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135 Cards in this Set

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Gross hematuria, Nephritic or Nephrotic?
NephrItic
Red Cell Casts, Nephritic or Nephrotic?
NephrItic
HTN, Nephritic or Nephrotic?
NephrItic
Caused by inflammatory diseases, Nephritic or Nephrotic?
NephrItic
Proteinuria, Nephritic or Nephrotic?
NephrOtic
Definition of Proteinuria
> 3.5 gm/24 hrs
Hypoalbuminemia, Nephritic or Nephrotic?
NephrOtic
Edema, Nephritic or Nephrotic?
NephrOtic
Hyperlipidemia, Hyperlipiduria, Nephritic or Nephrotic?
NephrOtic
Damage to visceral epithelial cell (podocytes), Nephritic or Nephrotic?
NephrOtic
Type of strep that causes APSG?
Group A Strep
Acute Poststreptococcal Glomerulonephritis, Nephritic or Nephrotic?
NephrItic
Subepithelial humps on EM
APSGN
Peripheral and periorbital edema
APSGN
Increased ASLO titers
APSGN
Serum antiDNase B high
APSGN
Crescent-moon shape
RP (Crescentic) GN
What are crescents?
proliferations of parietal epithelial cells of Bowman's capsule
Large, pale kidneys with petechiae
RPGN
RPGN, Nephritic or Nephrotic?
NephrItic
Hypercoaguable state, Nephritic or Nephrotic?
NephrOtic (small proteins like anticoagulants are lost first)
Membranous GN, Nephritic or Nephrotic?
NephrOtic
Granular deposits along the GBM
Membranous GN
Spike and Dome; subepithelial spike
Membranous GN
Pathogenesis of Membranous GN?
An-Ab mediated
Minimal Change Disease (Lipoid Nephrosis), Nephritic or Nephrotic?
NephrOtic
Homogenous, diffuse, linear pattern
Anti-GBM GN
classic subepithelial humps, but may also have subendothelial and itramembranous deposits
APSGN
Type I RPGN
anti-GBM w/ diffuse, linear deposits
Type II RPGN
IC mediated, lumpy bumpy, granular pattern
Type III RPGN
Pauci-Immune type; lack of IF staining
Severe oliguria
RPGN (Nephritic)
May be associated with atopy (eczema, rhinitis)
Minimal Change Disease
Normal glomeruli, no staining
Minimal Change
Associated with HIV, Heroin addiciton, Sickle cell and morbid obesity
FSGS
Most common cause of nephrotic syndrome in adults
FSGS
Foamy Lipid cells
Minimal change and FSGS
How do you make the Dx of FSGS?
Light Microscopy
HIV Nephropathy most common renal complication
FSGS
May be associated with atopy (eczema, rhinitis)
Minimal Change Disease
Normal glomeruli, no staining
Minimal Change
Associated with HIV, Heroin addiciton, Sickle cell and morbid obesity
FSGS
Most common cause of nephrotic syndrome in adults
FSGS
Dense Deposit Disease
Type 2 MPGN
Activation of the alternative complement pathway and normal complement pathway
Type 2 MPGN
Type of MPGN that occurs most often post transplant
Type 2 MPGN
Recurrent hematuria associated with URI
IgA Nephropathy (Berger Disease)
Henoch-Schonlein purpura
overlapping features iwth IgA Nephropathy
Mesangium association
IgA Nephropathy
Dx IgA Nephropathy
IF staining with IgA deposition
Diseases occuring most often post-transplantation
IgA, Membranous Proliferative (esp Type 2) and FSGS
Hypercoagulable state
NephrOtic
Uniform, diffuse thickening of capillary wall (looks like cheerios)
Membranous GN
90% if kids respond to coricosteriod therapy
Minimal Change
Adaptive response to loss of renal tissue
FSGS
Sclerosis caused by entrapped plasma proteins
FSGS
Proliferation of glomerular cells and leukocyte infiltration, and changes in the GBM
Memraboproliferative GN
Associated with chronic IC diseases like SLE, Hep, Endocarditis
Memraboproliferative GB
Possible T cell dysfunction and release of cytokines that damage the podocytes
Minimal Change
No renal failure, often no HTN
Minimal Change
Associated with hematopoietic malignancies
Membranous GN
How do you distinguish between Type 1 and 2 of Membranoproliferative GN?
IF, EM (Look the same microscopically!)
Large, hypercellular glomeruli with a lobular architecture and thickened GBM
Type 1 or 2 of Membranoproliferative GN (look the same microscopically)
Silver stains show "tram-track" or "double contour" due to mesangial cell interposition into the GBM
Membranoproliferative GN
Causes 2/3 of MPGN
Type 1
Type of MPGN with lots of complement staining
Type 1
Activation of classic and alternative complement pathways
Type 1 MPGN
Shows Granular C3 of IF ONLY
Type 2 MPGN
Type of MPGN with subendothelial deposits
Type 1
Dense deposits on EM; type of MPGN
Type 2
Lamina densa of the GBM is ribbon-like
Type 2 of MPGN
Tx of MPGN
steroids and immunosuppressive drugs are not helpful
Causes recurrent hematuria
IgA nephropathy (Berger Disesase)
Mesangial deposition of IgA
IgA Nephropathy
Name the 2 hereditary nephritis'
Alport and Thin membrane
Associated with nerve deafness, eye disorders
Alport
Which are affected most often in Alport?
Males (X-linked dominant)
Persistance of fetal like glomeruli
Alport
Foam cells present in what 3
minimal change, Alport and FSGS
Irregular thick and think GBM
Alport
Splitting of the lamina densa
Alport
What must the changes be in Alport?
Diffuse and widespread
Where is the mut in Alport?
Defective GBM synthesis, mut in the gene encoding the alpha 5 chain of type IV collagen
EM shows diffuse thinning of the GBM
Thin Membrane Disease (Benign Familial Hematuia)
RBC casts
Nephritic
WBC casts
Acute pyelo, AIN due to drugs, excludes a lower UTI
Renal tubular casts
ATN
Waxy or Broad casts
CRF
Hyaline casts
Proteinuria (insignificant in the absence of proteinuria)
Fatty casts with maltese crosses
nephrotic
Thick membranes
Membranous
Thick membranes and hypercellular
Membranoproliferative
What makes IF "lumpy bumpy"
if ICs are present (APSGN)
Loss of the negatively charged GBM
Minimal Change
Associated with IC diseases like SLE, Hep, Endocarditis
Membranoproliferative GN
CORRECT: Activation of classic and alternative Complement pathways
Type I MPGN
Globally hyalinized glomeruli
Chronic Glomerulonephritis
Purpuric skin lesions, ab pain, GI issues, IgA deposition in the mesangium
Henoch Schonlein purpura (Chronic GN)
> GFR and glomerular hypertrophy earlin in disease: cap BM thickening, diffuse mesangial sclerosis
Diabetic nephropathy
Capillary BM thickening detected by EM, diffuse mesangial sclerosis (AAteriole thickening too) and Nodular glomerulosclerosis (Hylaine masses at the periphery of the glom)
Diabetic Nephropathy
Ischemic or toxic injury to the tubules leads to what
ATN and ARF
Inlammatory reactions of the tubules and interstitium lead to what?
TIN
Morphology of ACUTE pyelo
Intratubular aggregates of PMNs and Tubular necrosis; papillary necrosis (Also seen in pts with diabetes and pts with obstruction)
Pelvocalyceal damage present
Chronic pyelo and analgesic nephropathy (Only ones that damage calyces)
Causes of chronic pyelo
Chronic reflux or obstruction (Does NOT have to have bacteria)
irregularly, asymmetric scars in the upper and lower poles of the kidney
Chronic Pyelo
Focal tubular atrophy with thyroidization (tubules filled with collloid casts)
Chronic Pyelo
Pts undergoing chemo are often given choltersine to prevent what?
Urate nephropathy (Tubulointerstitial disease)
What 3 things may cause Tubulointerstitial disease?
Urate nephropathy (chemo), Hypercalcemia/nephrocalcinosis, Multiple Myeloma
What do you see in benign nephrosclerosis
hyaline arteriosclerosis; suface of kidney has a fine, even granularity
Flea bitten kidney, fibrinoid necrosis with thrombosis, Onion skinning on silver stain of vessels
Malignant nephrosclerosis
What begins the path of TTP and HUS
endothelial damage that secrete large von Willebrand factor multimers induce agg
75% if childhood HUS is caused by what
e coli
Inherited deficiency of the complement regulatory protein Factor H
Familial HUS
Fever, neruo sx, hemolytic anemia, purpura; patchy r diffuse renal cortical necrosis
Idiopathic TTP
What is the defect in Idiopathic TTP?
ADAMTS-13, a protease that normally cleaves large von Willebrand multimers
Cortical necrosis with thickened glomeruli, deposits of fibrin in cap lumens, subendo & mesangium, fibrinoid necrosis of arterioles with thrmobi
Idiopathic TTP
Type of obstruction that presents with inability to concentrate the urine (polyuria and nocturia)
Bilateral partial
Type of obstruction that presents with anuria
Bilateral complete
Enlargement of the kidney, interstitial inflammation leading to fibrosis and tubular atrophy
obstruction of the kidney
MC stone
Calcium oxalate and phosphate
Struvite stones formed mainly after infections by urea splitting bacteria (Proteus and some staph)
Mg Ammonium Ph stones (bacteria convert urea to ammonia with resulting alkaline urine); can produce staghorn calculi (LARGE) stones in the renal pelvis
Name 2 benign renal tumors
Angiomyolipoma and Oncocytoma
Tumor composed of vessels, SM and fat; associated with tuberus sclerosis
Angiomyolipoma
AD syndrome associated with CNS and retinal hamartomas; associated with angiomyolipoma (benign)
Tuberus sclerosis
Mahogany brown tumor
Oncocytoma
EM shows abundant mito in cells; arise form CD
Oncocytoma (Benign)
Syndrome associated with RCC
Von-Hippel-Lindau (Hemangioblastomas of the cerebellum and retina)
Where is the defect in Von Hippel Lindau Syndrome? (Assoc with RCC)
VHL gene on chromo 3p25.3 (Normally a tumor suppressor gene that encodes for ubiquitin ligase complex)
Name the 2 types of RCC
Clear cell (MC) and Papillary
Losses of chromo 3p; Bright yellow tumor
Clear Cell RCC
Cuboidal cells with a papillary growth pattern and foam cells in papillary cores
Papillary RCC (NOT assoc with a 3p loss)
Where does RCC like to met?
IVC, lung (MC) and and bone (25% of pts will present with mets)
Why does RCC commonly cause paraneoplastic syndromes?
Overproduce erythropoietin and RBCs
What carcinoma does analgesic nephropathy put you at risk for?
Urothelial