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MHD Block 5 > Renal Pathology I-V > Flashcards

Renal Pathology I-V Flashcards

1
Q

Diagnosis of Tubulointerstitial nephritis (Labs, Histo, Pathology)

A

Histology/pathology findings: T-lymphocytes, monocytes infiltrating interstitium; Lab findings: UA with elevated Cr, white cells, white cell casts

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2
Q

Diagnosis of Rapidly progressive GN type III (Labs, Histo, Pathology)

A

Histology/pathology findings: Crescents, no immune complex deposits (pauci-immune), no EM dense deposits, no anti GBM autoantibodies; Lab findings: ANCA

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3
Q

Presentation, Epidemiology, Etiology and Pathogenesis of Wilm’s tumor

A

Pediatric (most common kidney tumor in kids)

Mutations in WT1, WT2 triggers nephrogenesis

WAGR = Wilms, Aniridia, GU malformation, mental Retardation

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4
Q

What disease process is pictured below?

A

Hyaline arteriolosclerosis

Renal changes associated with benign hypertension, causes narrowing of vascular lumens, corticla atrophy

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5
Q

What disease process is pictured below?

A

Childhood autosomal recessive polycystic kidney disease

Sacular dilatations of the collecting tubules (oriented perpendicular to cortical surface) are seen on gross and histological sections

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6
Q

What disease process is pictured below?

A

Diabetic nephropathy due to nonenzymatic glycosylation of the vascular basement membranes, hyaline arteriolosclerosis

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7
Q

Presentation, Epidemiology, Etiology and Pathogenesis of Acute pyelonephritis

A

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

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8
Q

What disease process is pictured below?

A

Postinfectious glomerulonephritis

Electron microscopy of PIGN showing subepithelial hump-like deposit which is made up of immune complex depositions

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9
Q

Diagnosis of Acute tubular injury/ acute tubular necrosis (Labs, Histo, Pathology)

A

Histology/pathology findings: Tubular necrosis, cells slough off and cast in distal tubule; Lab findings: Renal failure, Dx usually from clinical presentation

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10
Q

What disease process is pictured below?

(Hint: patient has had renal transplant)

A

Viral interstitial nephritis

Can mimic rejection, occurs in immunocompromised patients

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11
Q

What disease process is pictured below?

A

Thrombotic microangiopathy

Fibrin thrombi are seen in the glomeruli and small vessels

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12
Q

Diagnosis of Membranoproliferative Glomerular nephritis (Labs, Histo, Pathology)

A

Histology/pathology findings: Lobular tufts, thick glomerular basement membrane with “tram track appearance,” subendothelial IgG and complement activation; Lab findings: Low complement

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13
Q

Diagnosis of Autosomal recessive polycystic kidney disease (Labs, Histo, Pathology)

A

Histology/pathology findings: Enlarged reniform shape skdiney with sponge-like appearance, saccular dilatiation of the collecting tubules; Lab findings: Ultrasound, can do genetic testing

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14
Q

Diagnosis of Dense Deposit Disease (Labs, Histo, Pathology)

A

Histology/pathology findings: Complement deposits, but no Ig deposits. Dense deposits within lamina densa on EM; Lab findings: Complement levels, molecular studies

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15
Q

What disease process is pictured below?

A

IgA nephropathy

Mesangial proliferation due to deposits of IgA immune complexes

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16
Q

What disease process is pictured below?

A

AKI

Ischemic tubules show loss of polarity, eosinophilic degeneration with thinned epithelial lining

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17
Q

Diagnosis of Chronic pyelonephritis (Labs, Histo, Pathology)

A

Histology/pathology findings: Interstitial lymphocytes/glomerular periglomerular fibrosis and sclerosis, thyroidization of tubules; Lab findings: Routine UA, X-ray

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18
Q

What disease process is pictured below?

(Glomerulus on left, alveoli on right)

A

Goodpasture syndrome

The IgG cross reactts with pulmonary basement membrane leading to RPGN with hematuria as well as hemoptysis

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19
Q

Diagnosis of Lupus (Labs, Histo, Pathology)

A

Histology/pathology findings: Severe proliferative GN with necrosis and crescents. Abundant immune complex deposits; Lab findings: Autoantibodies: ANA’s, anti-Sm, anti-dsDNA

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20
Q

What disease process is pictured below?

A

Membranous nephropathy

EM shows subepithelial deposits within the basement membrane

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21
Q

Diagnosis of Focal and segmental glomerular sclerosis (FSGS) (Labs, Histo, Pathology)

A

Histology/pathology findings: Segmental obliteration of capillaries within some glomeruli; Lab findings: Nephrotic syndrome, genetic testing

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22
Q

What disease process is pictured below?

A

Postinfectious glomerulonephritis

Immunofluorescence shows glomerulus with “lumpy” pattern of IgG and Complement deposits

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23
Q

What disease process is pictured below?

A

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

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24
Q

Presentation, Epidemiology, Etiology and Pathogenesis of Acute postinfectious GN

A

Children 6-10y/o present with acute nephritic syndrome (rarer in adults) 1-4 weeks after GABHS infection, M protein generates antibody response

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25
Q

Diagnosis of Thrombotic microangiopathies (Labs, Histo, Pathology)

A

Histology/pathology findings: Widespread thrombosis in small vessels; Lab findings: Thrombocytopenia, schistocytes in peripheral blood smears

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26
Q

What disease process is pictured below?

A

Amyloidosis

Congo red stain + with green birefringence in polarized light

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27
Q

Presentation, Epidemiology, Etiology and Pathogenesis of Rapidly progressive GN type II

A

Children and young adults (10-40yo) present with Gross hematuria, oliguria Severe immune complex formation, necrosis and breaks in glomerular basement membrane

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28
Q

What disease process is pictured below?

A

Toxic ATI due to antifreeze poisoning

Calcium oxalate crystals form in the tubules

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29
Q

Presentation, Epidemiology, Etiology and Pathogenesis of Renal cell carcinoma

A

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

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30
Q

What disease process is pictured below?

A

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

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31
Q

Presentation, Epidemiology, Etiology and Pathogenesis of Acute tubular injury/ acute tubular necrosis

A

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

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32
Q

Presentation, Epidemiology, Etiology and Pathogenesis of Tubulointerstitial nephritis

A

Most often caused by drugs present with Nephritic syndrome, rash/fever/eosinophilia; 4 causes: infections, toxins, metabolic, neoplasms

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33
Q

What disease process is pictured below?

A

Oncocytoma

Gross: mahagony brown kidney with central stellate scar

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34
Q

What disease process is pictured below?

A

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

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35
Q

What disease process is pictured below?

A

RPGN type I: linear IF stain for IgG

Entire length of glomerular basement membrane has IgG deposits

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36
Q

Diagnosis of Acute drug induced interstitial nephritis (Labs, Histo, Pathology)

A

Histology/pathology findings: Interstitial inflammation, abundant eosinophils and edema; Lab findings: Renal failure, blood/urine eosinophilia

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37
Q

Diagnosis of Oncocytoma (Labs, Histo, Pathology)

A

Histology/pathology findings: Central stellate scar, mahogany brown colored kidney. Eosinophilic cytoplasm (H&E) and abundant mitochondria (EM); Lab findings: Radiology detects renal mass

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38
Q

What disease process is pictured below?

A

Clear cell renal cell carcinoma

Cytoplasm appears clear on histology

Highly vascular

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39
Q

Presentation, Epidemiology, Etiology and Pathogenesis of Angiomyolipoma

A

Rare present with ; Tumor arising from epithelioid cells around kidney blood vessels

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40
Q

What disease process is pictured below?

(Hint: variant of a disease)

A

Collapsing variant of FSGS, associated with HIV

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41
Q

What disease process is pictured below?

A

Hereditary nephritis (Alports syndrome)

EM shows splitting and lamination of the lamina densa in a “basket weave” pattern

42
Q

What disease process is pictured below?

A

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

43
Q

What disease process is pictured below?

A

Membranoproliferative glomerulonephritis

EM showing subendothelial deposits of IgG and complement forming the tram track appearance characteristic of MPGN

44
Q

Presentation, Epidemiology, Etiology and Pathogenesis of Adult polycystic kidney disease

A

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

45
Q

Diagnosis of Papillary necrosis (Labs, Histo, Pathology)

A

Histology/pathology findings: Necrotic renal papillae visible grossly and microscopically; Lab findings: UA with renal papilla

46
Q

Presentation, Epidemiology, Etiology and Pathogenesis of Rapidly progressive GN type I

A

Young men present with Gross hematuria, oliguria, hemoptysis Antiglomerular basement membrane antibodies

47
Q

Presentation, Epidemiology, Etiology and Pathogenesis of Minimal change disease

A

Children (2-6 y/o), rare in adults present with Edema (periorbital, generalized); Reversible podocyte injury due to cytokine production from immune depression, NSAIDS

48
Q

Diagnosis of Hereditary nephritis (Alport syndrome) (Labs, Histo, Pathology)

A

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

49
Q

What disease process is pictured below?

A

Chronic pyelonephritis

Interstitial lymphocytes

Periglomerular fibrosis and sclerosis

“Thyroidization” of dilated tubules

50
Q

What disease process is pictured below?

A

Acute drug induced interstitial nephritis

Abundant eosinophils are seen due to an IgE mediated response to a medication (Antibiotics, diuretics, NSAIDs)

51
Q

What is the structure pictured below?

A

Red blood cell cast

Negative impression (“cast”), molding of tubular lumen

52
Q

What disease process is pictured below?

A

Minimal change disease

Light microscopy (left) appears normal, but EM shows effacement of the epithelial cell foot processes

53
Q

Presentation, Epidemiology, Etiology and Pathogenesis of Focal and segmental glomerular sclerosis (FSGS)

A

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

54
Q

What disease process is pictured below?

A

Membranous nephropathy

IF shows granular deposits of IgG and C3 on the basement membrane

55
Q

What disease process is pictured below?

A

Membranoproliferative glomerulonephritis

Silver stain shows “tram track” appearance due to subendothelial IgG and complement deposits

56
Q

Diagnosis of Rapidly progressive GN type I (Labs, Histo, Pathology)

A

Histology/pathology findings: Cresecents on stain, linear stain on IF from glomeruli and alveoli; Lab findings: Anti-glomerular basement membrane antibodies in serum

57
Q

Diagnosis of Minimal change disease (Labs, Histo, Pathology)

A

Histology/pathology findings: Normal on LM, IF, effacement of foor processes seen on EM; Lab findings: Nephrotic syndrome

58
Q

Presentation, Epidemiology, Etiology and Pathogenesis of IgA nephropathy (Berger disease)

A

Children and young adults present with Recurrent hematuria 1-2 days after URT infection Mucosal infection, increased IgA production, immune complex deposition in mesangium

59
Q

What disease process is pictured below?

A

Membranous nephropathy

Spike and dome pattern on silver stain representing subepithelial deposits that interupt the basement membrane

60
Q

What disease process is pictured below?

A

Atheromatous plaque containing cholesterol clefts

These emboli can occude arteries within the kidney leading to pale infarct

61
Q

Diagnosis of IgA nephropathy (Berger disease) (Labs, Histo, Pathology)

A

Histology/pathology findings: Mesangial proliferation, IgA immune complexes seen on IF, electron dense deposits on EM; Lab findings: Hematuria, normal complement levels

62
Q

Diagnosis of Acute pyelonephritis (Labs, Histo, Pathology)

A

Histology/pathology findings: Acute inflammation with PMNs in the tubules and interstitium; Lab findings: CBC, UA, culture

63
Q

What disease process is pictured below?

A

Actue pyelonephritis

PMNs infiltrating (interstitial suppurative inflammation) with tubular necrosis

64
Q

Presentation, Epidemiology, Etiology and Pathogenesis of Thrombotic microangiopathies

A

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

65
Q

What disease process is pictured below?

A

Hyperplastic arteriolosclerosis caused by malignant hypertension

66
Q

What disease process is pictured below?

A

Oncocytoma

LM: Eosinophilic cytoplasm

EM shows abundant mitochondria

67
Q

What disease process is pictured below?

A

Dense deposit disease

Caused by dysregulation of the complement cascade, dense deposits are seen in the lamina densa on EM

68
Q

What disease process is pictured below?

A

NSAID induced interstitial nephritis

Acute hypersensitivity produces nephrotic syndrome and renal failure

69
Q

Presentation, Epidemiology, Etiology and Pathogenesis of Acute drug induced interstitial nephritis

A

All ages present with Rash, renal failure; IgE and T cell mediated immune reaction to drugs (synthetic antibiotics, diuretics, NSAIDs)

70
Q

What disease process is pictured below?

A

Wilm’s tumor

Malignant blastema (small blue cells), tubules, stroma

71
Q

What disease process is pictured below?

A

Chronic oxalate nephropathy

Can be caused by bariatric surgery, hyperoxaluria, glycol intoxication

72
Q

Presentation, Epidemiology, Etiology and Pathogenesis of Diabetic nephropathy

A

Associated with obesity, HTN, atherosclerosis present with Nephrotic syndrome; Nonenzymatic glycosylation of vascular basement membrane resulting in hyaline arteriosclerosis

73
Q

Presentation, Epidemiology, Etiology and Pathogenesis of Chronic pyelonephritis

A

Adults: obstructive; Children: reflux nephropathy, HTN present with Pyuria/proteinuria, poluria, nocturia, contracted kidneys ; Usually bacterial infection causing gradual renal insufficiency

74
Q

Presentation, Epidemiology, Etiology and Pathogenesis of Membranous nephropathy

A

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

75
Q

What disease process is pictured below?

A

IgA nephropathy (Berger disease)

Mesangial deposition of IgA

76
Q

Presentation, Epidemiology, Etiology and Pathogenesis of Oncocytoma

A

5% of renal tumors present with ; Tumor arrising from distal nephron (intercalated cells of collecting duct)

77
Q

Presentation, Epidemiology, Etiology and Pathogenesis of Amyloidosis

A

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

78
Q

What disease process is pictured below?

A

Postinfectious glomerulonephritis

Hypercellularity = endocapillary proliferation, obliterated capillaries, influx of PMNs

79
Q

Diagnosis of Renal cell carcinoma (Labs, Histo, Pathology)

A

Histology/pathology findings: 75% have clear cytoplasm, highly vascular; Lab findings: Radiology

80
Q

What disease process is pictured below?

A

Cystic renal dysplasia

Gross image shows grape like appearance with multiple cysts. Histology shows persistence of immature elements from metanephric differentiation (cartilage, mesenchyme)

81
Q

Presentation, Epidemiology, Etiology and Pathogenesis of Membranoproliferative Glomerular nephritis

A

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

82
Q

Diagnosis of Acute postinfectious GN (Labs, Histo, Pathology)

A

Histology/pathology findings: Hypercellular, neutrophilic infiltration, immune complexes on IF and EM; Lab findings: Tea-colored/smoky urine, hematuria, ASO titer high, decreased complement

83
Q

Diagnosis of Rapidly progressive GN type II (Labs, Histo, Pathology)

A

Histology/pathology findings: Crescents, immune complexes (granular IF, dense deposits on EM); Lab findings: Decreased complement if postinfections, SLE. Normal complement if IgA

84
Q

Diagnosis of Adult polycystic kidney disease (Labs, Histo, Pathology)

A

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

85
Q

Presentation, Epidemiology, Etiology and Pathogenesis of Autosomal recessive polycystic kidney disease

A

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

86
Q

Presentation, Epidemiology, Etiology and Pathogenesis of Dense Deposit Disease

A

Rare, older children present with Nephrotic syndrome and hematuria; Sustained activation of alternate pathway complement, not antibody mediated

87
Q

What disease process is pictured below?

A

Angiomyolipoma

Poorly formed vessels, smooth muscle, and fat

Benign renal tumor

88
Q

Diagnosis of Viral Interstitial nephritis (Labs, Histo, Pathology)

A

Histology/pathology findings: Immunostain for viral particles, infiltrate seen in kidney biopsy; Lab findings: PCR for virus

89
Q

Diagnosis of Amyloidosis (Labs, Histo, Pathology)

A

Histology/pathology findings: Amyloid deposits stain positive on Congo red, with apple green birefringence. Appear fibrillar on EM; Lab findings: N/A

90
Q

Presentation, Epidemiology, Etiology and Pathogenesis of Papillary necrosis

A

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

91
Q

Diagnosis of Wilm’s tumor (Labs, Histo, Pathology)

A

Histology/pathology findings: Primitive blastema (undifferentiated cells), abortive glomeruli/tubules/spindle cell stroma; Lab findings: Radiology

92
Q

What disease process is pictured below?

A

Adult polycystic kidney disease

Functional glomeruli can exist within the cysts, these gradually fail with time

93
Q

Diagnosis of Angiomyolipoma (Labs, Histo, Pathology)

A

Histology/pathology findings: Poorly formed vessels, smooth muscle, and fat in variable proportions; Lab findings: Radiology diagnoses

94
Q

Presentation, Epidemiology, Etiology and Pathogenesis of Hereditary nephritis (Alport syndrome)

A

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

95
Q

Diagnosis of Diabetic nephropathy (Labs, Histo, Pathology)

A

Histology/pathology findings: Mesangial expansion (KW nodules), thickened basement membranes, glomerular sclerosis; Lab findings: N/A

96
Q

What disease process is pictured below?

A

Mercury nephropathy demonstrating acidophilic intracellualr inclusions

97
Q

Presentation, Epidemiology, Etiology and Pathogenesis of Viral Interstitial nephritis

A

Renal transplant patients, immunocomprimised present with Mimics renal transplant rejection; Polyoma virus causes nephropathy

98
Q

What disease process is pictured below?

A

Rapidly progressing glomerulonephritis with glomerular crescent

99
Q

Presentation, Epidemiology, Etiology and Pathogenesis of Lupus

A

Young women present with Multisystem disorder, renal involvement with nephritis, edema; Immune DNA-antiDNA complexes

100
Q

Presentation, Epidemiology, Etiology and Pathogenesis of Rapidly progressive GN type III

A

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)

101
Q

Diagnosis of Membranous nephropathy (Labs, Histo, Pathology)

A

Histology/pathology findings: No inflammation/ proliferation/thickening, granular IgG/C deposits, loss of foot processes; Lab findings: Albumin, Lipids, LDL, complement levels

MHD Block 5 (1 decks)

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