Renal Pathology Flashcards by arcie cola

Q

Clinical Manifestation of Renal Diseases:

A

• Azotemia
• Uremia
• Nephritic syndrome
• Nephrotic syndrome
• Asymptomatic hematuria or proteinuria
• Acute kidney injury
• Chronic kidney disease

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Q

Clinical Manifestation of Renal Diseases

______
• biochemical abnormality that refers to an elevation of blood urea nitrogen (BUN) and creatinine levels, and is related largely to a decreased glomerular filtration rate (GFR).

A

Azotemia

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Q

Clinical Manifestation of Renal Diseases

______
• When azotemia leads to clinical signs and symptoms associated with biochemical abnormalities

A

Uremia

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Q

Clinical Manifestation of Renal Diseases

______
• clinical entity caused by inflammatory glomerular disease and is dominated by the acute onset of either grossly visible hematuria

A

Nephritic syndrome

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Q

Clinical Manifestation of Renal Diseases

______
• due to glomerular disease, is characterized by heavy proteinuria (more than ______ g/ day), hypoalbuminemia, severe edema, hyperlipidemia, and lipiduria (lipid in the urine)

A

Nephrotic syndrome, 3.5

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Q

Clinical Manifestation of Renal Diseases

______
• characterized by rapid decline in GFR (within hours to days) with concurrent dysregulation of fluid and electrolyte balance, and retention of metabolic waste products normally excreted by the kidney including ______ and ______

A

Acute kidney injury, urea, creatinine

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Q

Clinical Manifestation of Renal Diseases

______
• defined as the presence of a diminished GFR that is persistently less than 60 mL/min/1.73 m2 for at least 3 months, from any cause, and/or persistent albuminuria

A

Chronic kidney disease

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Q

Glomerular Diseases:

A

• NEPHRITIC SYNDROME
• PSAGN
• NEPHROTIC SYNDROME
• ALPORT SYNDROME (HEREDITARY NEPHRITIS)

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Q

Glomerular Diseases

______ - some glomeruli

A

Focal

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Q

Glomerular Diseases

______ - ALL glomeruli

A

Diffuse

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Q

Glomerular Diseases

______ - portion of glomerulus

A

Segmental

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Q

Glomerular Diseases

______ - whole glomerulus

A

Global

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Q

Glomerular Diseases

______ - only mesangial region

A

Mesangial

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Q

Glomerular Diseases

Pathologic Responses of the Glomerulus to Injury:

A

• Hypercellularity
• Basement Membrane Thickening
• Hyalinosis
• Sclerosis

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Q

Glomerular Diseases

Pathologic Responses of the Glomerulus to Injury

______
• Proliferation of mesangial or endothelial cells.

A

Hypercellularity

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Q

Glomerular Diseases

Pathologic Responses of the Glomerulus to Injury

______
• Infiltration of leukocytes, including neutrophils, monocytes, and, in some diseases, lymphocytes. The combination of infiltration of leukocytes and swelling and proliferation of mesangial and/or endothelial cells is often referred to as ______.

A

Hypercellularity, endocapillary proliferation

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Q

Glomerular Diseases

Pathologic Responses of the Glomerulus to Injury

______
• Formation of ______. These are accumulations of cells composed of proliferating glomerular epithelial cells and infiltrating leukocytes.

A

Hypercellularity, crescents

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Q

Glomerular Diseases

Pathologic Responses of the Glomerulus to Injury

______
• By light microscopy, this change appears as thickening of the capillary walls, best seen in sections stained with ______.

A

Basement Membrane Thickening, periodic acid–Schiff (PAS)

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Q

Glomerular Diseases

Pathologic Responses of the Glomerulus to Injury

______
• as applied to the glomerulus, denotes the accumulation of material that is homogeneous and eosinophilic by light microscopy

A

Hyalinosis

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Q

Glomerular Diseases

Pathologic Responses of the Glomerulus to Injury

______
• is characterized by deposition of extracellular collagenous matrix.

A

Sclerosis

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Q

Glomerular Diseases

Glomerular diseases presenting with a ______ are characterized by inflammation in the glomeruli.

A

nephritic syndrome

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Q

Glomerular Diseases

NEPHRITIC SYNDROME

The main clinical features of nephritic syndrome include the following:

A

• Hematuria (red blood cells and red cell casts in urine)
• Proteinuria (usually subnephrotic range) with or without edema
• Azotemia
• Hypertension

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Q

Glomerular Diseases

______
• The most common causes are immunologically mediated glomerular injury; lesions are characterized by proliferative changes and leukocyte infiltration

A

NEPHRITIC SYNDROME

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Q

Glomerular Diseases

______
• cluster of diseases is characterized histologically by diffuse proliferation of glomerular cells associated with influx (______) of leukocytes, typically caused by immune complexes

A

PSAGN, exudation

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Glomerular Diseases ______ • ______ is caused by immune complexes containing streptococcal antigens and specific antibodies.

PSAGN, Poststreptococcal GN

Glomerular Diseases PSAGN By immunofluorescence microscopy, there are granular deposits of ______ and ______, and sometimes ______ in the ______ and along the ______ (Fig. 20.8D). Although immune complex deposits are almost universally present, they are often ______ and ______. The characteristic electron microscopic findings are ______, ______, ______ deposits on the epithelial side of the membrane, often having the appearance of “______"

IgG, C3, IgM, mesangium, GBM, focal, sparse discrete, amorphous, electron-dense, humps

Glomerular Diseases ______ is caused by a derangement in glomerular capillary walls resulting in increased permeability to plasma proteins.

Nephrotic syndrome

Glomerular Diseases NEPHROTIC SYNDROME The manifestations of the syndrome include the following:

• Massive proteinuria, with the daily loss of 3.5 g or more of protein (less in children) • Hypoalbuminemia, with plasma albumin levels less than 3 g/dL • Generalized edema • Hyperlipidemia and lipiduria

Glomerular Diseases NEPHROTIC SYNDROME • The ______ is a direct consequence of decreased intravascular colloid osmotic pressure. There is also ______ and ______ retention, which aggravates the edema

generalized edema, sodium, water

Glomerular Diseases NEPHROTIC SYNDROME ______ • most frequent cause of nephrotic syndrome in children

Minimal change disease

Glomerular Diseases NEPHROTIC SYNDROME ______ • it is manifested by proteinuria and effacement of glomerular foot processes without antibody deposits

Minimal change disease

Glomerular Diseases NEPHROTIC SYNDROME ______ • the pathogenesis is unknown; secondary forms can be triggered by infections, immunization, drugs, and certain neoplastic lesions; the disease responds well to steroid therapy

Minimal change disease

Glomerular Diseases NEPHROTIC SYNDROME ______ • characterized by the presence of prominent IgA deposits in the mesangial regions and recurrent hematuria, is the most common type of glomerulonephritis worldwide.

IgA nephropathy

Glomerular Diseases ______ • Defective assembly of type 4 collagen

ALPORT SYNDROME (HEREDITARY NEPHRITIS)

Glomerular Diseases ______ • X linked dominant

ALPORT SYNDROME (HEREDITARY NEPHRITIS)

Glomerular Diseases ______ • Lens dislocation, posterior cataract, corneal dystrophy, nerve deafness, hematuria

ALPORT SYNDROME (HEREDITARY NEPHRITIS)

Glomerular Diseases ______ • EM: thin GBM, “basket weave appearance"

ALPORT SYNDROME (HEREDITARY NEPHRITIS)

Tubular & Interstitial Diseases:

• Acute Tubular Injury

Tubular & Interstitial Diseases Two major processes:

(1) ischemic or toxic tubular injury, (2) inflammation of the tubules and interstitium (tubulointerstitial nephritis).

Tubular & Interstitial Diseases ______ • is characterized by acute renal failure and often, but not invariably, morphologic evidence of tubular injury, in the form of necrosis of tubular epithelial cells.

Acute Tubular Injury (ATI)

Tubular & Interstitial Diseases Acute Tubular Injury ______ - renal hypoperfusion

Ischemic

Tubular & Interstitial Diseases Acute Tubular Injury ______ - toxic effects to tubules

Toxic

Tubular & Interstitial Diseases Acute Tubular Injury ______ - substance innate to the body

Endogenous

Tubular & Interstitial Diseases Acute Tubular Injury ______ - drugs, contrast, heavy metals, organic solvents

Exogenous

Tubular & Interstitial Diseases Acute Tubular Injury ______ • Adverse renal effects are related to their ability to inhibit cyclooxygenase–dependent prostaglandin synthesis. The selective ______, while sparing the gastrointestinal tract, do affect the kidneys because ______ is expressed in human kidneys

NSAID INDUCED NEPHROPATHY, COX-2 inhibitors, COX-2

Vascular Diseases:

• RENAL INFARCTS • RENAL ARTERY STENOSIS • NEPHROSCLEROSIS

Vascular Diseases ______ • Kidneys are susceptible to infarction, 25% of CO goes to kidneys

RENAL INFARCTS

Vascular Diseases ______ • Morphology: coagulative necrosis, “acidophilic tombstone”

RENAL INFARCTS

Vascular Diseases RENAL INFARCTS • Small infarcts are usually ______

silent

Vascular Diseases ______ • Cause are atherosclerosis (most common), advanced age, DM

RENAL ARTERY STENOSIS

Vascular Diseases ______ • associated with sclerosis of renal arterioles and small arteries; it is strongly associated with hypertension, which can be both a cause and a consequence of nephrosclerosis.

NEPHROSCLEROSIS

Vascular Diseases ______ • at autopsy is associated with advanced age

NEPHROSCLEROSIS

Congenital and Developmental Anomalies:

• Agenesis of the Kidney • Hypoplasia • Ectopic Kidneys • Horseshoe Kidneys

Congenital and Developmental Anomalies ______ • ______ is incompatible with life and usually encountered in stillborn infants. It is often associated with other congenital disorders (e.g., limb defects, hypoplastic lungs)

Agenesis of the Kidney, Bilateral agenesis

Congenital and Developmental Anomalies ______ • ______ is uncommon and compatible with normal life if no other abnormalities exist.

Agenesis of the Kidney, Unilateral agenesis

Congenital and Developmental Anomalies ______ • refers to failure of the kidneys to develop to a normal size

Hypoplasia

Congenital and Developmental Anomalies ______ • This anomaly may occur bilaterally, resulting in renal failure in early childhood, but it is more commonly encountered as a unilateral defect

Hypoplasia

Congenital and Developmental Anomalies ______ • ______ is observed in low-birth-weight infants and may contribute to their increased lifetime risk for chronic kidney disease.

Hypoplasia, True renal hypoplasia

Congenital and Developmental Anomalies ______ • The development of the metanephros into the kidneys may occur in ______

Ectopic Kidneys, ectopic foci

Congenital and Developmental Anomalies ______ • Fusion of the upper (______%) or lower poles (______%) of the kidneys produces a horseshoe-shaped structure that is continuous across the midline anterior to the great vessels

Horseshoe Kidneys, 10, 90

Cystic Diseases of the Kidney:

• Autosomal dominant (adult) polycystic kidney disease • Autosomal recessive (childhood) polycystic kidney disease • Cystic Diseases of the Renal Medulla - Medullary sponge kidney - Nephronophthisis - Multicystic Renal Dysplasia - Simple cysts

Cystic Diseases of the Kidney ______ • a hereditary disorder characterized by multiple expanding cysts of both kidneys that ultimately destroy the renal parenchyma and cause renal failure.

Autosomal dominant (adult) polycystic kidney disease

Cystic Diseases of the Kidney ______ • Many patients remain asymptomatic until renal insufficiency announces the presence of the disease

Autosomal dominant (adult) polycystic kidney disease

Cystic Diseases of the Kidney ______ • ______, ______, ______, and ______ subcategories have been defined, depending on the time of presentation and presence of associated hepatic lesions.

Autosomal recessive (childhood) polycystic kidney disease, Perinatal, neonatal, infantile, juvenile

Cystic Diseases of the Kidney ______ • The first two are the most common; serious manifestations are usually present at birth, and the young infant might succumb rapidly to renal failure.

Autosomal recessive (childhood) polycystic kidney disease

Cystic Diseases of the Kidney Cystic Diseases of the Renal Medulla • The two major types of medullary cystic disease are ______, a relatively common and usually innocuous structural change, and ______, which is almost always associated with renal dysfunction.

medullary sponge kidney, nephronophthisis

Cystic Diseases of the Kidney ______ • is restricted to multiple cystic dilations of the collecting ducts in the medulla.

Medullary sponge kidney

Cystic Diseases of the Kidney ______ • The condition occurs in adults and is usually discovered radiographically.

Medullary sponge kidney

Cystic Diseases of the Kidney ______ • Renal function is usually normal.

Medullary sponge kidney

Cystic Diseases of the Kidney ______ • On gross inspection, the papillary ducts in the medulla are dilated, and small cysts may be present.

Medullary sponge kidney

Cystic Diseases of the Kidney ______ • The cysts are lined by cuboidal epithelium or occasionally by transitional epithelium.

Medullary sponge kidney

Cystic Diseases of the Kidney ______ • This group of progressive renal disorders is characterized by variable number of cysts in the medulla, usually concentrated at the corticomedullary junction.

Nephronophthisis

Cystic Diseases of the Kidney ______ • Initial injury probably involves the distal tubules with tubular basement membrane disruption, followed by chronic and progressive tubular atrophy involving both medulla and cortex and interstitial fibrosis.

Nephronophthisis

Cystic Diseases of the Kidney ______ • Although the medullary cysts are important, the ______ is the cause of the eventual renal insufficiency.

Nephronophthisis, cortical tubulointerstitial damage

Cystic Diseases of the Kidney Nephronophthisis • Three variants of the nephronophthisis disease complex are recognized:

(1) sporadic, nonfamilial; (2) familial juvenile nephronophthisis (most common); and (3) renal-retinal dysplasia (15%) in which the kidney disease is accompanied by ocular lesions.

Cystic Diseases of the Kidney Nephronophthisis • Three variants of the nephronophthisis disease complex are recognized ______, nonfamilial

sporadic

Cystic Diseases of the Kidney Nephronophthisis • Three variants of the nephronophthisis disease complex are recognized ______ (most common)

familial juvenile nephronophthisis

Cystic Diseases of the Kidney Nephronophthisis • Three variants of the nephronophthisis disease complex are recognized ______ (______%) in which the kidney disease is accompanied by ocular lesions.

renal-retinal dysplasia, 15

Cystic Diseases of the Kidney ______ • ______ is a sporadic disorder that can be unilateral or bilateral and is often cystic.

Multicystic Renal Dysplasia, Dysplasia

Cystic Diseases of the Kidney ______ • The kidney is usually enlarged, extremely irregular, and multicystic The cysts vary in size from several millimeters to centimeters in diameter.

Multicystic Renal Dysplasia

Cystic Diseases of the Kidney ______ • On histologic examination, they are lined by flattened epithelium

Multicystic Renal Dysplasia

Cystic Diseases of the Kidney ______ • may be single or multiple and usually involve the cortex

Simple cysts

Cystic Diseases of the Kidney ______ • They are commonly 1 to 5 cm but may reach ______ cm or more in size.

Simple cysts, 10

Cystic Diseases of the Kidney ______ • They are translucent, lined by a gray, glistening, smooth membrane, and filled with clear fluid.

Simple cysts

Cystic Diseases of the Kidney ______ • On microscopic examination, these membranes are composed of a single layer of cuboidal or flattened cuboidal epithelium, which in many instances may be completely atrophic.

Simple cysts

Obstructive Uropathy, Urolithiasis ______ of the urinary tract increase susceptibility to infection and to stone formation, and unrelieved obstruction almost always leads to permanent renal atrophy, termed ______ or ______

Obstructive lesions, hydronephrosis, obstructive uropathy

Obstructive Uropathy, Urolithiasis (Obstructive lesions) common causes are as follows:

• Congenital anomalies: posterior urethral valves and urethral strictures, meatal stenosis, bladder neck obstruction; ureteropelvic junction narrowing or obstruction; severe vesicoureteral reflux • Urinary calculi • Benign prostatic hypertrophy • Tumors: carcinoma of the prostate, bladder tumors, contiguous malignant disease (retroperitoneal lymphoma), carcinoma of the cervix or uterus • Inflammation: prostatitis, ureteritis, urethritis, retroperitoneal fibrosis • Sloughed papillae or blood clots • Pregnancy • Uterine prolapse and cystocele • Functional disorders: neurogenic (spinal cord damage or diabetic nephropathy) and other functional abnormalities of the ureter or bladder (often termed dysfunctional obstruction)

Obstructive Uropathy, Urolithiasis ______ is the term used to describe dilation of the renal pelvis and calyces associated with progressive atrophy of the kidney due to obstruction to the outflow of urine

Hydronephrosis

Obstructive Uropathy, Urolithiasis Urolithiasis • Affects ______% to ______%

5, 10

Obstructive Uropathy, Urolithiasis Urolithiasis There are four main types of calculi:

(1) calcium stones (about 70%), composed largely of calcium oxalate or calcium oxalate mixed with calcium phosphate (2) another 15% are so-called triple stones or struvite stones, composed of magnesium ammonium phosphate (3) 5% to 10% are uric acid stones (4) 1% to 2% are made up of cystine.

Obstructive Uropathy, Urolithiasis Urolithiasis There are four main types of calculi • ______ (about ______%), composed largely of calcium oxalate or calcium oxalate mixed with calcium phosphate

calcium stones, 70

Obstructive Uropathy, Urolithiasis Urolithiasis There are four main types of calculi • another ______% are so-called ______ or ______, composed of magnesium ammonium phosphate

15, triple stones, struvite stones

Obstructive Uropathy, Urolithiasis Urolithiasis There are four main types of calculi • 5% to 10% are ______

uric acid stones

Obstructive Uropathy, Urolithiasis Urolithiasis There are four main types of calculi • 1% to 2% are made up of ______

cystine

______ • most common malignant tumor is ______, followed by ______, which is found in children and finally ______

NEOPLASMS, renal cell carcinoma, Wilms tumor, urothelial carcinoma of the calyces and pelves

Neoplasms BENIGN:

• Renal Papillary Adenoma • Angiomyolipoma • Oncocytoma

Neoplasms BENIGN ______ • Small, discrete adenomas arising from the renal tubular epithelium are found commonly (______% to ______%)

Renal Papillary Adenoma, 7, 22

Neoplasms BENIGN ______ • consists of vessels, smooth muscle, and fat originating from perivascular epithelioid cells.

Angiomyolipoma

Neoplasms BENIGN ______ • are present in ______% to ______% of patients with tuberous sclerosis, a disease caused by loss-of-function mutations in the TSC1 or TSC2 tumor suppressor genes.

Angiomyolipomas, 25, 50

Neoplasms BENIGN ______ • epithelial neoplasm composed of large eosinophilic cells having small, round, benign-appearing nuclei that have large nucleoli.

Oncocytoma

Neoplasms BENIGN ______ • It is thought to arise from the intercalated cells of collecting ducts, and accounts for approximately ______% to ______% of renal neoplasms

Oncocytoma, 5, 15

Neoplasms MALIGNANT:

• Renal Cell Carcinoma • Urothelial Carcinoma of the Renal Pelvis

Neoplasms MALIGNANT ______ • about 3% of all newly diagnosed cancers in the United States and account for 85% of renal cancers in adults

Renal Cell Carcinoma

Neoplasms MALIGNANT ______ • Tobacco is the most significant risk factor.

Renal Cell Carcinoma

Neoplasms MALIGNANT ______ • additional risk factors, including obesity (particularly in women); hypertension; unopposed estrogen therapy; and exposure to asbestos, petroleum products, and heavy metals.

Renal Cell Carcinoma

Neoplasms MALIGNANT Renal Cell Carcinoma • One of the striking characteristics of renal cell carcinoma is its tendency to invade the ______

renal vein

Neoplasms MALIGNANT Renal Cell Carcinoma • The classic clinical features of renal cell carcinoma are ______, ______, and ______, but all three are seen in only ______% of cases. (most reliable: ______)

costovertebral pain, palpable mass, hematuria, 10, hematuria

Neoplasms MALIGNANT Renal Cell Carcinoma • A particularly troublesome feature of renal cell carcinoma is its tendency to ______ widely before giving rise to any local symptoms or signs.

metastasize

Neoplasms MALIGNANT Renal Cell Carcinoma Classification of Renal Cell Carcinoma:

• Clear cell carcinoma • Papillary carcinoma • Chromophobe carcinoma • Xp11 translocation carcinoma • Collecting duct (Bellini duct) carcinoma

Neoplasms MALIGNANT Renal Cell Carcinoma Classification of Renal Cell Carcinoma ______ • most common type, accounting for ______% to ______% of renal cell cancers; made up of cells with clear or granular cytoplasm and are non papillary.

Clear cell carcinoma, 70, 80

Neoplasms MALIGNANT Renal Cell Carcinoma Classification of Renal Cell Carcinoma ______ • ______% to ______% of renal cancers. It is characterized by a papillary growth pattern and also occurs in both familial and sporadic forms

Papillary carcinoma, 10, 15

Neoplasms MALIGNANT Renal Cell Carcinoma Classification of Renal Cell Carcinoma ______ • ______% of renal cell cancers and is composed of cells with prominent cell membranes and pale eosinophilic cytoplasm, usually with a halo around the nucleus.

Chromophobe carcinoma, 5

Neoplasms MALIGNANT Renal Cell Carcinoma Classification of Renal Cell Carcinoma ______ • often occurs in young patients and is defined by translocations of the TFE3 gene located at Xp11.2 with a number of partner genes, all of which result in overexpression of the TFE3 transcription factor.

Xp11 translocation carcinoma

Neoplasms MALIGNANT Renal Cell Carcinoma Classification of Renal Cell Carcinoma ______ • The neoplastic cells consist of clear cytoplasm with a papillary architecture.

Xp11 translocation carcinoma

Neoplasms MALIGNANT Renal Cell Carcinoma Classification of Renal Cell Carcinoma ______ • ______% or less of renal epithelial neoplasms. They arise from collecting duct cells in the medulla

Collecting duct (Bellini duct) carcinoma, 1

Neoplasms MALIGNANT ______ • ______-______% primary renal tumors originate from the urothelium of the renal pelvis

Urothelial Carcinoma of the Renal Pelvis, 5, 10

Neoplasms MALIGNANT ______ • histologic examination, there are also foci of atypia or carcinoma in situ in grossly normal urothelium remote from the pelvic tumor

Urothelial Carcinoma of the Renal Pelvis

Neoplasms MALIGNANT Urothelial Carcinoma of the Renal Pelvis • There is an increased incidence of urothelial carcinomas of the renal pelvis in individuals with ______

Lynch syndrome