Chapter 20: Kidney

Question 1

Subepithelial humps seen in…

Answer 1

Acute glomerulonephritis

Question 2

Epimembranous deposits seen in…

Answer 2

Membranous glomerulopathy

Question 3

Subendothelial deposits seen in…

Answer 3

Lupus nephritis and MPGN

Question 4

Secondary causes of membranous glomerulopathy

Answer 4

• drugs (penicillamine, gold, NSAIDs)
• malignancy (lung and colon carcinoma, esp.)
• lupus
• infections (HCV, HBV, schisto)
• other autoimmune disorders (thyroiditis, etc)

Question 5

Types of FSGS

Answer 5

• primary/idiopathic
• associated with other diseases (HIV, sickle cell, obesity)
• secondary to scarring from previous necrotizing lesions such as IgA nephropathy
• as an adaptive response to loss of renal tissue
• inherited forms of nephrotic syndrome

Question 6

Causes of secondary MPGN

Answer 6

• chronic immune complex disorders: HCV (with cryoglobulinemia), HCV, lupus, etc
• A1AT deficiency
• malignancies (CLL, lymphoma)
• complement deficiency syndromes

Question 7

Alport syndrome

Answer 7

• usually X linked disorder due to abnormal chains of type IV collagen with resultant defective assembly of type IV collagen
• hematuria with CRF, nerve deafness, cataracts, lens dislocation
• diffuse GBM thinning
• abundant interstitial foam cells with focal and global glomerulosclerosis developing later
• lack of IHC staining for specific alpha 3, 4 or 5 chains; absence of alpha 5 staining also in skin biopsies from affected patients

Question 8

Dialysis related changes in kidneys

Answer 8

• arterial intimal thickening
• tubulointerstitial deposition of calcium oxalate crystals
• acquired cystic disease
• increased incidence of adenomas and carcinomas of the kidney

Question 9

Clinical features of HSP

Answer 9

• purpura of extensor surfaces of arms, buttocks and legs
• abdominal pain, vomiting, and GI bleeding
• nonmigratory arthralgia
• renal abnormalities including hematuria, nephritic syndrome and nephrotic syndrome

Question 10

What is the most common cause of acute renal failure?

Answer 10

Acute kidney injury

Question 11

Histologic features of acute kidney injury

Answer 11

• eosinophilic tubular casts made predominantly of Tamm-Horsfall protein
• loss of proximal tubule brush borders
• sloughing of non-necrotic epithelial cells into the tubule lumen
• tubular cell swelling and vacuolization
• in ischemic cases: patchy tubular epithelial necrosis and basement membrane rupture (tubulorrhexis)