Renal Pathology I-V Flashcards
Diagnosis of Tubulointerstitial nephritis (Labs, Histo, Pathology)
Histology/pathology findings: T-lymphocytes, monocytes infiltrating interstitium; Lab findings: UA with elevated Cr, white cells, white cell casts
Diagnosis of Rapidly progressive GN type III (Labs, Histo, Pathology)
Histology/pathology findings: Crescents, no immune complex deposits (pauci-immune), no EM dense deposits, no anti GBM autoantibodies; Lab findings: ANCA
Presentation, Epidemiology, Etiology and Pathogenesis of Wilm’s tumor
Pediatric (most common kidney tumor in kids)
Mutations in WT1, WT2 triggers nephrogenesis
WAGR = Wilms, Aniridia, GU malformation, mental Retardation
What disease process is pictured below?
Hyaline arteriolosclerosis
Renal changes associated with benign hypertension, causes narrowing of vascular lumens, corticla atrophy
What disease process is pictured below?
Childhood autosomal recessive polycystic kidney disease
Sacular dilatations of the collecting tubules (oriented perpendicular to cortical surface) are seen on gross and histological sections
What disease process is pictured below?
Diabetic nephropathy due to nonenzymatic glycosylation of the vascular basement membranes, hyaline arteriolosclerosis
Presentation, Epidemiology, Etiology and Pathogenesis of Acute pyelonephritis
Sexually active young women present with sudden onset, costovertebral angle pain, fever, frequency/urgency, urosepsis; Bacterial infection (most common: E.Coli, Proteus, Klebsiella) or fungal/viral in immunocompromised. Any factor making the urinary tract a better environment for growth increases risk
What disease process is pictured below?
Postinfectious glomerulonephritis
Electron microscopy of PIGN showing subepithelial hump-like deposit which is made up of immune complex depositions
Diagnosis of Acute tubular injury/ acute tubular necrosis (Labs, Histo, Pathology)
Histology/pathology findings: Tubular necrosis, cells slough off and cast in distal tubule; Lab findings: Renal failure, Dx usually from clinical presentation
What disease process is pictured below?
(Hint: patient has had renal transplant)
Viral interstitial nephritis
Can mimic rejection, occurs in immunocompromised patients
What disease process is pictured below?
Thrombotic microangiopathy
Fibrin thrombi are seen in the glomeruli and small vessels
Diagnosis of Membranoproliferative Glomerular nephritis (Labs, Histo, Pathology)
Histology/pathology findings: Lobular tufts, thick glomerular basement membrane with “tram track appearance,” subendothelial IgG and complement activation; Lab findings: Low complement
Diagnosis of Autosomal recessive polycystic kidney disease (Labs, Histo, Pathology)
Histology/pathology findings: Enlarged reniform shape skdiney with sponge-like appearance, saccular dilatiation of the collecting tubules; Lab findings: Ultrasound, can do genetic testing
Diagnosis of Dense Deposit Disease (Labs, Histo, Pathology)
Histology/pathology findings: Complement deposits, but no Ig deposits. Dense deposits within lamina densa on EM; Lab findings: Complement levels, molecular studies
What disease process is pictured below?
IgA nephropathy
Mesangial proliferation due to deposits of IgA immune complexes
What disease process is pictured below?
AKI
Ischemic tubules show loss of polarity, eosinophilic degeneration with thinned epithelial lining
Diagnosis of Chronic pyelonephritis (Labs, Histo, Pathology)
Histology/pathology findings: Interstitial lymphocytes/glomerular periglomerular fibrosis and sclerosis, thyroidization of tubules; Lab findings: Routine UA, X-ray
What disease process is pictured below?
(Glomerulus on left, alveoli on right)
Goodpasture syndrome
The IgG cross reactts with pulmonary basement membrane leading to RPGN with hematuria as well as hemoptysis
Diagnosis of Lupus (Labs, Histo, Pathology)
Histology/pathology findings: Severe proliferative GN with necrosis and crescents. Abundant immune complex deposits; Lab findings: Autoantibodies: ANA’s, anti-Sm, anti-dsDNA
What disease process is pictured below?
Membranous nephropathy
EM shows subepithelial deposits within the basement membrane
Diagnosis of Focal and segmental glomerular sclerosis (FSGS) (Labs, Histo, Pathology)
Histology/pathology findings: Segmental obliteration of capillaries within some glomeruli; Lab findings: Nephrotic syndrome, genetic testing
What disease process is pictured below?
Postinfectious glomerulonephritis
Immunofluorescence shows glomerulus with “lumpy” pattern of IgG and Complement deposits
What disease process is pictured below?
RPGN type III with c-ANCA (left) and p-ANCA (right)
c-ANCA is seen in Wegener’s
p-ANCA is seen in Churg-Strauss
Presentation, Epidemiology, Etiology and Pathogenesis of Acute postinfectious GN
Children 6-10y/o present with acute nephritic syndrome (rarer in adults) 1-4 weeks after GABHS infection, M protein generates antibody response
Diagnosis of Thrombotic microangiopathies (Labs, Histo, Pathology)
Histology/pathology findings: Widespread thrombosis in small vessels; Lab findings: Thrombocytopenia, schistocytes in peripheral blood smears
What disease process is pictured below?
Amyloidosis
Congo red stain + with green birefringence in polarized light
Presentation, Epidemiology, Etiology and Pathogenesis of Rapidly progressive GN type II
Children and young adults (10-40yo) present with Gross hematuria, oliguria Severe immune complex formation, necrosis and breaks in glomerular basement membrane
What disease process is pictured below?
Toxic ATI due to antifreeze poisoning
Calcium oxalate crystals form in the tubules
Presentation, Epidemiology, Etiology and Pathogenesis of Renal cell carcinoma
75% of adult renal cancers present with Triad: costovertebral pain, mass, hematuria. Advanced stages associated with fever, malaise, weakness, weight loss, paraneoplastic syndromes, metastases; Mutation of VHL gene (tumor suppressor), allows tumor to adapt to tissue hypoxia (EPO, VEGF, PDGF expressed). Tumor originates from proximal tubular epithelium
What disease process is pictured below?
Focal Segmentas Glomerulosclerosis (FSGS)
Some segmental obliteration of glomerular capillaries are seen in some glomeruli on paraffin sections
EM would show effacement of foot processes in ALL glomeruli
Presentation, Epidemiology, Etiology and Pathogenesis of Acute tubular injury/ acute tubular necrosis
Most common cause of acute renal failure present with Rapidly reduced renal function, oliguria, uremia, fluid overload, electrolyte abnormalities, acidosis; Tubular injury, disturbance in flow, reduced GFR, decreased O2/nutrient delivery, toxic injury
Presentation, Epidemiology, Etiology and Pathogenesis of Tubulointerstitial nephritis
Most often caused by drugs present with Nephritic syndrome, rash/fever/eosinophilia; 4 causes: infections, toxins, metabolic, neoplasms
What disease process is pictured below?
Oncocytoma
Gross: mahagony brown kidney with central stellate scar
What disease process is pictured below?
Multiple myeloma
Light chain casts are seen due to massive production of monoclonal light chains by malignant plasma cells
These casts lead to renal failure
What disease process is pictured below?
RPGN type I: linear IF stain for IgG
Entire length of glomerular basement membrane has IgG deposits
Diagnosis of Acute drug induced interstitial nephritis (Labs, Histo, Pathology)
Histology/pathology findings: Interstitial inflammation, abundant eosinophils and edema; Lab findings: Renal failure, blood/urine eosinophilia
Diagnosis of Oncocytoma (Labs, Histo, Pathology)
Histology/pathology findings: Central stellate scar, mahogany brown colored kidney. Eosinophilic cytoplasm (H&E) and abundant mitochondria (EM); Lab findings: Radiology detects renal mass
What disease process is pictured below?
Clear cell renal cell carcinoma
Cytoplasm appears clear on histology
Highly vascular
Presentation, Epidemiology, Etiology and Pathogenesis of Angiomyolipoma
Rare present with ; Tumor arising from epithelioid cells around kidney blood vessels
What disease process is pictured below?
(Hint: variant of a disease)
Collapsing variant of FSGS, associated with HIV
What disease process is pictured below?
Hereditary nephritis (Alports syndrome)
EM shows splitting and lamination of the lamina densa in a “basket weave” pattern
What disease process is pictured below?
Papillary necrosis
Analgesics, diabetes, sickle cell, obstruction, and TB can cause decreased blood flow to the already poorly perfused medulla, leading to ischemic changes and necrosis of the papillae
What disease process is pictured below?
Membranoproliferative glomerulonephritis
EM showing subendothelial deposits of IgG and complement forming the tram track appearance characteristic of MPGN
Presentation, Epidemiology, Etiology and Pathogenesis of Adult polycystic kidney disease
Common present with Asymptomatic or pain, colic, mass, hemorrhage, hematuria, progressive renal failure, polyuria, HRN, proteinuria; Autosomal dominant mutation (PKD1, PKD2) with high penetrance, polycystin gene mutation
Diagnosis of Papillary necrosis (Labs, Histo, Pathology)
Histology/pathology findings: Necrotic renal papillae visible grossly and microscopically; Lab findings: UA with renal papilla
Presentation, Epidemiology, Etiology and Pathogenesis of Rapidly progressive GN type I
Young men present with Gross hematuria, oliguria, hemoptysis Antiglomerular basement membrane antibodies
Presentation, Epidemiology, Etiology and Pathogenesis of Minimal change disease
Children (2-6 y/o), rare in adults present with Edema (periorbital, generalized); Reversible podocyte injury due to cytokine production from immune depression, NSAIDS
Diagnosis of Hereditary nephritis (Alport syndrome) (Labs, Histo, Pathology)
Histology/pathology findings: Normal appearing on histology, no immune complexes. EM: splitteing and layering of lamina densa; Lab findings: Hematuria, genetic testing for type IV collagen mutation
What disease process is pictured below?
Chronic pyelonephritis
Interstitial lymphocytes
Periglomerular fibrosis and sclerosis
“Thyroidization” of dilated tubules
What disease process is pictured below?
Acute drug induced interstitial nephritis
Abundant eosinophils are seen due to an IgE mediated response to a medication (Antibiotics, diuretics, NSAIDs)
What is the structure pictured below?
Red blood cell cast
Negative impression (“cast”), molding of tubular lumen
What disease process is pictured below?
Minimal change disease
Light microscopy (left) appears normal, but EM shows effacement of the epithelial cell foot processes
Presentation, Epidemiology, Etiology and Pathogenesis of Focal and segmental glomerular sclerosis (FSGS)
Adults (higher incidence in African Americans, Hispanics), rarer in children. Can also be secondary to HIV, parvovirus, heroin, sickle cell disease present with Nephrotic syndrome, reduced GFR, HTN, non-selective proteinuria; Irreversible podocyte injury
What disease process is pictured below?
Membranous nephropathy
IF shows granular deposits of IgG and C3 on the basement membrane
What disease process is pictured below?
Membranoproliferative glomerulonephritis
Silver stain shows “tram track” appearance due to subendothelial IgG and complement deposits
Diagnosis of Rapidly progressive GN type I (Labs, Histo, Pathology)
Histology/pathology findings: Cresecents on stain, linear stain on IF from glomeruli and alveoli; Lab findings: Anti-glomerular basement membrane antibodies in serum
Diagnosis of Minimal change disease (Labs, Histo, Pathology)
Histology/pathology findings: Normal on LM, IF, effacement of foor processes seen on EM; Lab findings: Nephrotic syndrome
Presentation, Epidemiology, Etiology and Pathogenesis of IgA nephropathy (Berger disease)
Children and young adults present with Recurrent hematuria 1-2 days after URT infection Mucosal infection, increased IgA production, immune complex deposition in mesangium
What disease process is pictured below?
Membranous nephropathy
Spike and dome pattern on silver stain representing subepithelial deposits that interupt the basement membrane
What disease process is pictured below?
Atheromatous plaque containing cholesterol clefts
These emboli can occude arteries within the kidney leading to pale infarct
Diagnosis of IgA nephropathy (Berger disease) (Labs, Histo, Pathology)
Histology/pathology findings: Mesangial proliferation, IgA immune complexes seen on IF, electron dense deposits on EM; Lab findings: Hematuria, normal complement levels
Diagnosis of Acute pyelonephritis (Labs, Histo, Pathology)
Histology/pathology findings: Acute inflammation with PMNs in the tubules and interstitium; Lab findings: CBC, UA, culture
What disease process is pictured below?
Actue pyelonephritis
PMNs infiltrating (interstitial suppurative inflammation) with tubular necrosis
Presentation, Epidemiology, Etiology and Pathogenesis of Thrombotic microangiopathies
All ages present with Microangiopathic hemolytic anemia, thrombocytopenia, renal failure. Clinical overlap with HUS, TTP; Endothelial injury from HUS –>uncontrolled complement activation, TTP, drug toxicities, malignant HTN, SLE
What disease process is pictured below?
Hyperplastic arteriolosclerosis caused by malignant hypertension
What disease process is pictured below?
Oncocytoma
LM: Eosinophilic cytoplasm
EM shows abundant mitochondria
What disease process is pictured below?
Dense deposit disease
Caused by dysregulation of the complement cascade, dense deposits are seen in the lamina densa on EM
What disease process is pictured below?
NSAID induced interstitial nephritis
Acute hypersensitivity produces nephrotic syndrome and renal failure
Presentation, Epidemiology, Etiology and Pathogenesis of Acute drug induced interstitial nephritis
All ages present with Rash, renal failure; IgE and T cell mediated immune reaction to drugs (synthetic antibiotics, diuretics, NSAIDs)
What disease process is pictured below?
Wilm’s tumor
Malignant blastema (small blue cells), tubules, stroma
What disease process is pictured below?
Chronic oxalate nephropathy
Can be caused by bariatric surgery, hyperoxaluria, glycol intoxication
Presentation, Epidemiology, Etiology and Pathogenesis of Diabetic nephropathy
Associated with obesity, HTN, atherosclerosis present with Nephrotic syndrome; Nonenzymatic glycosylation of vascular basement membrane resulting in hyaline arteriosclerosis
Presentation, Epidemiology, Etiology and Pathogenesis of Chronic pyelonephritis
Adults: obstructive; Children: reflux nephropathy, HTN present with Pyuria/proteinuria, poluria, nocturia, contracted kidneys ; Usually bacterial infection causing gradual renal insufficiency
Presentation, Epidemiology, Etiology and Pathogenesis of Membranous nephropathy
adults 30-60y/o present with Edema (decreased oncotic P), thrombosis (loss of ATIII) , infections; Subepithelial immune complex formation due to autoimmune response against renal antigen
What disease process is pictured below?
IgA nephropathy (Berger disease)
Mesangial deposition of IgA
Presentation, Epidemiology, Etiology and Pathogenesis of Oncocytoma
5% of renal tumors present with ; Tumor arrising from distal nephron (intercalated cells of collecting duct)
Presentation, Epidemiology, Etiology and Pathogenesis of Amyloidosis
Patients present with Nephrotic syndrome, heart involvement, macroglossia, submandibular swelling, periorbital purpura, shoulder pad; Deposits of abnormally folded protein often associated with plasma cell dyscrasia/multiple myeloma
What disease process is pictured below?
Postinfectious glomerulonephritis
Hypercellularity = endocapillary proliferation, obliterated capillaries, influx of PMNs
Diagnosis of Renal cell carcinoma (Labs, Histo, Pathology)
Histology/pathology findings: 75% have clear cytoplasm, highly vascular; Lab findings: Radiology
What disease process is pictured below?
Cystic renal dysplasia
Gross image shows grape like appearance with multiple cysts. Histology shows persistence of immature elements from metanephric differentiation (cartilage, mesenchyme)
Presentation, Epidemiology, Etiology and Pathogenesis of Membranoproliferative Glomerular nephritis
Older children, adults present with Nephrotic syndrome and hematuria; Primary immune complex formation (increased monoclonal Ab production) with activation of classical complement pathway. Can be secondary to autoimmune disorders, hepatitis, endocarditis, infection
Diagnosis of Acute postinfectious GN (Labs, Histo, Pathology)
Histology/pathology findings: Hypercellular, neutrophilic infiltration, immune complexes on IF and EM; Lab findings: Tea-colored/smoky urine, hematuria, ASO titer high, decreased complement
Diagnosis of Rapidly progressive GN type II (Labs, Histo, Pathology)
Histology/pathology findings: Crescents, immune complexes (granular IF, dense deposits on EM); Lab findings: Decreased complement if postinfections, SLE. Normal complement if IgA
Diagnosis of Adult polycystic kidney disease (Labs, Histo, Pathology)
Histology/pathology findings: Bilateral enlarged kidneys with massive cysts, functioning nephrons between cysts, hepatic cysts, berry aneurysms, mitral valve prolapse; Lab findings: Radiology to detect formation of cysts
Presentation, Epidemiology, Etiology and Pathogenesis of Autosomal recessive polycystic kidney disease
CHILDREN. Rare. Onset before birth or early in life present with Kidney dysfunction, liver sometimes involved, respiratory distress, Potter syndrome (oligohydrominos); Mutation in PKHD1 gene encoding fibrocystin
Presentation, Epidemiology, Etiology and Pathogenesis of Dense Deposit Disease
Rare, older children present with Nephrotic syndrome and hematuria; Sustained activation of alternate pathway complement, not antibody mediated
What disease process is pictured below?
Angiomyolipoma
Poorly formed vessels, smooth muscle, and fat
Benign renal tumor
Diagnosis of Viral Interstitial nephritis (Labs, Histo, Pathology)
Histology/pathology findings: Immunostain for viral particles, infiltrate seen in kidney biopsy; Lab findings: PCR for virus
Diagnosis of Amyloidosis (Labs, Histo, Pathology)
Histology/pathology findings: Amyloid deposits stain positive on Congo red, with apple green birefringence. Appear fibrillar on EM; Lab findings: N/A
Presentation, Epidemiology, Etiology and Pathogenesis of Papillary necrosis
present with severe kidney injury leading to ischemia of renal medulla; Analgesics, diabetes, sickle cell anemia, obstruction, TB can cause renal ischemia. Ischemia leads to papillary necrosis
Diagnosis of Wilm’s tumor (Labs, Histo, Pathology)
Histology/pathology findings: Primitive blastema (undifferentiated cells), abortive glomeruli/tubules/spindle cell stroma; Lab findings: Radiology
What disease process is pictured below?
Adult polycystic kidney disease
Functional glomeruli can exist within the cysts, these gradually fail with time
Diagnosis of Angiomyolipoma (Labs, Histo, Pathology)
Histology/pathology findings: Poorly formed vessels, smooth muscle, and fat in variable proportions; Lab findings: Radiology diagnoses
Presentation, Epidemiology, Etiology and Pathogenesis of Hereditary nephritis (Alport syndrome)
5-20 y/o w/ sensory deficits, renal failure between 20-50 y/o present with Hearing, ocular abnormalities with isolated hematuria X-linked inheritance
Diagnosis of Diabetic nephropathy (Labs, Histo, Pathology)
Histology/pathology findings: Mesangial expansion (KW nodules), thickened basement membranes, glomerular sclerosis; Lab findings: N/A
What disease process is pictured below?
Mercury nephropathy demonstrating acidophilic intracellualr inclusions
Presentation, Epidemiology, Etiology and Pathogenesis of Viral Interstitial nephritis
Renal transplant patients, immunocomprimised present with Mimics renal transplant rejection; Polyoma virus causes nephropathy
What disease process is pictured below?
Rapidly progressing glomerulonephritis with glomerular crescent
Presentation, Epidemiology, Etiology and Pathogenesis of Lupus
Young women present with Multisystem disorder, renal involvement with nephritis, edema; Immune DNA-antiDNA complexes
Presentation, Epidemiology, Etiology and Pathogenesis of Rapidly progressive GN type III
Older patients > 65 y/o present with Oliguria, hematuria, hemoptysis, shortness of breath. ELK: ENT/Lung/Kidney ANCA - causes neutrophil degranulation (cANCA for Wegners, pANCA for Churg-Strauss)
Diagnosis of Membranous nephropathy (Labs, Histo, Pathology)
Histology/pathology findings: No inflammation/ proliferation/thickening, granular IgG/C deposits, loss of foot processes; Lab findings: Albumin, Lipids, LDL, complement levels
