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Year 2 Renal > Renal pathology III > Flashcards

Renal pathology III Flashcards

1
Q

what 3 diseases are associated with asymptomatic isolated hematuria?

A
  • IgA nephropathy (Berger disease)
  • alport syndrome
  • thin GBM disease
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2
Q

what is the most common type of primary glomerulonephropathy worldwide?

A

IgA nephropathy

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3
Q

what are the symptoms of IgA nephropathy?

A
  • mild hematuria

- mild proteinuria

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4
Q

what are the LM, IF, and EM findings in IgA nephropathy?

A
  • LM: mesangial proliferation / hypercellularity
  • IF: mesangial IgA
  • EM: mesangial deposits
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5
Q

what is alport syndrome?

A

defect of the GBM due to mutation in the gene encoding the alpha-5 chain of type IV collagen

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6
Q

what is the inheritance pattern of alport syndrome?

A

X-linked dominant (incomplete - women can get it)

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7
Q

what are the symptoms of alport syndrome?

A
  • sensorineural hearing loss
  • renal failure / microscopic hematuria
  • proteinuria (indicates progression)
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8
Q

what are the key lesions of alport syndrome?

A
  • GBM thickening / splitting / LAMINATION

- “basket-weave” pattern

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9
Q

which disease is associated with a basket weave pattern on histology?

A

alport syndrome

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10
Q

what are the LM, IF, and EM findings in thin GBM disease?

A
  • LM: normal
  • IF: negative
  • EM: thin GBM
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11
Q

what are the secondary glomerulonephropathies?

A
  • SLE
  • diabetes
  • amyloidosis
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12
Q

in SLE there is granular immune complex deposition of what factors?

A
  • IgG
  • IgA
  • IgM
  • C3
  • C4
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13
Q

what is the only glomerular disease with all Ig deposition?

A

SLE

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14
Q

where does amyloid get trapped in amyloidosis?

A
  • glomeruli
  • blood vessels
  • tubules
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15
Q

what is the pathogenesis of kidney amyloidosis?

A
  • GBM becomes leaky to proteins and the patient gets nephritic syndrome
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16
Q

what stain is used to visualize amyloid? how does it appear?

A
  • Congo Red

- apple green biorefringence

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17
Q

what is the pathogenesis of acute tubular necrosis?

A

destruction of renal tubular epithelium

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18
Q

what are the two types of acute tubular necrosis?

A
  • ischemic

- nephrotoxic

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19
Q

what drugs are nephrotoxic?

A
  • aminoglycosides
  • amphotericin B
  • gentamycin
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20
Q

what heavy metal is nephrotoxic?

A

mercury

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21
Q

what organic solvents are nephrotoxic?

A

carbon tetrachloride

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22
Q

how is myoglobin nephrotoxic?

A

causes rhabdomyolysis (in heat stroke)

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23
Q
  • dilated tubules with flattened epithelium
  • necrotic debris in tubules

diagnosis?

A

acute tubular necrosis (ATN)

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24
Q

what is the cause of acute interstitial nephritis?

A

drug induced hypersensitivity

25
Q

what drugs cause acute interstitial nephritis? what is seen clinically after ingestion?

A
  • synthetic penicillins
  • rifampin
  • ibuprofen
  • thiazide diuretics

2 weeks later:

  • fever
  • eosinophilia
  • rash
  • acute renal failure
26
Q

what is the main pathogen associated with pyelonephritis?

A

e. coli

27
Q

what is the cause of acute pyelonephritis?

A

infections of the pelicalyceal system and renal parenchyma

28
Q

how does acute pyelonephritis present? how is the diagnosis made?

A
  • presentation: pain in the costo-vertebral angle along with other signs of infection
  • diagnosis: pus (WBC) casts, urine culture
29
Q

polymorphonuclear casts in tubules - diagnosis?

A

acute pyelonephritis

30
Q

what are the key lesions in acute pyelonephritis?

A
  • neutrophilic infiltrates in tubules

- neutrophilic casts in tubules

31
Q

how does acute pyelonephritis differ from acute interstitial nephritis?

A

in acute pyelonephritis the inflammatory infiltrates include neutrophils

32
Q

what is the main etiology of chronic pyelonephritis?

A

obstruction (congenital or acquired)

33
Q

is chronic pyelonephritis more common in males or females?

A

females

34
Q

what are the hallmark features of chronic pyelonephritis?

A
  • pitting geographic scars

- thyroidization

35
Q
  • inflammatory infiltrate
  • fibrosis
  • pitting geopraphic scars

diagnosis?

A

chronic pyelonephritis

36
Q

atrophic tubules that resemble thyroid gland is associated with what renal disease?

A

chronic pyelonephritis

37
Q
  • pitting geographic scars
  • thyroidization

these are hallmark features of what disease?

A

chronic pyelonephritis

38
Q

papillary adenomas are always located in which part of the kidney?

A

cortex

39
Q

angiomyolipomas are associated with what condition?

A

tuberous sclerosis

40
Q

what are the signs and symptoms of tuberous sclerosis?

A
  • mental retardation
  • multisystem hamartomas
  • angiomyolipomas
41
Q

angiomyolipomas consist of what 3 structures?

A
  • thick walled vessels
  • smooth muscle
  • fat
42
Q

what are the main risk factors for renal cell carcinoma?

A
  • tobacco
  • chronic renal failure
  • acquired cystic renal disease
43
Q

what are the primary symptoms of renal cell carcinoma?

A
  • hematuria

- abdominal mass

44
Q

renal cell carcinoma strongly tend to invade what vessel early in the disease?

A

renal VEIN

45
Q

what are the renal cell carcinoma histotypes? which is most common?

A
  • clear cell (most common)
  • papillary
  • chromophobe
46
Q

what is the gross appearance of renal cell carcinoma?

A
  • yellow orange
  • sharp borders
  • gray-white necrosis and foci of hemorrhagic discoloration
47
Q

what is the histological appearance of renal cell carcinoma?

A
  • rounded or polygonal cells
  • clear or granular cytoplasm
  • abundant capillaries
48
Q
  • rounded or polygonal cells
  • clear or granular cytoplasm
  • abundant capillaries

diagnosis?

A

renal cell carcinoma

49
Q

what is the gross appearance of chromophil (papillary) renal cell carcinoma?

A

thick capsule with red / brown reactive changes and hemorrhage

50
Q

what is the histological appearance of chromophil (papillary) renal cell carcinoma?

A
  • papillary structures, many of which enclose clusters of foamy macrophages
  • abundant eosinophilic cytoplasm and mildly atypical nuclei
  • sparse capillaries
51
Q
  • papillary structures, many of which enclose clusters of foamy macrophages
  • abundant eosinophilic cytoplasm and mildly atypical nuclei
  • sparse capillaries

diagnosis?

A

chromophil (papillary) renal cell carcinoma

52
Q

von hippel lindau syndrome is characterized by what types of lesions? where?

A

cavernous hemangiomas in:

  • cerebellum
  • brain stem
  • eye
53
Q

on hippel lindau carries a very high incidence of what type of cancer?

A

renal cell carcinoma

54
Q

what is the histological appearance of urothelial carcinoma of renal pelvis?

A

papillary growth lined by urothelial cells mild nuclear atypia and pleomorphism

55
Q

what is the most common renal malignancy of early childhood?

A

wilms tumor

56
Q

wilms tumor is caused by what type of genetic defect? which genes? which chromosome?

A
  • loss of function mutation of tumor suppressor genes WT1 or WT2
  • chromosome 11
57
Q

wilms tumor histology

A

epithelial component surrounded by metanephric blastema and tumor immature spindle cell stroma

58
Q

epithelial component surrounded by metanephric blastema and tumor immature spindle cell stroma

diagnosis?

A

wilms tumor

59
Q

what is the difference between clear cell RCC and papillary RCC?

A
  • clear cell RCC has clear cytoplasm and abundant capillaries
  • papillary RCC has eosinophilic cytoplasm and sparse capillaries

Year 2 Renal (38 decks)

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