renal pathology 2
Terms
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- What is prerenal azotemia?
- selective rise in BUN during early renal failure
- Define segmental. (kidney pathology)
- involving part of the glomerular tuft
- hematuria, hypertension, oliguria, azotemia = ?
- Nephritic Syndrome, "I" = inflammation
- LM findings in post-strep glomerulonephritis?
- lumpy bumpy and hypercellular w/ neutrophils
- EM findings in post-strep glomerulonephritis?
- subepithelial humps (from deposition of cationic antigen)
- IF findings in post-strep glomerulonephritis?
- granular
- Goodpasture's is what type of hypersensistivity?
- type II (IgG binding directly to BM)
- Goodpasture's IF?
- linear
- Symptoms of Goodpasture's?
- hemoptysis, hematuria
- Membranoproliferative glomerulonephritis EM?
- subendothelial humps; "tram track"
- Course of crescentic glomerulonephritis?
- rapid (the Red Crescent is the Islamic Red Cross, an organization that provides relief during emergencies, like crescentic glomerulonephritis)
- Course of Membranoproliferative glomerulonephritis?
- slow
- IgA nephropathy IF and EM?
- mesangial deposits of IgA (Mes"A"ngium)
- Which can be post infectious, IgA nephropathy or Goodpasture's?
- IgA nephropathy
- Signs of nephrotic syndrome?
- massive proteinuria, hypoalbuminemia, generalized edema, hyperlipidemia (think "erotic" = an erection(edema) and ejaculate(massive proteinuria)
- LM of membranous glomerulonephritis?
- diffuse capillary and basement membrane thickening
- IF of membranous glomerulonephritis?
- granular
- EM of membranous glomerulonephritis?
- spike and dome ("if you have a spike in your dome, you must be insane in the "membran"e," -Chirag)
- Minimal change disease EM?
- foot process effacement
- Most common cause of childhood nephrotic syndrome?
- minimal change disease
- Focal segmental glomerular sclerosis LM?
- segmental sclerosis and hyalinosis
- Diabetic nephropathy LM?
- Kimmelstiel-Wilson lesions
- SLE (5 patterns of renal involvement) LM?
- wire-loop appearance w/ extensive granular BM depsits in membranous glomerulonephritis pattern
- What is the most common kidney stone?
- Calcium (with either oxalate of phosphate)
- What kidney stone is associated with a bacterial infection?
- Ammonium magnesium phosphate (struivte) stones are associated with urase positive bugs that make ammonium
- What are the two most common stone-forming bacteria?
- proteus vulgaris and Staph.
- What stones are associated with gout?
- Uric acid stones
- What else can cause uric acid stones?
- Any disease with high cell turnover (remember that uric acid is a by-product of DNA formation), so leukemia and myeloproliferative disease
- What stones are associated with cystineuria?
- cystine stones
- What two stones are radiolucent?
- Uric acid and cystine (the two purely metabolic causes)
- What are the complications of stones?
- Hydronephrosis and pyelonephritis
- What causes calcium stones?
- Anything that increases calcium in the blood, so high PTH, malignancy (bone breakdown, PTH production), vitamin D overdose.
- Renal Cell Carcinoma: Is this a common renal cancer?
- Yes, the most common
- Renal Cell Carcinoma: Who is prone to this?
- males, ages 50-70, smokers, gene deletions on chromosome 3
- Renal Cell Carcinoma: This is a cancer of what cell type?
- renal tubule cells, histologically they appear clear.
- Renal Cell Carcinoma: What are the clinical signs of this cancer?
- flank pain, fever, hematuria, palpable mass, secondary polycythemia
- Renal Cell Carcinoma: How does it spread?
- It invades the renal veins and IVC, to spread hematogenously
- Renal Cell Carcinoma: What hormones can it produce?
- ACTH, prolactin, Parathyroid-like hormone, gonadotropins and renin.
- Wilm's Tumor: Who gets this cancer?
- Children 2-4 years
- Wilm's Tumor: Is it common?
- The most common renal cancer in children
- Wilm's Tumor: What is the chromosomal abnormality that leads to this?
- deletion of tumor suppressor gene WT1 on chromosome 11
- Wilm's Tumor: What tetrad is it associated with?
- WAGR - Wilm's, Anirida (lack of an iris), Genitourinary malformation, and Retardation
- Wilm's Tumor: How does it present?
- huge palpable mass and hemihypertrophy
- Wilm's Tumor: What is the histological appearance?
- mixed - with stromal, mesenchymal, tubular, glomerular and fibrous elements
- Transitional Cell Carcinoma: Where does this cancer occur?
- Urinary spaces (tract, calyces, pelvis, bladder)
- Transitional Cell Carcinoma: Does it recur?
- yes, often
- Transitional Cell Carcinoma: How does it spread?
- Local invasion
- Transitional Cell Carcinoma: What can predispose you to it?
- Pee SAC toxins - Phenacetin, Smoking, Aniline dye (benezenes), and Cyclophsophimide.
- Transitional Cell Carcinoma: How does it present?
- Hematuria