Uropathology Flashcards

Question

Rapidly progressive (e.g. Anti-GBM)

Answer 1

Manifestation of severe glomerular damage. Secondary to autoimmune disease (SLE, GPA) and infection. Histology: hypercellularity (increase in mesangial, epithelial and endothelial cells and increased number of inflammatory cells). Treatment: plasma exchange, steroids, cyclophosphamide and often dialysis.

Answer 2

IgM, IgG, C1q, C3

Answer 3

Pauci-immune

Answer 4

Linear IgG

Answer 5

IgG and C3 in chunky, irregular mesangial and capillary wall pattern (Stary sky)

Answer 6

Benign - uncommon (Urothelial papilloma, nephrogenic adenoma) Cancer- 90% carcinoma, 5% squamous cell carcinoma and adenocarcinoma

Answer 7

Finger-like projections High grade cellular features: cellular atypia High grade nuclear features: nuclear pleomorphism, hyperchromatic nuclei, high N:C ratio, frequent mitotic figures

Answer 8

PATIENT INFORMATION: CLINICAL INFORMATION: MACROSCOPIC description: MICROSCOPIC description: CLINICAL DIAGNOSIS:

Answer 9

Gleason grading - based on architecture and predominant patterns

Answer 10

renal clear cell carcinoma (usually from cells of the PCT)

Answer 11

- Most are sporadic - 60% patients with von Hippel-Lindau syndrome (autosomal dominant) develop bilateral multiple RCCs

Answer 12

Some trigger (could be infection, cross-reactivity)  APC present beta-islet or insulin peptides to CD4+ TH cells CD4+ TH cells activate CD8 T cells and B cells (class switching, antibody production) = CD8 T cell-mediated death of pancreatic beta islet cells, or antibody-mediated destruction

Answer 13

- Insulin autoantibodies (anti IAA) - Glutamic acid decarboxylase (Anti-GAD65) - Antibodie to protein tyrosine phophatase (anti IA-2A) - Antibody to zinc transporter 8 (anti ZnT8)

Answer 14

- Start IV FLUIDS first – 1L of 0.9% saline (no potassium) to run over 1 hr - Start continuous FIXED RATE IV insulin infusion - CONTINUE long acting insulin (e.g. Insulatard, Glargine, Levemir) at usual dose and usual time If this is a new diagnosis of diabetes, prescribe 10 units subcutaneous long-acting Glargine at 22.00 hrs Infusion instructions: 50 units Actrapid insulin made up to 50ml with 0.9% saline (1 unit per ml), to be administered via syringe driver at rate of 0.1 units/kg/hr Ongoing assessment and corrections Aims: - Correct fluid and electrolyte imbalance - Maintain plasma potassium between 4.0-5.0 mmol/L - Deliver enough insulin to clear blood of ketones, aiming for blood ketone level of < 0.3 mmol/L

Answer 15

- Macrovascular disease = accelerate atherosclerosis - Microvascular disease = basement membrane dysfunction - Infection = ischaemia, immune dysfunction and hyperglycaemia

Answer 16

Accelerated atherosclerosis - Aorta, coronary and renal arteries - PVD - Stroke

Answer 17

Basement membrane dysfunction - Retinopathy - Diabetic nephropathy - Peripheral nephropathy

Answer 18

- Soft tissue - Upper and lower urinary tract - Respiratory tract

Answer 19

I. Isolated macrophage foam cells II. Cells filled with intracellular lipid forming fatty streaks III. Small extracellular lipid pools IV. Smooth muscle and collagen surrounding a core of extracellular lipid V. Fibrotic calcified plaques with a lipid core VI. High risk plaque with ulceration, haematoma or thrombosis

Answer 20

1) light increase in mesangial matrix and arteriolar hyalinosis surrounding artery 2) hyaline material grows to form nodular protein aggregates within the capillary loops - Kimmelstiel-Wilson nodules 3) Structural changes result in microaneyrusm formation ) and eventually complete sclerosis and loss of function

Answer 21

Macro: presence of multiple subcortical abscesses with surrounding hyperaemia Micro: lneutrophils infiltrating the tubules and interstitium (Note that pyelonephritis usually spares the glomeruli). There is some necrosis of tubular epithelial cells and in this particularly severe cases, colonies of bacteria within the kidney

Answer 22

- Paired morning and plasma urine sample - Water deprivation test – abstain from fluid and food for 8hrs At baseline t=0, empty bladder, record body weight and measre U&Es, plasma and urine osmolality Record hourly urine output At t=2/4/6/7/8 hours, weight patient and repeat blood and urine samples At 8 hours gives demopressin

Answer 23

- MRI head - Desmopressin + underlying condition

Answer 24

- Renal studies (USS kidneys, urine dip, uni analysis, uACR, U&Es) - Correct metabolic disturbances Remove causal drugs (if possible…) Consider trial of high dose desmopressin Consider trial of thiazides or NSAIDs