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Pathology > Renal Pathology > Flashcards

Renal Pathology Flashcards

1
Q

Angiotensin II

A

Vasoconstricts peirpheral resistance arterioles and efferent arterioles, stimulates synthesis and release of aldosterone

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2
Q

Renal derived PGE2

A

Vasodilates the afferent arterioles

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3
Q

1-alpha-hydroxylase is synthesized in where of kidney? What does it do?

A
  1. Proximal renal tubule cells

2. converts 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol

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4
Q

Two functions of vitamin D

A
  1. increase GI absorption of calcium and phosphate

2. promotes bone mineralization (release of alkaline phosphatase from osteoblasts)

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5
Q

Hematuria: upper urinary tract

A
  1. renal stone
  2. GN
  3. Renal cell carcinoma
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6
Q

Hematuria: lower urinary tract

A
  1. infection
  2. transitional cell carcinoma (in absence of infection)
  3. benign prostatic hyperplasia (microscopic hematuria in males)
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7
Q

Drugs associated with hematuria

A
  1. anticoagulants

2. cyclophosphamide: hemorrhagic cystitis

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15
Q

Dipstick detects what?

A

albumin

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16
Q

SSA detects what?

A

albumin and globulins

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17
Q

Normal serum BUN level

A

7-18mg/dL

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18
Q

Where is BUN absorbed? What does it depend on?

A

Proximal tubule, flow dependent.

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19
Q

Decreased GFR = more or less BUN absorbed

A

More

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20
Q

Increased GFR = more or less BUN absorbed

A

Less

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21
Q

Most common cause of increased serum BUN level?

A

CHF

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22
Q

Normal serum creatinine level

A

0.6 to 1.2 mg/dL

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23
Q

Non-selective proteinuria with loss of albumin and globulin

A

post-streptococcal glomerulonephritis

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24
Q

Loss of negative charge on GBM, selective proteinuria with loss of only albumin

A

minimal change disease

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25
Q

Nephritic or nephrotic: <3.5g/24 hours of protein loss

A

Nephritic

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26
Q

Inability to reabsorb glucose, amino acids, uric acid, phosphate, and bicarbonate - leading to proteinuria

A

Fanconi syndrome

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27
Q

Defect in reabsorption of neutral AA (tryptophan) in GI and kidney - leading to proteinuria

A

Hartnup disease

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28
Q

Decreased cardiac output: increase or decrease BUN

A

Increase. low CO=low GFR=more absorption in proximal

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29
Q

Third degree burns: increase or decrease serum BUN

A

increase. increased aa degradation.

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30
Q

Causes of pre-renal Azotemia: Serum BUN:Cr >15

A
  1. decrease in CO
  2. hypoperfusion and decrease in GFR
  3. blood loss, CHF
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31
Q

Acute GN (poststreptococcal GN): increase or decrease serum BUN

A

increase

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32
Q

Urinary tract obstruction: increase or decrease BUN

A

increase.

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33
Q

Increase plasma volume (pregnancy): increase or decrease BUN

A

decrease, increase plasma volume, increases GFR, decreases serum BUN

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34
Q

Kwashiorkor: BUN level increase or decrease

A

decrease serum BUN

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35
Q

Azotemia

A

increase in serum BUN and creatinine

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36
Q

Normal serum BUN:creatinine ratio

A

15

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37
Q

Why use creatinine for renal clearance testing?

A

it is filtered, not reabsorbed or secreted

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40
Q

Causes of Renal Azotemia: Ratio <15

A

parenchymal damage, ATN, chronic renal failure

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41
Q

Postrenal Azotemia: ration>15 initially, <15 if obstruction persists

A

obstruction below the kidneys

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42
Q

Ccr equation

A

Ccr=Ucr x V/Pcr

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43
Q

Smoky-colored urine

A

nephritic type of GN

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44
Q

Black urine after exposure to light

A

alkaptonuria, increase in homogentisic acid in the urine

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45
Q

Vegan urine pH

A

alkaline,

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46
Q

Meat eater urine pH

A

acidic

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47
Q

Absent urine UBG, increase urine bilirubin

A

obstructive jaundice

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48
Q

Increase urine UBG, absent urine bilirubin

A

extravascular hemolytic anemia

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49
Q

increase urine UBG, increase urine bilirubin

A

hepatitis

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50
Q

4 types of kidney stones

A
  1. calcium oxalate
  2. uric acid
  3. triple phosphate
  4. cystine
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51
Q

Oval fat bodies

A

nephrotic syndrome

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52
Q

Hyaline cast without proteinuria

A

no significance

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53
Q

RBC Cast

A

nephritic type of GN (poststreptococcal GN)

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54
Q

WBC Cast

A

acute pyelonephritis, acute tubulointerstitial nephritis

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55
Q

Renal tubular cell cast

A

acute tubular necrosis

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56
Q

Fatty cast

A

nephrotic cast

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57
Q

Waxy cast

A

sign of chronic renal failure

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58
Q

Calcium oxalate

A

renal stone, ethylene glycol poisoning

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59
Q

Cystine hexagonal crystal

A

cystinuria

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63
Q

Vasoconstrictor of efferent arterioles

A

ATII

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64
Q

What produces negative charges of GBM?

A

Heparin sulfate

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65
Q

fusion of podocytes

A

nephrotic syndrome

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66
Q

Proliferation of parietal epithelial cells

A

Crescents

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67
Q

Horseshoe Kidney

A

Congenital disorder: fused at lower lobe. kidney trapped behind inferior mesenteric artery.

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68
Q

Increased incidence with Turner’s syndrome

A

Horseshoe kidney

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69
Q

Most common cystic disease in children. abnormal development of one or both kidneys

A

renal dysplasia

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70
Q

AR inheritance, cysts bilaterally cortex and medulla, hepatic fibrosis, maternal oligohydramnios

A

juvenile polycystic kidney disease

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71
Q

AD inheritance, chromosome 16, bilateral cystic disease by 20-25 years, cysts in liver, pancreas, and spleen, intracranial berry aneurysms, intracerebral hemorrhage, CRF by 40-60

A

adult polycystic kidney disease

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72
Q

Swiss-cheese appearance, multiple cysts of collecting ducts in medulla

A

medullary sponge kidney

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73
Q

Most common cause is renal dialysis

A

acquired polycystic kidney disease

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74
Q

Linear IF

A

anti-GBM, goodpasture syndrome

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75
Q

Only a few glomeruli ar abnormal

A

Focal GN

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76
Q

All glomeruli are abnormal

A

Diffuse glomerulonephritis

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77
Q

4 types of nephritic glomerular disease

A
  1. IgA glomerulopathy (Bergers disease)
  2. Acute proliferative GN/post-streptococcal GN
  3. DIffuse proliferative GN (SLE)
  4. Rapidly progressive crescentic GN
78
Q

> 100 nuclei in affected glomeruli

A

Proliferative GN

79
Q

Thick GBM, no proliferative change

A

membranous glomerulopathy

80
Q

Thick GBM, hypercellular glomeruli

A

membranoproliferative GN

81
Q

Fibrosis involving only a segment of the involved glomerulus

A

focal segmental glomerulosclerosis

82
Q

Proliferation of parietal epithelial cells around glomerulus

A

crescentic GN

83
Q

Inovlves only glomeruli and no other target organs (MCD)

A

primary glomerular disease

84
Q

involves glomeruli and other target organs

A

secondary glomerular disease

85
Q

Granular irregular deposits in the capillaries

A

poststreptococcal GN

86
Q

Fusion of podocytes

A

All nephrotic disease (like MCD)

87
Q

Subendothelial immunocomplex deposits

A

proliferative GN due to SLE

88
Q

Subepitheial immunocomplex deposits, hypercellular

A

posttreptococcal GN

89
Q

5 Types of Nephrotic Glomerular Disease

A
  1. MCD
  2. Focal segmental glomerulosclerosis
  3. diffuse membranous gloemropathy
  4. Type I MPGN
  5. Type II MPGN
90
Q

Nephritic Syndrome

A

Neutrophil-related injury to glomeruli, hypertension (salt retention), oliguria, hematuria (dysmorphic RBCs), RBC casts, proteinuria 15

94
Q

Overlapping features with Henoch-Schonlein purpura

A

IgA glomerulopathy

95
Q

Episodic bouts of hematuria following an upper respiratory infection

A

IgA glomerulopathy

96
Q

Increaed anti-DNase B titers, ASO not increased

A

Acute proliferative GN/post-streptococcal GN

97
Q

Wire looping, serum ANA test positive with anti-dsDNA antibodies,

A

DIffuse proliferative GN (SLE)

98
Q

ARF over days, Goodpastures syndrome, Wegener’s granulomatosis (c-ANA), hemoptysis and ends with renal failure

A

Rapidly progressive crescentic GN

99
Q

Cytokine injury to podocytes, loss of negative charge on GBM, proteinuria >3.5, fatty casts

A

nephrotic syndrome

100
Q

Pitting edema due to hypoalbuminemia

A

Nephrotic syndrome

101
Q

Pitting edema due to salt rentention

A

Nephritic syndrome

102
Q

Hypercholesterolemia, hypogammaglobulinemia

A

nephrotic syndrome

103
Q

Kimmelstiel-Wilson disease

A

Diabetic glomerulopathy

104
Q

Diabetic glomerulopathy is type of systemic disease in nephrotic or nephritic syndrome?

A

Nephrotic syndrome

105
Q

Two types of ATN

A
  1. ischemic

2. nephrotoxic

109
Q

Most common nephrotic syndrome in children, selective proteinuria, Hodgkin’s lymphoma as secondary cause, negative IF, fusion of podocytes,

110
Q

What is the treatment for MCD?

A

Steroid therpy

111
Q

Negative IF, HIV secondary cause, nonselective proteinuria, hypertension early, poor prognosis

A

Focal Segmental Glomerulosclerosis

112
Q

Most common nephrotic syndrome in adults, diffuse thickening of membranes (spikes and domes) beneath subepithelial deposits, subepithelial with granular ICs,

A

diffuse membranous gloemropathy

113
Q

Common causes of oliguria

A
  1. prerenal azotemia
  2. acute GN
  3. ATN
  4. postrenal azotemia
114
Q

Most common type of MPGN, HBV, HCV, subendothelial ICs with granular IF, tram tracks splitting of GBM, hypertension, hematuria

A

Type I MPGN

115
Q

C3 nephritic factor, dense deposit disease, tram tracks, hypertension, hematuria

A

Type II MPGN

116
Q

Nonenzymatic glycosylation of GBM

A

Diabetic glomerulopathy

117
Q

Osmotic damage in diabetic glomerulopathy is due to?

118
Q

Afferent/efferent hyaline arteriolosclerosis, nodular masses in mesangial matrix

A

Diabetic glomerulopathy

119
Q

microalbuminuria as initial laboratory finding, what med should be prescribed in the begining?

A

Diabetic glomerulopathy

121
Q

How is Alport inherited

A

X-linked, or autosomal dominant

122
Q

autoantibodies to IV collagen in GBM, lipid accumulation in VECs-foam cells, sensorineural hearing loss and ocular abnormalities

A

Alport Syndrome

123
Q

Persistent microscopic hematuria

A

Thin basement membrane disease (benign familial hematuria)

124
Q

Most common cause of chronic glomerulonephritis

A

RPGN (rapidly progressive glomerulonephritis)

125
Q

Most common cause of ARF

A

acute tubular necrosis (ATN)

128
Q

Preprenal azotemia due to hypovolemia

A

Ischemic ATN

129
Q

Ischemic ATN on endothelial cells

A

Net effect is vasoconstriction of afferent arterioles, which decreases GFR

130
Q

Pigmented renal tubular cell casts

A

Ischemic ATN (in both types of ATN)

131
Q

Aminoglycosides, heavy metals, damages in proximal tubule cells, tubular BM intact, hyperkalemia, increased BUN/creatinine

A

Nephrotoxic type of ATN

132
Q

Acute pyelonephritis mos common cause

A

Tubulointerstitial nephritis (TIN)

133
Q

What bacteria is most common cause of APN?

134
Q

Vesicoureteral reflex (VUR)

A

Urine reflex into ureters during micturition

138
Q

FENa equation

A

FENa=[(UNaxPcr)/(PnaxUcr)]x100

139
Q

FENa < 1%

A

indicates good tubular function

140
Q

FENa>2%

A

tubular dysfunction, highly predictive of ATN as cause of oliguria

141
Q

Findings in APN and not lower UTIs

A

fever, flank pain, WBC casts in urine,

142
Q

Treatment for APN

A

CIprofloxacin

143
Q

Causes of chronic pyelonephritis (CPN)

A

VUR in young girls, lower urinary tract obstruction

144
Q

U-shaped cortical scars overlying a blunt calyx, chronic inflammation, scarring, tubular atrophy, thyroidization

145
Q

Acute drug-induced TIN

A

penicillin, methicillin, rifampin, sulfonamides, NSAIDs, diuretics

146
Q

Reflux nehropathy causes what in children?

A

hypertension

147
Q

abrupt onset fever, oliguria, rash, BUN:Cr ratio <15, eosinophilia

A

Acute drug-induced TIN

148
Q

Chronic use of acetaminophen and aspirin for 3 or more years, renal papillary necrosis (medulla problem)

A

Analgesic nephropathy

149
Q

Ring defect on IVP

A

Renal papillary necrosis of Analgesic nephropathy

150
Q

Treatment for calcium stone, uric acid stone, struvite stone

A
  1. HCTZ, cellulose phosphate (binds calcium in intestine)
  2. allopurinol
  3. surgery and antibiotics
151
Q

How to prevent urate nephropathy?

A

Allopuriol before aggressive cancer therapy

152
Q

Nuclear acid-fast inclusions in PCT

A

Chronic lead poisoning

153
Q

Bence Jones Proteinuria produced tubular casts

A

Multiple Myeloma

154
Q

What reaction dues BJ proteinuria produce?

A

casts with foreign body giant cell reaction

155
Q

Nephrocalcinosis

A

multiple myeloma

156
Q

Normocytic anemia; qualitative platelet defect: prolonged bleeding time

A

Chronic Renal Failure

157
Q

Secondary hyperparathyroidism (HPTH)

A

Chronic Renal Failure

158
Q

Hypertension, pericarditis, CHF, atherosclerosis

A

Chronic Renal Failure

159
Q

Uremic frost (urea crystals deposit in skin)

A

Chronic Renal Failure

160
Q

Hyperkalemia and metabolic acidosis, hypocalcemia, hyperphosphatemia

A

Chronic Renal Failure

161
Q

Biomarker of kidney function

A

cystatin C

162
Q

Free water clearance is zero (lack concentration and dilution), waxy/broad casts

A

Chronic Renal Failure

163
Q

Most common renal disease in essential hypertension, hyaline arteriolosclerosis of arterioles in renal cortex, finely granular cortical surface due to atrophy of tubules, glomerular sclerosis

A

Benign Nephrosclerosis (BNS)

164
Q

Most common cause of malignant hypertension

A

Pre-existing BNS

165
Q

Onion skin appearance

A

Malignant hypertension

166
Q

Initial treatment for malignant hypertension

A

IV nitroprusside

167
Q

Most common cause of Renal infarction

A

emoblization from thrombi in left side of the heart

168
Q

Hematuria, loss concentration, renal papillary necrosis, APN

A

sickle cell nephropathy

169
Q

Anuria followed by ARF in pregnant women

A

Diffuse cortical necrosis

170
Q

Dilated ureter and renal pelvis, with thinning of overlying cortex and medulla due to compression atrophy

A

Hydronephrosis

171
Q

Most common metabolic abnormality causing calcium stones

A

hypercalciuria

172
Q

Most common renal stone in adult

A

calcium oxalate

173
Q

Most common renal stone in kids

A

calcium phosphate

174
Q

Staghorn calculus, urease producers, urine is alkaline and smells like ammonia

A

magnesium ammonium phosphate (MAP)

177
Q

Hamartoma associated with tuberous sclerosis

A

Angiomyolipoma

178
Q

Von Hippel-Lindau disease (VHL), asbestos exposure,smoking, yellow tumor with renal vein invasion, PCT cells, poor prognosis, hemorragic

A

Renal cell carcinoma

179
Q

Ectopic secretion EPO and PTH-related peptide

A

Renal cell carcinoma

180
Q

Transitional cell carcinoma most common cause

A

smoking, phenacetin abuse, aniline dyes, cyclophosphamide

181
Q

Squamous cell carcinoma

A

Renal pelvic cancer

182
Q

Most common primary renal tumor in children

A

Wilm’s tumor

183
Q

Child with unilateral flank mass and hypertension

A

Wilm’s Tumor

184
Q

Genetic type associated with WIlm’s Tumor

A

AD, chromosome 11,

185
Q

WAGR w/ Wilm’s tumor

A

Wilm’s tumor, aniridia (absent iris), genital abnormalities, retardataion

186
Q

Beckwith-Wiedemann Syndrome of Wilms Tumor

A

Wilm’s tumor, enlarged body organs, hemihypertrophy of extremities

187
Q

Wilm’s tumor derived from

A

mesonephric mesoderm

Pathology (10 decks)

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