Renal Pathology Mushkies Flashcards
What is nephrotic syndrome?
A breakdown in the selectivity of the glomerular filtration barrier
What is nephritic syndrome?
The manifestations of glomerular inflammation, characterised by PHAROH
- Proteinuria and oedema
- Haematuria
- Azotemia
- RBC casts
- Oliguria
- HTN
How can you classify renal pathology?
- Glomerulus
- Tubules and Interstitium
- Blood vessels
How can you classify glomerular disease?
- Nephrotic syndrome
2. Nephritic syndrome
How can you classify tubulointerstitial disease?
- ATN
2. Tubulointerstitial nephritis
What are 3 causes of tubulointerstitial nephritis?
- Acute pyelonephritis
- Chronic pyelonephritis
- Acute Interstitial nephritis
- Chronic Interstitial nephritis
How can you classify blood-vessel renal disease?
Thrombotic microangiopathies –> HUS and TTP
What is the triad of nephrotic syndrome?
Proteinuria
Hypoalbuminaemia
Oedema
What are the primary causes of nephrotic syndrome?
- Minimal change disease
- Membranous glomerular disease
- FSGS
- Diabetes
- Amyloidosis
In which causes of nephrotic syndrome do you see loss of podocyte foot processes on EM?
Minimal change disease, membranous glomerular disease and FSGS
What do you see on LM of membranous glomerular disease?
Diffuse glomerular basement membrane thickening
What do you see on LM of FSGS?
- Focal and segmental glomerular consolidation and scarring
2. Hyalinosis
How can you classify causes of membranous glomerular disease?
- Primary
2. Secondary = infection, SLE, malignancy, drugs
In what population is FSGS most common?
Afro-Caribbean people
What are the causes of FSGS?
- Primary (majority)
2. Secondary = Obesity and HIV nephropathy
What can you see on LM of diabetic nephropathy?
- Diffuse glomerular basement membrane thickening
2. Mesangial matrix nodules a.k.a. Kimmelstiel Wilson nodules
What can you see on LM of amyloidosis?
Apple green birefringence with Congo red stain
How can you classify amyloid renal disease?
- AA = TB, RhA
2. AL = multiple myeloma
What are the causes of nephritic syndrome?
- Post-streptococcal GN
- IgA nephropathy
- Rapidly progressive (crescenteric) GN
- Hereditary nephritis (Alport’s syndrome)
- Thin basement membrane disease (Benign familial haematuria)
How can you diagnose post-streptococcal GN?
- 1-3wks after streptococcal throat infection or impetigo
1. Raised ASOT titre, low C3
How can you diagnose IgA Nephropathy (Berger disease)
- Commonest GN worldwide
2. Presents 1-2 days after an URTI with frank haematuria
What is the most aggressive GN?
Rapidly progressive (crescenteric) GN, can cause ESRF within weeks
How can you classify rapidly-progressive GN?
- Type I = anti-GBM Ab
- Type II = Immune complex
- Type III = Pauci-immune (ANCA-associated)
What causes anti-GBM GN?
Goodpasture’s disease due to anti-GBM Ab against Type IV collagen
What causes Immune complex mediated GN?
- Post-infectious GN
- SLE
- IgA nephropathy
What causes Pauci-immune GN?
- cANCA = GPA
2. pANCA = MPA
What do yo usee on light microscopy of rapidly progressive GN?
Crescents
What do you see on fluorescence microscopy of rapidly progressive GN?
- Type I = linear deposition of IgG in GBM
Type II = granular (lumpy bumpy) deposition of IgG on GBM
Type III = lack of/scanty immune complex deposition
What causes hereditary nephritis (Alport’s syndrome)?
Hereditary glomerular disease caused by mutation in Type IV collagen alpha 5 chain, and is X-linked
What is the triad of Alport’s syndrome?
- Nephritic syndrome
- Sensorineural deafness
- Eye disorders (lens dislocation, cataracts)
What causes thin basement membrane disease (benign familial haematuria)?
Mutation in Type IV collagen alpha 4 chain, and is autosomal dominant
What are 3 causes of asymptomatic haematuria?
- Thin basement membrane disease
- IgA nephropathy
- Alport syndrome
What is the most common cause of AKI?
ATN
What are the causes of ATN?
- Ischaemia
2. Nephrotoxins
What nephrotoxins can cause ATN?
- Drugs = gentamicin, NSAIDS
- Contrast
- Myoglobin
- Heavy metals
What do you see on histopathology of ATN?
Necrosis of short segments of tubules
What is tubulointerstitial nephritis?
A group of renal inflammatory disorders that involved the tubules and interstitium
- Acute pyelonephritis
- Chronic pyelonephritis and reflux nephropathy
- Acute interstitial nephritis
- Chronic interstitial nephritis/analgesic nephropathy
What is acute interstitial nephritis?
A hypersensitivity reaction, usually to a drug e.g. Abx, NSAIDs, diuretics. Thus, usually occurs days after drug exposure
What is Chronic interstitial nephritis/analgesic nephropathy?
Seen in elderly with long term analgesic consumption (NSAIDs/paracetamol)
What are the 2 thrombotic microangiopathies?
HUS and TTP
What is HUS?
- Triad of MAHA, thrombocytopenia and AKI. Caused by E Coli 0157:H7.
- Children visiting petting zoos
- Thrombi are confined to kidneys
What is TTP?
- Pentad of MAHA, thrombocytopenia, AKI, neuro symptoms and fever
- Caused by mutation in ADAMTS13
- Thrombi occur throughout circulation
What is CKD?
Progressive, irreversible loss of renal function characterised by prolonged symptoms and signs of uraemia
What are the commonest causes of CKD?
- DM
- GN
- HTN and vascular disease
- Reflux nephropathy (chronic pyelonephritis)
- PCKD
What are the 2 forms of APCKD?
PKD1 (85%) on Chr 16
PKD2 (15%) on Chr 4
How many classes of lupus nephritis are there?
6
What are the 3 types of RCC?
- Clear cell carcinoma = well differentiated
- Papillary carcinoma = commonest in dialysis associated cystic disease
- Chromophobe renal carcinoma = pale, eosinophilic cells
