Renal - Pathoma Flashcards
Pathoma Renal
Unilateral renal agenesis leads to __________ of the existing kidney.
Bilateral renal agenesis leads to __________ __________.
Unilateral renal agenesis leads to hypertrophy of the existing kidney.
Bilateral renal agenesis leads to Potter Sequence.
Pathoma Renal
Are there any long-term sequelae of unilateral renal agenesis in the extant kidney?
Yes: increased risk of renal failure later in life due to hyperfiltration
Pathoma Renal
What condition is a non-inherited congenital malformation of the kidneys resulting in cysts and abnormal tissue in the renal parenchyma?
Dysplastic kidney
(usually unilateral, but must be distinguished from PKD if bilateral)
Pathoma Renal
Which form of PKD is associated with hepatic fibrosis and portal hypertension?
Which form is associated with hepatic cysts?
ARPKD
Both ADPKD and ARPKD
Pathoma Renal
A patient presents with shrunken kidneys, parenchymal fibrosis, and worsening renal failure.
You note cysts specifically in the medullary collecting ducts. What disease is this?
Medullary cystic kidney disease
Pathoma Renal
What is the expected BUN:Cr ratio, FENa, and OsmolarityUrine for prerenal azotemia?
> 15
< 1%
> 500 mOsm/kg
Pathoma Renal
Explain the BUN:Cr ratio (> 15), FENa (< 1%), and OsmolarityUrine (> 500 mOsm/Kg) seen in prerenal azotemia.
BUN:Cr ratio — The kidneys increase fluid and BUN reabsorption
FENa — Tubular function remains intact
OsmolarityUrine — Tubular function remains intact
Pathoma Renal
What is the expected BUN:Cr ratio, FENa, and OsmolarityUrine for postrenal azotemia?
> 15
< 1%
> 500 mOsm/kg
Pathoma Renal
Explain the BUN:Cr ratio (> 15), FENa (< 1%), and OsmolarityUrine (> 500 mOsm/Kg) seen in prerenal azotemia.
BUN:Cr ratio — Increased tubular pressure forces BUN back into serum
FENa — Tubular function remains intact
OsmolarityUrine — Tubular function remains intact
Pathoma Renal
What is the expected BUN:Cr ratio, FENa, and OsmolarityUrine for intrarenal azotemia?
< 15
> 2%
< 500 mOsm/kg
Pathoma Renal
Explain the BUN:Cr ratio (< 15), FENa (> 2%), and OsmolarityUrine (
BUN:Cr ratio — Tubular function decreases, resulting in decreased BUN reabsorption
FENa — Tubular function is impaired
OsmolarityUrine — Tubular function is impaired
Pathoma Renal
In what condition might post-renal azotemia lead to a low BUN:Cr ratio (< 15) and an elevated FENa (> 2%)?
Long-standing post-renal azotemia
Pathoma Renal
What are the two major etiologies of acute tubular necrosis?
(1) Ischemia (i.e. secondary to prerenal azotemia)
(2) Nephrotoxicity
Pathoma Renal
Name some of the nephrotoxic substances associated with acute tubular necrosis:
A___________
H___________
M___________
U___________
R___________
E___________
Name some of the nephrotoxic substances associated with acute tubular necrosis:
Aminoglycosides**
Heavy metals
Myoglobinuria
Urate
Radiocontrast dye
Ethylene glycol
Pathoma Renal
How can urate-induced acute tubular necrosis be avoided in patients undergoing chemotherapy?
Hydration + allopurinol
Pathoma Renal
What are the serum changes associated with acute tubular necrosis [think ion change(s) and pH]?
Hyperkalemia
+
metabolic alkalosis
Pathoma Renal
True/False.
Patients with acute tubular necrosis may require dialysis to treat their electrolyte imbalances, but they typically recover completely within a few weeks.
True.
Pathoma Renal
What cause of intrarenal azotemia is associated with drugs that act like haptens?
Acute interstitial nephritis
Pathoma Renal
Name some of the drugs that act like haptens and are associated with acute interstitial nephritis.
NPD
NSAIDs,
penicillins,
diuretics
Pathoma Renal
In addition to a case of severe acute interstitial nephritis resulting from hapten-like drugs (e.g. NSAIDs, penicillins, diuretics, etc.), name a few potential etiologies of renal papillary necrosis:
C________________
D________________
S________________
S________________
In addition to a case of severe acute interstitial nephritis resulting from hapten-like drugs (e.g. NSAIDs, penicillins, diuretics, etc.), name a few potential etiologies of renal papillary necrosis:
Chronic analgesic abuse
Diabetes mellitus
Sickle cell trait or disease
Severe acute pyelonephritis
Pathoma Renal
A patient presents with puffy eyes, foamy urine, hypoalbuminema, and hyperlipidemia. What is the likely generic diagnosis requiring further work-up?
Nephrotic syndrome
(may also present with hypertension, infection, clotting, etc.)
Pathoma Renal
Nephrotic syndrome is characterized by a proteinuria of what amount?
> 3.5 g / day
Pathoma Renal
What are the four serum characteristics of nephrotic syndrome?
(Two hypos- and two hypers-)
Hypoalbuminemia
Hypogammaglobulinemia
Hypercoagulable states
Hyperlipidemia and Hypercholesterolemia
Pathoma Renal
Why does nephrotic syndrome result in a hypercoagulable state?
Loss of antithrombin III
Pathoma Renal
What result may be seen in the urine due to the hyperlipidemia and hypercholesterolemia seen in nephrotic syndrome?
Fatty casts
Pathoma Renal
Name the major causes of nephrotic syndrome:
M______________
F______________
M______________
M______________
D______________
S______________
Name the major causes of nephrotic syndrome:
Minimal change disease
Focal segmental glomerulosclerosis
Membranous nephropathy
Membranoproliferative glomerulonephritis
Diabetes mellitus
Systemic amyloidosis
Pathoma Renal
What is the most common cause of nephrotic syndrome in children?
And in Caucasians?
And in Hispanics?
And in African-Americans?
Minimal change disease
Membranous nephropathy
Focal segmental glomerulosclerosis
Focal segmental glomerulosclerosis
Pathoma Renal
Although minimal change disease is idiopathic, it may be associated with what disease?
Hodgkin lymphoma
Pathoma Renal
How does minimal change disease appear on H&E?
Normal glomeruli;
maybe some lipids in proximal tubule cells
Pathoma Renal
How does minimal change disease appear on electron microscopy?
Foot process effacement
Pathoma Renal
True/False.
Minimal change disease is associated with loss of albumin and gammaglobulin in the urine.
False.
Minimal change disease is associated with loss of albumin only (selective proteinuria).
Pathoma Renal
Good response to steroids is seen in which etiology(ies) of nephrotic syndrome?
Minimal change disease only
Pathoma Renal
The damage in minimal change disease is mediated by what?
T cell cytokines
(hence the excellent response to steroids)
Pathoma Renal
Which major causes of nephrotic syndrome are immunofluorescence-negative?
Minimal change disease
Focal segmental glomerulosclerosis
(also DM and amyloidosis)
Pathoma Renal
True/False.
Focal segmental glomerulosclerosis is the most common cause of nephrotic syndrome in Hispanics and African-Americans. It is IF-negative and typically idiopathic (although also associated with HIV, heroin use, and sickle cell disease).
True.
Pathoma Renal
How does focal segmental glomerulosclerosis appear on H&E?
Exactly what the name says:
Some glomeruli (focal) and only some parts of those glomeruli (segmental) are sclerosed
I.e. focal segmental glomerulosclerosis
Pathoma Renal
How does focal segmental glomerulosclerosis appear on electron microscopy?
Foot process effacement
Pathoma Renal
True/False.
Membranous nephropathy is usually idiopathic, but it may be associated with HIV, heroin use, and sickle cell disease.
False (The previous description matched focal segmental glomerulosclerosis.).
Membranous nephropathy is usually idiopathic, but it may be associated with hepatitis B and C, solid tumors, SLE, and some drugs (e.g. NSAIDS, penicillamine).
Pathoma Renal
How does membranous nephropathy appear on immunofluorescence?
Subepithelial ‘spike and dome’ deposits
Pathoma Renal
How does membranous nephropathy appear on H&E?
Thick glomerular basement membrane
Pathoma Renal
How does membranoproliferative glomerulonephritis appear on H&E?
Thick glomerular basement membrane;
‘tram-track’ appearance
Pathoma Renal
Both membranous nephropathy and membranoproliferative glomerulonephritis present with thickened glomerular basement membranes, but a ‘tram-track’ appearance is only associated with which?
Membranoproliferative glomerulonephritis
Pathoma Renal
What antibody is associated with membranous nephropathy?
Anti-phospholipase A2 receptor antibodies
Pathoma Renal
Granular, subepithelial, ‘spike and dome’ IF on EM is characteristic of which etiology of nephrotic syndrome?
Membranous nephropathy
Pathoma Renal
Granular, subendothelial IF on EM is characteristic of which etiology of nephrotic syndrome?
Type I membranoproliferative glomerulonephritis
Pathoma Renal
Granular, intramembranous IF on EM is characteristic of which etiology of nephrotic syndrome?
Type II membranoproliferative glomerulonephritis
Pathoma Renal
Type I membranoproliferative glomerulonephritis is associated with ___________ immune complex deposits.
Type II membranoproliferative glomerulonephritis is associated with ___________ immune complex deposits.
Type I membranoproliferative glomerulonephritis is associated with subendothelial immune complex deposits.
Type II membranoproliferative glomerulonephritis is associated with intramembranous immune complex deposits (dense deposit disease).
Pathoma Renal
Which form of membranoproliferative glomerulonephritis is associated with HBV and HCV?
Type I
(subendothelial deposits)
Pathoma Renal
Which form of membranoproliferative glomerulonephritis is associated with C3 nephritic complement (an autoantibody that stabilizes C3 convertase)?
Type II
(intramembranous deposits - dense deposit disease)
Pathoma Renal
Type II (intramembranous) membranoproliferative glomerulonephritis is associated with ___________ complement, an autoantibody that stabilizes ___________.
Type II (intramembranous) membranoproliferative glomerulonephritis is associated with C3 nephritic complement, an autoantibody that stabilizes C3 convertase.
Pathoma Renal
Which etiologies of nephrotic syndrome typically respond very poorly to steroids and progress to chronic renal failure?
Focal segmental glomerulosclerosis
Membranous nephropathy
Membranoproliferative glomerulonephritis
Pathoma Renal
The nonenzymatic glycosylation of vascular basement membranes seen in DM leads to what form of sclerosis?
Which arteriole is most affected?
Hyaline arteriolosclerosis;
efferent
Pathoma Renal
How do the glomeruli appear in patients with DM?
Mesangial sclerosis;
Kimmelstiel-Wilson nodules
Pathoma Renal
How can the progress of hyperfiltration-induced damage associated with diabetes mellitus be slowed?
ACE inhibitors
Pathoma Renal
True/False.
After the lungs, the kidneys are the most commonly involved organs in systemic amyloidosis.
False.
The kidneys are the most commonly involved organs in systemic amyloidosis.
Pathoma Renal
Amyoidosis-induced nephrotic syndrome is characterized by amyloid deposits in what location(s)?
The mesangium
Pathoma Renal
After staining with _________, amyloidosis can be seen under polarized light as ___________ birefringence.
After staining with congo red, amyloidosis can be seen under polarized light as apple-green birefringence.
Pathoma Renal
Casts in the urine indicate a pathology of which organ(s)?
The kidneys only
Pathoma Renal
What is the main sign that a renal disorder is likely a nephritic syndrome (rather than nephrotic)?
RBC casts and dysmorphic RBCs in urine
(signs of glomerular inflammation)
Pathoma Renal
Nephritic syndromes are characterized by the presence of urinary ________ casts, _______uria, _______ proteinuria, _______tension, and _______ retention.
Nephritic syndromes are characterized by the presence of urinary RBC casts, oliguria, limited proteinuria, hypertension, and salt retention.
Pathoma Renal
Which may be characterized by puffy eyes (due to salt retention) and hypertension, nephrotic syndrome or nephritic syndrome or both?
Both.
Pathoma Renal
Which is usually characterized by oliguria, nephrotic syndrome or nephritic syndrome or both?
Nephritic syndrome
Pathoma Renal
Describe the proteinuria associated with nephritic syndrome.
Limited;
< 3.5 g / day
Pathoma Renal
What would renal biopsy show in a patient with a nephritic syndrome?
Hypercellular, inflammed glomeruli
Pathoma Renal
What is the main etiology for all the forms of nephritic syndrome?
Immune-complex deposition
(and C5a activation attracting neutrophils)
Pathoma Renal
What is the most common nephropathy worldwide?
IgA nephropathy
(Berger disease - a form of nephritic syndrome)
Pathoma Renal
Describe the classic presentation for IgA nephropathy (Berger disease).
Hematuria (gross or microscopic) with RBC casts following some form of mucosal infection (e.g. a gastroenteritis)
(usually in an individual between their teens and early 30s)
Pathoma Renal
Why are mucosal infections associated with IgA nephropathy (Berger disease)?
Mucosal infections ramp up IgA production
Pathoma Renal
Does IgA nephropathy (Berger disease) cause any immunofluorescence findings?
Yes;
mesangial immune-complex deposition
Pathoma Renal
True/False,
IgA nephropathy is known to sometimes slowly progress to renal failure.
True.
Pathoma Renal
Name the nephritic syndrome caused by inherited defects in type IV collagen.
Name the nephritic syndrome caused by acquired autoantibodies to type IV collagen.
Alport syndrome
Goodpasture syndrome
Pathoma Renal
What, if any, effect does Alport syndrome have on the glomerular basement membrane?
Thinning and splitting
Pathoma Renal
Describe the major presentation of Alport syndrome.
Isolated hematuria;
sensory hearing loss;
ocular disturbances
(‘can’t see, bloody pee, can’t hear a bee’)
Pathoma Renal
Name a nephritic syndrome that typically follows infection and that progresses to rapidly progressive glomerulonephritis in some cases.
Poststreptococcal glomerulonephritis
Pathoma Renal
1% of pediatric cases of poststreptococcal glomerulonephritis progress to what?
25% of adult cases of poststreptococcal glomerulonephritis progress to what?
Renal failure;
rapidly progressive glomerulonephritis
Pathoma Renal
True/False.
25% of pediatric cases of poststreptococcal glomerulonephritis progress to full-blown renal failure.
1% of pediatric cases of poststreptococcal glomerulonephritis develop into a rapidly progressive glomerulonephritis.
False.
1 % of pediatric cases of poststreptococcal glomerulonephritis progress to full-blown renal failure.
25 % of adult cases of poststreptococcal glomerulonephritis develop into a rapidly progressive glomerulonephritis.
Pathoma Renal
Poststreptococcal glomerulonephritis typically results from ______genic strains of S. pyogenes but may also result from non___________ organisms as well.
Poststreptococcal glomerulonephritis typically results from nephritogenic strains of S. pyogenes but may also result from nonstreptococcal organisms as well.
Pathoma Renal
Poststreptococcal glomerulonephritis is typically seen in _________ (children/adults) but may also be seen in _________ (children/adults).
Poststreptococcal glomerulonephritis is typically seen in children but may also be seen in adults.
Pathoma Renal
How long after a pharyngeal or cutaneous infection with group A streptococcus will development of poststreptococcal glomerulonephritis usually arise?
2 - 3 weeks
Pathoma Renal
Describe the appearance on EM, if any change from normal, of the immune-complex deposits seen in poststreptococcal glomerulonephritis.
Granular immunofluorescence in subepithelial‘humps’
Pathoma Renal
What is the treatment for poststreptococcal glomerulonephritis?
Supportive
Pathoma Renal
A patient presents with fibrin/macrophage crescent structures in their Bowman capsules.
What form of renal pathology does this indicate?
Rapidly progressive glomerulonephritis
Pathoma Renal
How long does it typically take for rapidly progressive glomerulonephritis to develop into renal failure?
Weeks to months
Pathoma Renal
A patient presents with fibrin/macrophage crescent structures in their Bowman capsules, indicating rapidly progressive glomerulonephritis.
What can be used to differentiate the many different etiologies?
Immunofluorescence
Pathoma Renal
A patient presents with fibrin/macrophage crescent structures in their Bowman capsules, indicating rapidly progressive glomerulonephritis.
You note linear immunofluorescence. Name the most likely potential etiology(ies).
Goodpasture syndrome
Pathoma Renal
A patient presents with fibrin/macrophage crescent structures in their Bowman capsules, indicating rapidly progressive glomerulonephritis.
You note granular immunofluorescence. Name the most likely potential etiology(ies).
(1) Poststreptococcal glomerulonephritis (most common)
(2) Diffuse proliferative glomerulonephritis (seen in SLE)
Pathoma Renal
A patient presents with fibrin/macrophage crescent structures in their Bowman capsules, indicating rapidly progressive glomerulonephritis.
You note pauci-immune immunofluorescence. Name the most likely potential etiology(ies).
(1) Granulomatosis with polyangiitis
(2) Microscopic polyangiitis
(3) Churg-Strauss
Pathoma Renal
What does it mean that the renal immunofluorescence associated with granulomatosis with polyangiitis, microscopic polyangiitis, and Churg-Strauss are all pauci-immune?
It means there is no immunofluorescence
Pathoma Renal
What form of renal disease is most common in patients with SLE?
Diffuse proliferative glomerulonephritis
(a form of rapidly progressive glomerulonephritis)
Pathoma Renal
Identify the immunofluorescence pattern for each of the following etiologies of rapidly progressive glomerulonephritis:
Microscopic polyangiitis
Goodpasture syndrome
Diffuse proliferative glomerulonephritis
Negative (pauci-immune)
Linear
Granular (usually sub-endothelial)
Pathoma Renal
Identify the immunofluorescence pattern for each of the following etiologies of rapidly progressive glomerulonephritis:
Granulomatosis with polyangiitis
Poststreptococcal glomerulonephritis
Churg-Strauss
Negative (pauci-immune)
Granular
Negative (pauci-immune)
Pathoma Renal
Identify each of the following renal pathologies as either nephrotic or nephritic syndromes:
Alport syndrome
Membranous nephropathy
Poststreptococcal glomerulonephritis
Nephritic
Nephrotic
Nephritic
Pathoma Renal
Identify each of the following renal pathologies as either nephrotic or nephritic syndromes:
Minimal change disease
Membranoproliferative glomerulonephritis
IgA nephropathy
Nephrotic
Nephrotic
Nephritic
Pathoma Renal
Identify each of the following renal pathologies as either nephrotic or nephritic syndromes:
Focal segmental glomerulosclerosis
Systemic amyloidosis
Rapidly progressive glomerulonephritis
Nephrotic
Nephrotic
Nephritic
Pathoma Renal
Identify each of the following pathologies as being more associated with either nephrotic or nephritic syndromes:
SLE
HIV
Streptococcus pyogenes
Nephritic or nephrotic (usually diffuse proliferative glomerulonephritis; may also be membranous nephropathy)
Nephrotic (focal segmental glomerulosclerosis)
Nephritic (poststreptococcal glomerulonephritis)
Pathoma Renal
Identify each of the following pathologies as being more associated with either nephrotic or nephritic syndromes:
Diabetes mellitus
Hepatitis B
Sickle cell disease
Nephrotic
Nephrotic (membranous nephropathy; membranoproliferative glomerulonephritis)
Nephrotic (focal segmental glomerulosclerosis)
Pathoma Renal
Identify each of the following pathologies as being more associated with either nephrotic or nephritic syndromes:
Hepatitis C
Solid tumors
Mucosal infections
Nephrotic (membranous nephropathy; membranoproliferative glomerulonephritis)
Nephrotic (membranous nephropathy)
Nephritic (IgA nephropathy)
Pathoma Renal
Identify each of the following pathologies as being more associated with either nephrotic or nephritic syndromes:
Goodpasture syndrome
Alport syndrome
Churg-Strauss
Nephritic (rapidly progressive glomerulonephritis)
Nephritic
Nephritic (rapidly progressive glomerulonephritis)
Pathoma Renal
True/False.
A patient presenting with hematuria almost certainly has a nephritic syndrome.
False.
This could be a urinary tract tumor, kidney stone, polycystic kidney disease, BPH, renal cyst(s), sickle cell disease, hydronephrosis, pyelonephritis (if fever present), benign familial hematuria, idiopathic hematuria, etc.
Pathoma Renal
In cases of cystitis, fever is usually _________.
In cases of cystitis, fever is usually absent.
Pathoma Renal
Describe the gold standard lab findings for a typical UTI:
Culture —
Describe the lab findings in a typical UTI:
Culture — > 100,000 colony-forming units (gold standard)
Pathoma Renal
Describe the lab findings in a typical UTI:
Urinalysis —
Describe the lab findings in a typical UTI:
Urinalysis — Cloudy urine + > 10 WBCS / hpf
Pathoma Renal
Describe the lab findings in a typical UTI:
Dipstick —
Describe the lab findings in a typical UTI:
Dipstick — Positive leukocyte esterase + nitrites
Pathoma Renal
What urine dipstick result indicates pyuria?
Leukocyte esterase
Pathoma Renal
True/False.
Urinary dipstick in case of UTIs is will typically show the presence of nitrates.
False.
Urinary dipstick in case of UTIs is will typically show the presence of nitrites.
(Bacteria convert nitrates to nitrites.)
Pathoma Renal
What urine dipstick result indicates presence of bacteria?
(Why?)
Nitrites
(Bacteria convert nitrates to nitrites.)
Pathoma Renal
What are the two main etiologies for UTI development?
Escherichia coli (80%)
Staphylococcus saprophyticus
Pathoma Renal
Name three culture-positive etiologies for UTI besides E. coli (80%) and S. saprophyticus.
- Klebsiella pneumoniae*
- Proteus mirabilis*
- Enterococcus faecalis*
Pathoma Renal
Name two culture-negative etiologies for UTI (i.e. which bacteria cause pyuria with a negative urine culture?).
- Chlamydia trachromatis*
- Neisseria gonnorrheae*
(Note: dysuria due to urethritis is a dominant presenting sign.)
Pathoma Renal
Name the three most common etiologies of pyelonephritis.
E. coli (90%)
- Enterococcus faecalis*
- Klebsiella spp.*
Pathoma Renal
What condition can lead to ‘thyroidization’ of the kidney(s)?
(I.e. tubules are atrophic and contain eosinophilic proteinaceous material.)
Chronic pyelonephritis
Pathoma Renal
What is a major instigating factor for chronic pyelonephritis in children?
Vesicoureteral reflux
Pathoma Renal
What is a major instigating factor for chronic pyelonephritis in adults?
Obstruction
(e.g. BPH or cervical carcinoma)
Pathoma Renal
What renal scarring pattern is characterstic of the effects of vesicoureteral reflux?
Scarring at the upper and lower poles; blunted calyces
Pathoma Renal
Risk factors for nephrolithiasis mainly center around a high _________ in the urinary filtrate and a low _________ in the urinary filtrate.
Risk factors for nephrolithiasis mainly center around a high [solute] in the urinary filtrate and a low volume in the urinary filtrate.
Pathoma Renal
What are the main ways that the pain of nephrolithiasis is described?
Colicky,
unilateral,
flank
(in conjunction with hematuria)
Pathoma Renal
What is the most common type of renal stone?
Calcium (oxalate or phosphate salts)
Pathoma Renal
What is the most common cause of calcium oxalate (or phosphate) nephrolithiasis?
What is the treatment?
Idiopathic hypercalcuria;
hydrochlorothiazide
Pathoma Renal
After calcium (phosphate or oxalate), what are the next two most common types of nephrolithiasis?
(1) Calcium (oxalate or phosphate)
(2) Ammonium magnesium phosphate
(3) Uric acid
Pathoma Renal
A patient presents with colicky right flank pain and hematuria.
Urinalysis shows radiolucent crystals.
Radiolucence most likely indicates what type of stone?
Uric acid nephrolithiasis
Pathoma Renal
Identify if each of the following nephrolithiasis is radiopaque or radiolucent:
Calcium (oxalate or phosphate)
Struvite (ammonium magnesium phosphate)
Uric acid
Identify if each of the following nephrolithiasis is radiopaque or radiolucent:
Calcium (oxalate or phosphate) - Radiopaque
Struvite (ammonium magnesium phosphate) - Radiopaque
Uric acid - Radiolucent
Pathoma Renal
Which form of nephrolithiasis has the strongest association with infection (e.g. due to Proteus vulgaris or Klebsiella spp.)?
Struvite (ammonium magnesium phosphate)
Pathoma Renal
What is the major predisposing factor for uric acid nephrolithiasis?
Hyperuricemia
(e. g. due to gout, leukemia, myeloproliferative disorders)
* (Other factors include hot and arid conditions, low urine volume, and low pH.)*
Pathoma Renal
Name the mainstay treatment for each of the following forms of nephrolithiasis:
Calcium (oxalate or phosphate)
Struvite (ammonium magnesium phosphate)
Uric acid
Calcium - Hydrochlorothiazide
Struvite - Surgery + antibiotics
Uric acid - Hydration + urine alkalinization (+ allopurinol for gout)
Pathoma Renal
Name a rare form of nephrolithiasis most commonly seen in children with a certain genetic defect.
Cystine stones
Pathoma Renal
Treatment is extremely similar for which two forms of nephrolithiasis?
Uric acid stones
Cystine stones
(hydration + urine alkalinization)
Pathoma Renal
Describe the microscopic appearance of the following types of nephrolithiasis:
Calcium (phosphate or oxalate)
Struvite (ammonium magnesium phosphate)
Pathoma Renal
Describe the microscopic appearance of the following types of nephrolithiasis:
Uric acid
Cystine
Pathoma Renal
Name the three most common causes of end-stage renal disease (i.e. chronic renal failure).
- Diabetes mellitus
- Hypertension
- Glomerular disease
Pathoma Renal
ESRD treatment includes dialysis and renal transplant. The dialysis often leads to ________ development, increasing risk of subsequent ________ carcinoma.
ESRD treatment includes dialysis and renal transplant. The dialysis often leads to cyst development, increasing risk of subsequent renal cell carcinoma.
Pathoma Renal
List the major effects of chronic renal failure:
_______emia
_______tension
_______kalemia
Metabolic _____osis
_______calcemia and renal osteo____________
Anemia due to decreased _____________
List the major effects of chronic renal failure:
Azotemia
Hypertension
Hyperkalemia
Metabolic acidosis
Hypocalcemia and renal osteodystrophy
Anemia due to decreased erythropoietin
Pathoma Renal
List some of the major effects of the azotemia (~uremia) associated with chronic renal failure (ESRD).
(E.g. appetite, inflammatory, hematogenous, and motor effects)
Mnemonic: ESRD makes you NAP-PE.
Nausea
Anorexia
Pericarditis
-
Platelet dysfunction
Encephalopathy (and asterixis)
Pathoma Renal
Which substance is the main controlling factor over the diameter of the afferent arteriole lumen?
PGE2
(Hence, why NSAIDs restrict blood flow to the glomeruli.)
Pathoma Renal
Which substance is the main controlling factor over the diameter of the efferent arteriole lumen?
Angiotensin II
(Hence, why ACE inhibitors dilate the efferent arteriole.)
Pathoma Renal
Angiomyolipomas are ______omas more commonly seen in patients with ____________.
Angiomyolipomas are hamartomas more commonly seen in patients with tuberous sclerosis.
Pathoma Renal
Renal cell carcinomas arise from what tissue(s)?
Renal tubule epithelium
Pathoma Renal
What are the three classic S/Sy of which some mix is typically seen in renal cell carcinoma?
Hematuria
Palpable mass
Flank pain
Pathoma Renal
Name some of the paraneoplastic syndromes associated with renal cell carcinoma.
EPO-, renin-, PTHrP-, and ACTH-secreting tumors
Pathoma Renal
Renal cell carcinomas are rarely associated with left-sided _________.
Renal cell carcinomas are rarely associated with left-sided varicoceles.
Pathoma Renal
What are the most common gross and microscopic findings in renal cell carcinomas?
Gross - yellow mass
Microscopic - clear cells
Pathoma Renal
Loss of VHL leads to increases in what factors?
IGF-1
HIF transcription factor (increasing VEGF and PDGF)
Pathoma Renal
What is the classic anatomical location and demographic associated with sporadic renal cell carcinoma?
Upper renal pole;
60-year-old male
Pathoma Renal
What is the major risk factor for sporadic renal cell carcinoma?
Cigarette smoke
Pathoma Renal
Although renal cell carcinomas are especially at-risk for hematogenous spread (via the renal vein), what lymph nodes are most likely to be involved?
The retroperitoneal nodes
Pathoma Renal
What tumor arises from renal blastema and is characterized by primitive glomeruli, tubules, and stromal cells?
Wilms tumor
Pathoma Renal
Wilms tumors are _________ (benign/malignant).
Wilms tumors are malignant.
Pathoma Renal
True/False.
Renal cell carcinoma is the most common renal malignancy in children.
False.
Wilms tumor is the most common renal malignancy in children.
Pathoma Renal
What is the classic presentation for Wilms tumor?
Unilateral flank mass, hematuria, and hypertension
Pathoma Renal
Why do Wilms tumors present with hypertension?
Tumor renin secretion
Pathoma Renal
Name the three syndromes associated with Wilms tumor.
WAGR
Denys-Drash
Beckwith-Wiedmann
(‘What could go wrong dining and dashing at BWs?’)
Pathoma Renal
Besides the presence of a nephroblastoma (Wilms tumor), name the main aspects of WAGR syndrome.
Aniridia, Genital abnormalities, mental/motor Retardation
Pathoma Renal
Besides the presence of a nephroblastoma (Wilms tumor), name the main aspects of Denys-Drash syndrome.
Progressive glomerular disease,
male pseudohermaphroditism
(‘double Ds get the PP’)
Pathoma Renal
Besides the presence of a nephroblastoma (Wilms tumor), name the main aspects of Beckwith-Wiedmann syndrome.
Neonatal hypoglycemia,
muscular hemihypertrophy,
organomegaly
Pathoma Renal
Name the respective mutation associated with each of the following syndromes:
WAGR -
Denys-Drash -
Beckwith-Wiedmann -
Name the respective mutation associated with each of the following syndromes:
WAGR - WT1 (deletions)
Denys-Drash - WT1 (mutations)
Beckwith-Wiedmann - WT2
Pathoma Renal
What is the major risk factor for urothelial (transitional cell) carcinomas?
Name some others.
Cigarette smoke;
naphthylamine, azo dyes, long-term cyclophosphamide or phenacetin use
Pathoma Renal
Describe the flat form of urothelial (transitional cell) carcinoma.
Early p53 mutations:
high-grade, flat tumor with early invasion
Pathoma Renal
Describe the papillary form of urothelial (transitional cell) carcinoma.
Low-grade papillary tumor that progresses to high-grade and then invades
Pathoma Renal
True/False.
Urothelial (transitional cell) carcinomas are often multifocal and recurrent.
True.
Pathoma Renal
What must occur before squamous cell carcinomas can arise in the bladder or other lower urinary tract locations?
Squamous metaplasia
(from transitional epithelia)
Pathoma Renal
Name three very distinct risk factors for squamous cell carcinoma of the bladder.
Chronic cystitis (older woman)
Schistosoma haematobium (Egyptian male)
Long-standing nephrolithiasis
Pathoma Renal
Name three structural risk factors for adenocarcinoma of the bladder.
Urachal remnant
Cystitis glandularis
Extrophy of the bladder
