Robbins Ch 20 Part II Flashcards
Which systemic disease has a glomerular lesion that has a wire-loop appearance on light microscopy?
SLE
What is the most common and severe form of SLE?
It leads to what filling Bowman’s space?
1) Class IV: diffuse lupus nephritis
2) Lateral crescents
How does Henoch-Schönlein Purpura differ from Berger’s?
Henoch-Schönlein Purpura is systemic while Berger’s is localized to kidney
What is found on immunofluorescence for Henoch-Schönlein Purpura?
IgA is deposited in the renal mesangium and sometimes with C3 and IgG
Fibrillary Glomerulonephritis is characterized by what deposition seen on immunofluorescence?
Polyclonal IgG (mostly IgG4)
What is characterized morphologically by damage to tubular epithelial cells and clinically by an acutely diminished renal function?
Acute Tubular Injury/Necrosis
Can acute tubular injury be reversed?
Yes
Ischemic Acute Tubular Injury/Necrosis shows focal tubular epithelial cell necrosis and basement membrane eruption with?
Toxic ATI shows focal, nonspecific necrosis especially at?
1) Large skipped areas of unaffected tubule
2) The straight portion of the proximal tubule and the thick ascending limb
Eosinophilic hyaline and pigmented granular casts are common with Acute Tubular Injury/Necrosis, especially in the distal tubules and collecting ducts. What do these casts contain?
Tamm-Horsfall protein (urinary glycoprotein normally secreted by the cells of the ascending thick limb and distal tubules)
At what point in its clinical course does Acute Tubular Injury/Necrosis present with hematuria?
Never
What occurs during the maintenance phase of Acute Tubular Injury/Necrosis?
What needs to be monitored during the recovery phase?
1) Decrease in urine output (oliguria)
2) Hypokalemia and increased risk of infection
What is diagnostic for Acute Tubular Injury/Necrosis?
Dirty Brown Granular Casts, also called “renal failure casts”
What bacteria are the most common etiology for pyelonephritis?
It is spread most commonly through?
1) Gram-negative, most commonly E. coli
2) Ascending infection from a lower urinary tract infection
What allows bacteria to gain access to ureters?
What makes it easier for the bacteria to ascend?
1) Vesicoureteral Reflux
2) Stasis of urine
What are the hallmarks of acute pyelonephritis?
1) Patchy interstitial suppurative inflammation (focal abscesses or large wedge-like areas)
2) Intratubular WBC aggregates (WBC casts on urinalysis)
3) Tubular necrosis
What complications of acute pyelonephritis is seen in diabetics, sickle cell disease, and those with urinary tract obstruction?
Papillary necrosis
What predisposing conditions increases the susceptibility to acute pyelonephritis?
Pregnancy and DM
What are the only two conditions that impact the calyces?
Chronic pyelonephritis and analgesic nephropathy
What is the most common pyelonephritic scarring that occurs early in childhood from superimposition of UTI on congenital vesicoureteral reflux and intrarenal reflux?
Reflux nephropathy
Chronic obstructive pyelonephritis is characterized by?
Defective posterior urethral valves bilaterally
Chronic pyelonephritis leads to a dilated, flattened epithelium filled with?
Thyroid colloid (thyroidization)
What is a rare form of chronic pyelonephritis that is characterized by foam cells mixed with plasma cells, giant cells, and other WBCs?
It is often associated with what infections?
1) Xanthogranulomatous pyelonephritis
2) Proteus infections
Acute (Drug-Induced) TubuloInterstitial Nephritis is what type of hypersensitivity?
What do the drugs act as?
1) Type I and IV
2) Haptens
What are patients with analgesic nephropathy more likely to develop?
Urothelial carcinoma of the renal pelvis
Bence-Jones proteinuria and cast nephropathy occurs in 70% of patients with?
Multiple myeloma
Benign Nephrosclerosis is characterized by sclerosis of the renal arterioles and small arteries associated with?
Aging and HTN
How are the vessels affected due to benign nephrosclerosis?
1) Thickened walls
2) Narrowed lumens
How are the kidneys described with benign nephrosclerosis?
Grain leather
Malignant Hypertension Nephrosclerosis causes what to appear on the cortical surface from rupture of arterioles or glomerular capillaries?
What appearance does this have?
1) Petechial hemorrhage
2) “Flea-bitten” appearance
Unilateral Renal Artery Stenosis while uncommon, may occur in what population?
It causes what appearance?
1) Old diabetic men
2) String of beads
Thrombotic Thrombocytopenic Purpura is often associated with inherited or acquired deficiencies of?
This protease regulates the function of?
1) ADAMTS13
2) von Willebrand Factor
The most common cause of typical hemolytic-uremic syndrome is?
E. Coli Hamburgers (O157:H7) containing shiga-like toxin
Atypical hemolytic-uremic syndrome is due to inherited mutations of complement regulatory proteins, most commonly in?
Factor H
What is the Thrombotic Thrombocytopenic Purpura pentad?
1) Fever
2) Neurologic symptoms
3) Microangiopathic hemolytic anemia
4) Thrombocytopenia
5) Renal failure
When a infant has a horseshoe kidney the ascent of the kidneys into their normal position in the abdomen below the adrenal glands are restricted by the?
Most of theses patients deal with what type of fusion?
1) Inferior mesenteric artery
2) Lower pole fusion
Which Polycystic Kidney Disease Gene is an integral membrane protein expressed in all segments of the renal tubules and many extrarenal tissues?
Which is expressed in tubular epithelial cells, particularly those of the distal nephron?
Majority of cases have which gene defective?
Which has a better prognosis?
1) PKD1
2) PKD2
3) PKD1
4) PKD2
Autosomal Dominant Polycystic Kidney Disease is characterized by multiple expanding cysts of both kidneys that ultimately leads to?
Destruction of renal parenchyma which results in renal failure
How is Autosomal Dominant Polycystic Kidney Disease characterized morphologically?
Bilaterally enlarged kidneys reaching enormous sizes (4kg/kidney reported)
What may be seen on imaging for a young patient that is characteristic of ADPKD?
Isolated, basilar subarachnoid hemorrhage
Which polycystic kidney disease is the childhood form?
Which is the adult form?
1) Autosomal Dominant Polycystic Kidney Disease
2) Autosomal Recessive Polycystic Kidney Disease
The cysts in Autosomal Recessive Polycystic Kidney Disease are lined by cuboidal cells because?
All the cysts come from the collecting tubules
What is the most common genetic cause of end stage renal disease in children and young adults?
Nephronophthisis
Which nephronophthisis variant is most common?
Familial juvenile nephronophthisis
How is nephronophthisis characterized morphologically?
Small kidneys with contracted granular surfaces
How does nephronophthisis present clinically?
1) Polyuria
2) Polydipsia
3) Salt wasting
What is the histologic characteristic feature of multicystic renal dysplasia?
Islands of undifferentiated mesenchyme, often with cartilage, and immature collecting ducts
Acquired (dialysis associated) cystic disease have cysts that often contain?
Calcium oxalate crystals
Urinary tract obstruction almost always leads to?
Permanent renal atrophy (hydronephrosis or obstructive uropathy)
What congenital anomaly can lead to an obstructive urinary lesion?
Posterior urethral valves
What is characterized by dilation of the renal pelvis and calyces associated with progressive atrophy of the kidney due to obstruction to outflow of urine?
Hydronephrosis
Bilateral partial obstruction in relation to hydronephrosis leads to?
Bilateral complete obstruction?
1) Inability to concentrate urine causing polyuria
2) Death unless the obstruction is relieved
The most important determinant of urolithiasis is?
Supersaturation which is increased urinary concentration of the stones’ constituents
What is the most common type of stone?
When both hypercalciuria and hypercalcemia are present with it, it is the result of what condition?
1) Calcium Oxalate Stones
2) Hyperparathyroidism
What are struvite stones made of?
What occupies the renal pelvis and are caused by infection and are made up of struvite stones?
1) Magnesium ammonium Phosphate
2) Staghorn Calculi
While renal papillary adenomas have malignant potential at any size, it is especially considered malignant if?
Greater than 3 cm
Angiomyolipoma are benign neoplasms consisting of vessels, smooth muscle, and fat from the perivascular epithelioid cells and are associated with?
Tuberous Sclerosis
Oncocytomas come from the intercalated cells of?
They are tan to brown, well-circumscribed with a?
1) Collecting ducts
2) Central scar
What is the most common renal cancer in adults?
What is the greatest risk factor for it?
1) Renal cell carcinoma (adenocarcinoma)
2) Smoking
What syndrome will cause nearly all patients to develop bilateral renal cell carcinoma?
Von-Hippel-Lindau syndrome
What is the most common type of renal cell carcinoma?
98% of cases are caused by?
1) Clear cell carcinoma
2) Chromosome 3 deletion where the VHL gene is
Which type of renal cell carcinoma is associated with dialysis-associated cystic disease?
Papillary Carcinoma
What is the classic triad of symptoms seen with renal cell carcinoma?
1) Hematuria (which is the most reliable)
2) Flank pain
3) Mass
What is the most notable symptom of urothelial carcinoma of the pelvis?
What is the number one risk factor?
What condition is it associated with?
1) Painless hematuria
2) Smoking
3) Analgesic nephropathy
