Renal Pathology Flashcards
What are the features of the basement membrane in the glomerulus?
1) Negatively charged
2) Filtration slits between podocytes
Smaller and more positively charged can get through.
High permeability to water and small solutes.
What is the terminology for glomerular lesions when involving ALL glomerulus in the kidney?
1) FOCAL –> less than 50% all gloms involved
2) DIFFUSE –> more than all 50% of gloms involved
What is the terminology for glomerular lesions when referring to one individual glomerulus in the kidney?
1) SEGMENTAL –> less than 50% of individual glom involved
2) GLOBAL –> more than 50% of individual glom involved
What is the BASIC pathogenesis of primary glomerular disorders?
Usually immune mediated and produces an inflammatory response.
Accumulation of cells and release of substances which promote further accumulation and proliferation of cells.
Tissue damage caused by these cells and complement leads to:
1) Decreased GFR → tubular injury
2) Production of ECM → sclerosis / obliteration of glom
What are some different examples of autoimmune mechanisms for primary glomerular disorders?
1) Antibody against a constituent of the glom (EG: Basement membrane –> antiGBM disease – Goodpastures)
2) Antibody against something that has been deposited in the glom
3) Deposition of a circulating Ag-Ab immune complex
What are some histological alterations in glomeruli?
1) Hypercellularity
a) Proliferation of mesangial, endothelial +/- epithelial cells
b) Leucocyte infiltration
c) Formation of crescents = accumulation of cells in
Bowman’s Space
2) Basement membrane thickening
Accumulation of immune complexes – usual
Other things – amyloid, fibrin, cryoglobulins
3) Hyalinisation and sclerosis
What is acute glomerulonephritis and what are typical symptoms/signs?
Inflammatory alteration in glomeruli
1) Haematuria
2) ↑Cr and urea
3) Oliguria
4) +/- Proteinuria
What is nephrotic syndrome and what are typical symptoms/signs?
Kidney damage characterised by high levels of protein in the urine
1) Proteinuria
2) Leads to oedema
3) Foamy urine
4) Hyperlipidaemia
What is more common transitional neoplasia of the renal pelvis or renal cell carcinoma?
Renal cell carcinoma.
What is the classic triad of renal cell carcinoma symptoms
1) Haematuria
2) Flank pain
3) Palpable flank mass
What is the main route of spread of renal cell carcinoma?
Into the renal vein and then dissemination to lungs, bones and sometimes unusual sites for metastases such as skin. Lymph node spread is not common.
What are some features of transitional neoplasias?
May infiltrate underlying tissues but often remain on the surface of the urinary tract.
Metastasis is rare.
When in the upper ureter can cause obstruction and produce hydronephrosis.
