Renal Pathology Flashcards
1
Q
Describe basic kidney anatomy and histology
A
- Renal corpuscule (glomerulus / bowmans capsule)
- PCT, loop of henle, DCT, collecting tubules
2
Q
List the different glomerular diseases
A
- Glomerulonephritis
- Pyelonephritis
- Acute Tubular Necrosis
- Kidney Stones
- Renal Cell Carcinoma
- Transitional Cell Carcinoma
- Polycystic Kidney Disease
3
Q
What is glomerulonephritis and list the types
A
- Inflammation of the glomerulus
- Immune related
- Antibody-antigen complexes build and become trapped (block filtration, tissue injury, long term complete / phagocyte activation), proteinuria
- Proliferation of messengial cells, entrapment of leukocytes, blockage of glomeruli, hematuria, edema
- Enlarged hyper-cellular glomeruli and humps of antigen-antibody complexes
- Types: Nephritic, nephrotic and cresentic
4
Q
What is nephrotic glomerulonephritis
A
- Minimal change disease
- Focal segmental glomerulosclerosis
- Membranous nephropathy and membranoproliferative glomerulonephritis
- Derangement of capillary walls / thin of foot processes
- Proteinuria, decreased serum albumin / oncotic pressure
- Increased edema, swelling in legs / ankles, fatigue, poor appetite, high lipids in urine, hypoalbuminemia
- Absence of immune deposits, immune dysfunction, damage to glomerulus, benign
- Resolves with corticosteroid therapy
5
Q
What is nephritic glomerulonephritis
A
- Acute post infectious (post-streptococcal)
- IgA nephropathy (Berger disease) and hereditary nephritis
- Inflammatory cells in glomeruli
- Type III HS reaction (1-2 w after sore throat or 6 w after skin infection)
- Acute onset of hematuria, oliguria, proteinuria, azotemia
6
Q
What is crescent glomerulonephritis
A
- Extensive glomerular crescents
- Proliferating cells in Bowmans capsule (histologic marker)
- Rapidly progressive
- Rupture of glomerular capillaries causes cellular and humoral inflammatory mediators to fill BC
- Rapid loss of renal function, glomerular injury
7
Q
What is acute pyelonephritis
A
- Kidney infection
- suppurative inflammation of kidney and pelvis
- Caused by E. coli
- Risk factors (female, UTO, catheterisation, vesicoureteral reflux)
- Complication of UTI (cystitis, prostatitis, urethritis)
- Bacteria reach kidney by haematogenous infection (septicaemia / endocarditis) or ascending UTI / UTO (renal calculi)
8
Q
What is chronic pyelonephritis
A
- Bacterial infection
- Vesicoureteral reflux / obstruction
- Caused by chronic UTO / repeated bouts of acute inflammation
- Intrarenal reflux (scarring / chronic inflammation)
- Border of cortex / medulla focal infiltrations of lymphocytes / plasma cells
- Renal tubes are dilated and filled with pink protein casts
- Connective tissue in interstitium, thickening of arteriole walls, lumen narrows (secondary hypertension)
9
Q
What is a UTI
A
- Short urethra of females allows faecal bacteria to easily enter urethra
- More common in sexually active women
- Urethritis, cystitis or pyelitis / pyelonephritis (complications)
- Dysuria, urinary urgency / frequency, fever, cloudy / blood tinged urine, back pain (kidneys)
- Treated with antibiotics
10
Q
What is acute tubular necrosis
A
- Destruction of tubular epithelial cells
- Caused by ischaemia, toxic injury, hypersensitivity to drugs, UTO (tumour)
- Loss of renal function, common cause of acute renal failure
- Tubule cell injury and disturbances in BF
- Loss of brush border, flattening cells, intratubular cast formation, sloughing
- Intratubular obstruction
- Pre-renal, initiation, extension, maintenance and repair
11
Q
What is renal cell carcinoma
A
- Primary carcinoma of the kidney parenchyma arising from the tubular epithelium
- Risk Factors: Smoking, obesity, hypertension, occupational exposure (asbestos, petroleum, heavy metals) and genetics
12
Q
What is transitional cell carcinoma
A
- Bladder can expand significantly (transitional epithelium)
- Most common cancer of bladder, ureter, urethra and rarely the renal pelvis
- Risk Factors: Smoking, industrial exposure, schistosoma haematobium infection, drugs and radiation
13
Q
What are cystic kidney diseases
A
- Heterogenous group of kidney diseases Cysts: - Single / multiple cystic spaces - Variable size (1-5 cm) - Clear fluid - Confined to cortex - Membrane singe layer of cuboidal or flattened cuboidal epithelium - No clinical significance
14
Q
What is polycystic disease
A
- Hereditary disorder
- Multiple expanding cysts which ultimately destroy renal parenchyma
- Autosomal dominant or recessive
15
Q
What is autosomal dominant polycystic disease
A
- Partial replacement of renal parenchyma by cysts, bilateral, kidneys enlarged
- 15-30 years
- Defective PKD1 gene on chromosome 16
- Palpable renal masses and progression to choleric renal failure
- Hypertension, hematuria, UTI, ischemic atrophy of intervening renal substance
- Serous filled cysts with normal nephrons between cysts
