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CPR Exam 3 > Renal Pathology Pt. 3 > Flashcards

Renal Pathology Pt. 3 Flashcards

1
Q

what are the hereditary nephritises?

A

Alport syndrome

Thin basement membrane lesion/benign familial hematuria

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2
Q

what is alport syndrome?

A

X-linked

mutated gene encoding collagen IV

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3
Q

what is the clinical presentation of alport syndrome?

A

hematuria
CKD
nerve deafness
eye disorders

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4
Q

what are the characteristics of alport syndrome under an electron microscope?

A

moth-eaten/frayed basement membrane

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5
Q

what is thin basement membrane disease?

A

AR

mutated gene encoding a3 or a4 chains of collagen IV

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6
Q

what is the clinical presentation for thin basement membrane disease?

A

asymptomatic hematuria

usually uncovered during routine UA

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7
Q

which systemic diseases cause secondary nephrotic syndrome?

A

DM
SLE
Hep C
HIV

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8
Q

which systemic diseases cause secondary nephritic syndrome?

A

SLE
bacterial endocarditis
goodpasture syndrome
Henoch Schonlein purpura

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9
Q

what is the pathogenesis underlying diabetic nephropathy?

A

metabolic defect linked to hyperglycemia produces thick GBM

hemodynamic effects associated with glomerular hypertrophy contribute to glomerulosclerosis

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10
Q

what can be seen histologically in diabetic glomerulosclerosis?

A

diffuse capillary basement membrane thickening

diffuse mesangial sclerosis

nodular glomerulosclerosis (PAS positive)

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11
Q

what can be seen histologically in advanced renal hyaline arteriolosclerosis?

A

marked thickened, tortuous afferent arteriole

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12
Q

what are the 3 prototypical renal lesions associated with diabetes?

A

nodular glomerular lesions
vascular lesions (arteriolosclerosis)
necrotizing papillitis

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13
Q

what are the 6 classifications of glomerular disease caused by SLE?

A 
I. Minimal mesangial lupus nephritis
II. Mesangial proliferative lupus nephritis
III. focal lupus nephritis
IV. diffuse lupus nephritis
V. membranous lupus nephritis
VI. advanced sclerosing lupus nephritis
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14
Q

which class of glomerular disease are most commonly seen in SLE?

A

IV. diffuse lupus nephritis

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15
Q

how does Henoch Schonlein purpura affect the kidneys?

A

IgA is deposited in the glomerular mesangium

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16
Q

what is fibrillary glomerulonephritis?

A

morphological variant of glomerulonephritis associated with fibrillar deposits in the mesangium and capillary walls

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17
Q

what is the clinical presentation of fibrillary glomerulonephritis?

A

nephrotic syndrome
hematuria
progressive renal failure

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18
Q

which three systemic disorders manifest in the kidneys with foci of glomerular necrosis and crescent formation?

A

goodpasture syndrome
microscopic polyangiitis
Wegener granulomatosis

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19
Q

what infection is associated with essential mixed cryoglobulinemia?

A

Hep C

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20
Q

what is the pathogenesis of essential mixed cryoglobulinemia?

A

IgG-IgM complexes that induce cutaneous vasculitis, synovitis, and proliferative glomerulonephritis

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21
Q

what is acute tubular injury?

A

acute renal failure and morphologic evidence of tubular necrosis

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22
Q

what are the causes of ATI?

A

ischemia

direct toxic injury by endogenous or exogenous agents

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23
Q

what is the most common cause of acute renal failure?

A

ATI

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24
Q

what are some uncommon causes of ATI?

A

hypersensitivity to drugs

urinary obstruction

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25
what is the necrosis pattern associated with ischemic necrosis ATI?
patchy in PCT patchy in PST patchy in LoH
26
what is the necrosis pattern associated with toxic necrosis ATI?
continuous in PCT continuous in PST patchy in LoH
27
what is clinically evident in the initiation stage of AKI?
oliguria
28
what is clinically evident in the maintenance stage of AKI?
oliguric crisis with some uremic features | hyperkalemia
29
what is clinically evident in the recovery stage of AKI?
large urine volumes large loss of water, Na, K hypokalemia susceptibility to infection
30
what is tubulointerstitial nephritis?
a group of renal diseases involving inflammatory injuries to tubules and interstitium that are insidious in onset
31
what are the clinical manifestations of tubulointerstitial nephritis?
azotemia | inability to concentrate urine (polyuria)
32
what are the primary etiologies of tubulointerstitial nephritis?
``` infections toxins metabolic diseases chronic obstruction neoplasms immunologic reactions vascular diseases ```
33
what is the pathway of infection to the kidneys?
UTI --> cystitis --> pyelonephritis
34
what is chronic pyelonephritis?
recurrent or continuous infection of the kidney with resultant damage to the pelvis/calyces/parenchyma resulting in anatomic distortion
35
what is the most common UTI causing bacteria?
E. coli
36
what other bacteria are known to cause UTI?
Proteus Klebsiella Enterobacter sp.
37
what anatomic defects predispose a patient to pyelonephritis?
vesicoureteral reflux | intrarenal reflux
38
what medical conditions predispose a patient to pyelonephritis?
diabetes pregnancy BPH *being female*
39
what are possible complications of pyelonephritis?
papillary necrosis pyonephrosis perinephric abscess
40
what is the most common cause of pyelonephritis?
ascending cystitis combined with a predisposing anatomical defect
41
what is the most common cause of vesicoureteral reflux?
congenital partial or complete lack of oblique angle of the intravesical portion of the ureter
42
what is the most common cause of AKI?
pyelonephritis
43
what is the second most common cause of AKI?
tubulointerstitial nephritis induced by drugs or toxins
44
what drugs cause tubulointerstitial nephritis?
``` analgesics synthetic penicillins (methicillin, ampicillin) rifampin diuretics NSAIDs allopurinol cimetidine ```
45
what is the clinical presentation of tubulointerstitial nephritis induced by drugs/toxins?
fever eosinophilia interstitial renal parenchymal infiltrates
46
what is a potential complication of analgesic nephropathy?
urothelial carcinoma
47
what is urate nephropathy?
precipitation of uric acid crystals in the renal tubules leading to obstruction of the nephrons and acute renal failure
48
what is the primary cause of acute uric acid nephropathy?
chemotherapy causing tumor lysis syndrome
49
what is the primary cause of chronic urate nephropathy?
hyperuremic syndrome --> gout
50
what is a potential complication of hyperuricemia?
renal stones/nephrolithiasis
51
what are potential complications of hypercalcemia?
formation of calcium stones | deposition of calcium in the kidney
52
what is acute phosphate nephropathy?
accumulations of calcium phosphate crystals in the tubules that can occur in patients after consuming high doses of oral phosphate solutions in preparation for colonoscopy
53
what is myeloma kidney?
renal insufficiency as a result of multiple myeloma
54
what factors contribute to renal damage in myeloma kidney?
``` Bence-Jones proteinuria cast nephropathy amyloidosis light-chain deposition disease hypercalcemia hyperuricemia ```
55
what is bile cast nephropathy?
hepatorenal syndrome in which renal dysfunction manifests in patients with advanced liver failure due to bile cast formation in the distal nephron
56
what are the renal vascular diseases?
``` nephrosclerosis renal artery stenosis thrombotic microangiopathies atheroembolic renal disease sickle-cell nephropathy ```
57
what is benign nephrosclerosis?
morphologic changes associated with hyaline sclerosis of the renal arterioles and small arteries
58
what is the effect of benign nephrosclerosis?
multi-focal ischemia of the renal parenchyma supplied by the sclerotic vessels
59
what conditions contribute to the formation of benign nephrosclerosis?
age HTN DM
60
what is malignant arteriosclerosis?
a medical emergency renal vascular disorder exhibiting injury associated with accelerated HTN
61
what are the pathologic effects of malignant arteriosclerosis?
ischemic kidney injury elevated renin a self-perpetuating cycle of damage and HTN
62
what is the pathogenic pathway of malignant HTN?
renal vascular damage increased permeability of small vessels endothelial irreversible injury focal vascular cell death/hemorrhage platelet deposition/thrombosis fibrinoid necrosis of arterioles and small vessels hyperplastic arteriolitis (renal failure)
63
what are the renal morphological changes associated with malignant htn?
"flea-bitten" appearance of renal hemorrhages
64
what is the clinical presentation of malignant htn?
``` BP >180/120 papilledema retinal hemorrhages encephalopathy CV abnormalities renal failure ```
65
what is renal artery stenosis?
potentially curable form of HTN secondary to atherosclerosis or fibromuscular dysplasia
66
what are the thrombotic microangiopathies that result in renal damage?
hemolytic uremic syndrome | thrombotic thrombocytopenic purpura
67
what is HUS?
endothelial cell injury and activation due to Shiga-like toxin (E. coli O157:H7)
68
what is TTP?
acquired deficiency of ADAMTS13 resulting in abnormal function of vWF
69
what is the clinical presentation of TTP?
``` fever neurological symptoms microangiopathic hemolytic anemia thrombocytopenia renal failure ```
70
what is the most common cause of renal atheroembolism?
mural thrombosis from left side of the heart
71
what are the clinical signs of renal atheroembolism?
``` flank pain hematuria HTN arrhythmia nausea/vomiting oliguria/anuria ```
72
what is sickle cell nephropathy?
papillar necrosis due to accelerated sickling in the renal medulla
73
what are the clinical features of sickle cell nephropathy?
hematuria hyposthenuria (diminished concentrating ability) proteinuria

CPR Exam 3 (15 decks)

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