritic syndrome - commonly asymptomatic with painless haematuria
What will IgA glomerulonephritis show on renal biopsy?
IgA deposits in the mesangium
What causes membranoproliferative glomerulonephritis?
Idiopathic (type 2 - infection, lupus, malignancy)
Commonly hodgkin’s lymphoma
What type of syndrome will membranoproliferative glomerulonephritis cause?
Either
What is the histological appearance of membranoproliferative glomerulonephritis?
Big lobulated hypercellular glomeruli with thick membranes
TRAM TRACKS
What kidney issues can diabetes cause?
Diffuse and nodular glomerulosclerosis Kimmel Stiel Wilson Lesions Afferent arterial sclerosis Pyelonephritis Papillary necrosis
What is the bosniak score?
Predicts malignant change in a kidney cyst
What is ADPCKD due to?
PKD1: chromosome 16
PKD2: chromosome 4
What is ARPCKD due to?
PKDH1: chromosome 6
How will ADPCKD present?
When adult Lots and lots of cysts Haemorrhage Infarction Rupture Pain Haematuria Liver cysts Cerebral aneurysms leading to subarachnoid haemorrhage
How will ARPCKD present?
In children
Younger the age, the higher the mortality
Kidney of a normal size with dilated collecting ducts
What is xanthogranulomatous pyelonephritis?
Infection that creates a mass that resembles a malignancy
What benign tumour is assoc with the kidneys?
Oncocytoma
What malignant tumours are assoc with the kidneys?
Chromophobe
Clear cell
Papillary
Collecting duct
What paediatric tumour is associated with the kidneys?
Wilm’s tumour
Describe an oncocytoma
Small, oval, well circumscribed
Mahogany brown with a central stellate scar
What is an oncocyte?
A pink cell with a fluffy cytoplasm due to a very high number of mitochondria
What is the histological appearance of a chromophobe?
Oncocytic but with raisinoid nuclei and perinuclear halos
What is the histological appearance of a papillary tumour?
Low grade
Papillary projections
What is the histological appearance of a collecting duct carcinoma?
High grade appearance with a very desmoplastic stroma
Poor survival - mean around 4 month
What are risk factors for developing clear cell carcinoma?
Obesity
Genetic influecnen
What is the common presentation of clear cell carcinoma?
Haematuria
Mass
Hypertension - rare
NEPHRITIC SYNDROME
What colour is a clear cell carcinoma?
Yellow
Where will clear cell carcinoma of the kidney spread?
Propensity to spread up the renal vein, into the IVE and into the heart
Doesn’t grow on the vessel walls, grows like a finger projection
What genetic condition predisposes to renal carcinoma?
VHL
Codes for hypoxia inducible factor which acts as a transcription factor for VEGF, PDGFRB and EPO
