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Medicine and Surgery Mushkies > Renal Pathology Mushkies > Flashcards

Renal Pathology Mushkies Flashcards

1
Q

What is nephrotic syndrome?

A

A breakdown in the selectivity of the glomerular filtration barrier

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2
Q

What is nephritic syndrome?

A

The manifestations of glomerular inflammation, characterised by PHAROH

  1. Proteinuria and oedema
  2. Haematuria
  3. Azotemia
  4. RBC casts
  5. Oliguria
  6. HTN
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3
Q

How can you classify renal pathology?

A
  1. Glomerulus
  2. Tubules and Interstitium
  3. Blood vessels
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4
Q

How can you classify glomerular disease?

A
  1. Nephrotic syndrome

2. Nephritic syndrome

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5
Q

How can you classify tubulointerstitial disease?

A
  1. ATN

2. Tubulointerstitial nephritis

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6
Q

What are 3 causes of tubulointerstitial nephritis?

A
  1. Acute pyelonephritis
  2. Chronic pyelonephritis
  3. Acute Interstitial nephritis
  4. Chronic Interstitial nephritis
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7
Q

How can you classify blood-vessel renal disease?

A

Thrombotic microangiopathies –> HUS and TTP

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8
Q

What is the triad of nephrotic syndrome?

A

Proteinuria
Hypoalbuminaemia
Oedema

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9
Q

What are the primary causes of nephrotic syndrome?

A
  1. Minimal change disease
  2. Membranous glomerular disease
  3. FSGS
  4. Diabetes
  5. Amyloidosis
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10
Q

In which causes of nephrotic syndrome do you see loss of podocyte foot processes on EM?

A

Minimal change disease, membranous glomerular disease and FSGS

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11
Q

What do you see on LM of membranous glomerular disease?

A

Diffuse glomerular basement membrane thickening

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12
Q

What do you see on LM of FSGS?

A
  1. Focal and segmental glomerular consolidation and scarring

2. Hyalinosis

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13
Q

How can you classify causes of membranous glomerular disease?

A
  1. Primary

2. Secondary = infection, SLE, malignancy, drugs

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14
Q

In what population is FSGS most common?

A

Afro-Caribbean people

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15
Q

What are the causes of FSGS?

A
  1. Primary (majority)

2. Secondary = Obesity and HIV nephropathy

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16
Q

What can you see on LM of diabetic nephropathy?

A
  1. Diffuse glomerular basement membrane thickening

2. Mesangial matrix nodules a.k.a. Kimmelstiel Wilson nodules

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17
Q

What can you see on LM of amyloidosis?

A

Apple green birefringence with Congo red stain

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18
Q

How can you classify amyloid renal disease?

A
  1. AA = TB, RhA

2. AL = multiple myeloma

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19
Q

What are the causes of nephritic syndrome?

A
  1. Post-streptococcal GN
  2. IgA nephropathy
  3. Rapidly progressive (crescenteric) GN
  4. Hereditary nephritis (Alport’s syndrome)
  5. Thin basement membrane disease (Benign familial haematuria)
20
Q

How can you diagnose post-streptococcal GN?

A
  1. 1-3wks after streptococcal throat infection or impetigo

1. Raised ASOT titre, low C3

21
Q

How can you diagnose IgA Nephropathy (Berger disease)

A
  1. Commonest GN worldwide

2. Presents 1-2 days after an URTI with frank haematuria

22
Q

What is the most aggressive GN?

A

Rapidly progressive (crescenteric) GN, can cause ESRF within weeks

23
Q

How can you classify rapidly-progressive GN?

A
  1. Type I = anti-GBM Ab
  2. Type II = Immune complex
  3. Type III = Pauci-immune (ANCA-associated)
24
Q

What causes anti-GBM GN?

A

Goodpasture’s disease due to anti-GBM Ab against Type IV collagen

25
Q

What causes Immune complex mediated GN?

A
  1. Post-infectious GN
  2. SLE
  3. IgA nephropathy
26
Q

What causes Pauci-immune GN?

A
  1. cANCA = GPA

2. pANCA = MPA

27
Q

What do yo usee on light microscopy of rapidly progressive GN?

A

Crescents

28
Q

What do you see on fluorescence microscopy of rapidly progressive GN?

A
  1. 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
29
Q

What causes hereditary nephritis (Alport’s syndrome)?

A

Hereditary glomerular disease caused by mutation in Type IV collagen alpha 5 chain, and is X-linked

30
Q

What is the triad of Alport’s syndrome?

A
  1. Nephritic syndrome
  2. Sensorineural deafness
  3. Eye disorders (lens dislocation, cataracts)
31
Q

What causes thin basement membrane disease (benign familial haematuria)?

A

Mutation in Type IV collagen alpha 4 chain, and is autosomal dominant

32
Q

What are 3 causes of asymptomatic haematuria?

A
  1. Thin basement membrane disease
  2. IgA nephropathy
  3. Alport syndrome
33
Q

What is the most common cause of AKI?

A

ATN

34
Q

What are the causes of ATN?

A
  1. Ischaemia

2. Nephrotoxins

35
Q

What nephrotoxins can cause ATN?

A
  1. Drugs = gentamicin, NSAIDS
  2. Contrast
  3. Myoglobin
  4. Heavy metals
36
Q

What do you see on histopathology of ATN?

A

Necrosis of short segments of tubules

37
Q

What is tubulointerstitial nephritis?

A

A group of renal inflammatory disorders that involved the tubules and interstitium

  1. Acute pyelonephritis
  2. Chronic pyelonephritis and reflux nephropathy
  3. Acute interstitial nephritis
  4. Chronic interstitial nephritis/analgesic nephropathy
38
Q

What is acute interstitial nephritis?

A

A hypersensitivity reaction, usually to a drug e.g. Abx, NSAIDs, diuretics. Thus, usually occurs days after drug exposure

39
Q

What is Chronic interstitial nephritis/analgesic nephropathy?

A

Seen in elderly with long term analgesic consumption (NSAIDs/paracetamol)

40
Q

What are the 2 thrombotic microangiopathies?

A

HUS and TTP

41
Q

What is HUS?

A
  1. Triad of MAHA, thrombocytopenia and AKI. Caused by E Coli 0157:H7.
  2. Children visiting petting zoos
  3. Thrombi are confined to kidneys
42
Q

What is TTP?

A
  1. Pentad of MAHA, thrombocytopenia, AKI, neuro symptoms and fever
  2. Caused by mutation in ADAMTS13
  3. Thrombi occur throughout circulation
43
Q

What is CKD?

A

Progressive, irreversible loss of renal function characterised by prolonged symptoms and signs of uraemia

44
Q

What are the commonest causes of CKD?

A
  1. DM
  2. GN
  3. HTN and vascular disease
  4. Reflux nephropathy (chronic pyelonephritis)
  5. PCKD
45
Q

What are the 2 forms of APCKD?

A

PKD1 (85%) on Chr 16

PKD2 (15%) on Chr 4

46
Q

How many classes of lupus nephritis are there?

A

6

47
Q

What are the 3 types of RCC?

A
  1. Clear cell carcinoma = well differentiated
  2. Papillary carcinoma = commonest in dialysis associated cystic disease
  3. Chromophobe renal carcinoma = pale, eosinophilic cells

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