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Block 9 Week 5 > Renal Pathology II- FUNG > Flashcards

Renal Pathology II- FUNG Flashcards

1
Q

What is the most cost effective method of analyzing urine?

A

urine dipstick

Urinalysis is also inexpensive

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2
Q

What does the urine dipstick analyze?

A 
pH
Specific gravity
Protein
Glucose
Ketones
Nitrite
Leukocyte esterase
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3
Q 
What are these:
Specific gravity
Protein
Glucose
Ketones
Hemoglobin
Bile
Urobilinogen
A

chemical exams of urine

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4
Q 
What are these:
Casts
Organisms
Red cells
White cells
Epithelial cells
Crystals
A

Microscopic exam

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5
Q

What are these:
Color
Turbidity

A

Macroscopic exam

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6
Q

What are the causes of AKI?

A

Ischemia, Direct toxic injury, acute tublointerstitial nephritis, obstruction

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7
Q

What are the ischemic causes of AKI?

A

HUS, DIC, vasculitis, hypertension, shock

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8
Q

What are the direct toxic injury causes of AKI?

A

drugs, contrast dye, myoglobin, hemoglobin, radiation

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9
Q

What is the cause of acute tubulointerstitial nephritis that causes AKI?

A

hypersensitivity reactions

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10
Q

What is the most common cause of acute renal failure? What will your tubules look like?

A

AKI

injured

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11
Q

What areas are most damaged in ischemic acute tubular necrosis?

A

PCT and loop of Henle

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12
Q

What areas are most affected by toxic acute tubular necrosis?

A

PCT!!!!!! and a little bit of loop of Henle

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13
Q

What is tubulointerstitial nephritis?

A

group of renal disease characterized by histologic and functional alterations predominantly involving the tubules and interstitium.

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14
Q

What is acute tubulointerstital nephritis like?

A

rapid in onset

-histologically: edema, acute inflammatory infiltrate, focal tubular necrosis

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15
Q

What is chronic tubulointerstital nephritis like?

A

mononuclear infiltrate, interstitial fibrosis, widespread tubular atrophy

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16
Q

What are the causes of tubulointerstitial nephritis?

A 
Infection 
Toxins 
Metabolic disease
Obstruction
Neoplasms
Vascular
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17
Q

What is the evolution of tubulointerstitial nephritis?

A 
in the early phase (easy to distinguish from glomerular disease):
-inability to concentrate urine
-metabolic acidosis
-defects in tubular secretion/absorption
Late stage (difficult to distinguish)
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18
Q

What is pyelonephritis?

A

common disorder affecting the tubules, interstitium and renal pelvis

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19
Q

Pyelonephritis is an acute or chronic complication of (blank)

A

cystitis

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20
Q

What are the infecting organisms that cause pyelonephritis?

A

E. coli
Proteus
Klebsiella
Enterobacter

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21
Q

The infecting organisms of pyelonephritis are most commonly derived from patients (blank)

A

fecal flora

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22
Q

What are the organisms that cause hematogenous infection that leads to tubulointerstitial nephritis?

A

staph

E. coli

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23
Q

What is acute pyelonephritis?

A

acute suppurative inflammation caused by a microbial infection

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24
Q

What are the predisposing factors that cause acute pyelonephritis?

A 
obstruction
instrumentation
vesicoureteral reflux
female 
diabetes
25
Q

What are the symptoms of acute pyelonephritis?

A
  • Pain at costovertebral angle
  • fever
  • malaise
  • dysuria
  • frequency
  • urgency
  • WBC casts
26
Q

What is chronic pyelonephritis?

A

chronic tubulointerstitial inflammation and renal scarring w/ involvement of the calyces

27
Q

What are the 2 types of chronic pyelonephritis?

A
  • reflux nephropathy

- chronic obstructive pyelonephritis

28
Q

How do drugs and toxins produce renal injury?

A
  • acute hypersensitivity nephritis
  • direct toxicity
  • chronic injury and chronic renal insufficiency
  • analgesic nephropathy (Directly toxic)
  • NSAID nephropathy (Directly toxic)
29
Q

What is multiple myeloma?

A

Cancer of the plasma cells resulting in abnormal protein formation that results in kidney problems

30
Q

What are the findings of multiple myeloma affecting the kidney?

A
  • bence jones proteinuria
  • amyloidosis
  • progresses to light chain deposition disease
31
Q

What are the 2 ways that hypertension manifests and what does it cause?

A

benign nephrosclerosis

malignant nephrosclerosis

32
Q

What can renal artery stenosis cause?

A

hypertension

33
Q

What is thrombotic microangiopathy characterized by?

A
  • Microangiopathic hemolytic anemia
  • Thrombocytopenia
  • Renal failure
34
Q

What are the 2 forms of thrombotic microangiopathies?

How can you tell the difference?

A

Hemolytic uremic syndrome
Thrombotic thrombocytopenic pupura
TTP has fever, neurological symptoms

35
Q

What causes hemolytic uremic syndrome (HUS)?

A

shiga toxin from E. coli

36
Q

Wht causes TTP?

A

ADAMTS13 (can’t cleave von willebrand factor into smaller monomers)

37
Q

What are the types of cystic kidney diseases?

A
  • simple cysts
  • acquired cysts
  • polycystic kidney disease
  • medullary cystic disease
38
Q

How do you get adult polycystic kidney disease?

A
  • autosomal dominant
  • PKD1 chromosome 16p12.3
  • PKD2 chromosome 4q21
39
Q

What are the extra renal anomalies associated with adult polycystic kidney disease?

A
  • polycystic liver disease
  • intracranial berry aneurysms
  • mitral valve prolapse
40
Q

in adult PKD you acquire cysts throughout life but dont present until (Blank) decades of life

A

4th-5th

41
Q

What are the forms of childhood polycystic kidney disease and what are the most common forms? what is it caused by? What is it associated with?

A

perinatal, neonatal, infantile, juvenile
-perinatal and infantile

PKHD1-chromosome 6p21-23
associated with hepatic fibrosis

42
Q

What are the three types of medullary cysts?

A
  • medullary sponge kidney
  • nephronophthisis
  • adult-onset medullary cystic disease
43
Q

What does medullary cysts present with and when does it present?

A

tubular defects

presents earlier in life (except the adult-onset form)

44
Q

What are the most common causes of obstruction?

A

tumors and calculi

45
Q

What is hydronephrosis?

A

increased pressure in the pelvocalyceal system -> leads to dilation of the pelvis and atrophy of the kidney parenchyma

46
Q

Why does nephrolithiasis occur and what are the four types?

A

occurs sporadically and genetic predisposition
4 types:
-calcium oxalate (70%)
-Struvite (magnesium ammonium phosphate (15% caused by proteus UTIs)
-Uric acid (5-10%)
-Cysteine (1-2%)

47
Q

In order for calculi to form, there must be (blank)

A

supersaturation

48
Q

What are calcium oxalate stones caused by?

A

Hypercalcuria

49
Q

What are struvite crystals due to?

A

Post UTI by proteus

50
Q

What are uric acid stones due to?

A

idiopathic, gout, leukemia (leukemia->increased cell turnover-> increased uric acid)

51
Q

What are cystein stones due to?

A

genetic defects in renal absorption of AAs

52
Q

What are the benign neoplasms found in the kidney?

A

Papillary adenoma
Angiomyolipoma
Oncytoma

53
Q

What are the malignant neoplasms found in the kidney?

A
  • Renal cell carcinoma (several variants; clear cell is the MOST COMMON; chromophobe is pink and can be confused with oncocytes)
  • Urothelial carinoma (common)
  • Wilms Tumor
54
Q

What is this:
benign tumor composed of BVs, smooth muscle and mature adipose tissue.
What is it associated with?

A 
Angiomyolipoma
Tuberous sclerosis (25% of pnts)
55
Q

What are the three types of renal cell carcinoma? How are they typically caused?

A

most are sporadic, some are hereditary

  • Von Hippel-Lindau (inactivation of VHL gene)
  • Hereditary clear cell carcinoma (chromosome 3 defect)
  • Hereditary papillary carcinoma (chromosome 7 defect)
56
Q

Where do most RCC’s arise from?

A

the PCT

57
Q

What is the most common malignant renal tumor in children (average age 3)?

A

wilms tumor- comprised of blastema

58
Q

What diseases is Wilms tumor associated with?

A

WAGR syndrome, denys-Drash syndrome, beckwidth-wiedemann syndrome

59
Q

What is the most common type of lower urinary tract cancer and usually arises in the bladder. A major risk factor is cigarette smoke. It is a malignant tumor rising from the urothelial lining of the renal pelvis, ureter, bladder, or urethra and is associated with early p53 mutation.

A

Urothelial carcinoma

Block 9 Week 5 (5 decks)

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