Fa: Renal - Pathology - 1

Front 1

What does it tell you if there are casts in the urine?

Back 1

Hematuria / pyuria is of renal origin (vs bladder if there are no casts)

Front 2

What are the types of casts that can be present in the urine?

Back 2

- RBC casts
- WBC casts
- Fatty casts ("oval fat bodies")
- Granular ("muddy brown") casts
- Waxy casts
- Hyaline casts

Front 3

What can RBC casts in the urine indicate?

Back 3

- Glomerulonephritis
- Ischemia
- Malignant hypertension

Front 4

What can WBC casts in the urine indicate?

Back 4

- Tubulointerstitial inflammation
- Acute pyelonephritis
- Transplant rejection

Front 5

What can fatty casts ("oval fat bodies") in the urine indicate?

Back 5

Nephrotic syndrome

Front 6

What can granular ("muddy brown") casts in the urine indicate?

Back 6

Acute Tubular Necrosis

Front 7

What can waxy casts in the urine indicate?

Back 7

Advanced renal disease / chronic renal failure

Front 8

What can hyaline casts in the urine indicate?

Back 8

Non-specific, can be a normal finding, often seen in concentrated urine samples

Front 9

What can hematuria without casts in the urine indicate?

Back 9

- Bladder cancer
- Kidney stones

Front 10

What can pyuria (pus) with no casts in the urine indicate?

Back 10

Acute Cystitis

Front 11

What terms can be used to describe glomerular disorders?

Back 11

- Focal vs Diffuse
- Proliferative
- Membranous
- 1° Glomerular disease
- 2° Glomerular disease

Front 12

What does the term "focal" mean when naming a glomerular disorder? Example?

Back 12

<50% of glomeruli are involved
- Eg: focal segmental glomerulosclerosis

Front 13

What does the term "diffuse" mean when naming a glomerular disorder? Example?

Back 13

>50% of glomeruli are involved
- Eg: diffuse proliferative glomerulonephritis

Front 14

What does the term "proliferative" mean when naming a glomerular disorder? Example?

Back 14

Hypercellular glomeruli
- Eg: Mesangial Proliferative

Front 15

What does the term "membranous" mean when naming a glomerular disorder? Example?

Back 15

Thickening of the glomerular basement membrane
- Eg: Membranous Nephropathy

Front 16

What does the term "1° Glomerular Disease" tell you about the glomerular disorder? Example?

Back 16

Involves only glomeruli, thus a 1° disease of the kidney
- Eg: minimal change disease

Front 17

What does the term "2° Glomerular Disease" tell you about the glomerular disorder? Example?

Back 17

Involves glomeruli and other organs, thus a disease of another organ system, or a systemic disease that has impact on the kidney
- Eg: SLE and diabetic nephropathy

Front 18

What are the types of glomerular diseases?

Back 18

- Nephritic Syndrome
- Nephrotic Syndrome
- Both

Front 19

What are the types of Nephritic Syndromes?

Back 19

- Acute Post-Streptococcal Glomerulonephritis
- Rapidly Progressive Glomerulonephritis
- Berger Disease (IgA Glomerulonephropathy)
- Alport Syndrome

*Note that the classic nephritic disorders can exhibit some nephrotic features

Front 20

What are the types of Nephrotic Syndromes?

Back 20

- Focal Segmental Glomerulosclerosis
- Membranous Nephropathy
- Minimal Change Disease
- Amyloidosis
- Diabetic Glomerulonephropathy

Front 21

What are the types of glomerular diseases that are characterized as both Nephritic and Nephrotic Syndromes?

Back 21

- Diffuse Proliferative Glomerulonephritis
- Membranoproliferative Glomerulonephritis

Front 22

What makes a renal disease a "Nephrotic syndrome"?

Back 22

- Massive Pr"O"teinuria (>3.5 g/day, frothy urine)
- Hyperlipidemia
- Fatty casts
- Edema

Front 23

What are Nephrotic Syndromes associated with? Why?

Back 23

- Thromboembolism (hypercoagulable state d/t AT III loss in urine)
- Increased risk of infection (due to loss of immunoglobulins)

Front 24

Which type of nephrotic syndrome is associated with the following LM findings: segmental sclerosis and hyalinosis?

Back 24

Focal Segmental Glomerulosclerosis

Front 25

Which type of nephrotic syndrome is associated with the following LM findings: diffuse capillary and GBM thickening?

Back 25

Membranous Nephropathy

Front 26

Which type of nephrotic syndrome is associated with the following LM findings: normal glomeruli (lipid may be seen in PCT cells)?

Back 26

Minimal Change Disease (Lipoid Nephrosis)

Front 27

Which type of nephrotic syndrome is associated with the following LM findings: congo red stain shows apple-green birefringence under polarized light?

Back 27

Amyloidosis

Front 28

Which type of nephrotic syndrome is associated with the following LM findings: mesangial expansion, GBM thickening, and eosinophilic nodular glomerulosclerosis (Kimmelstiel-Wilson lesion)?

Back 28

Diabetic Glomerulonephropathy

Front 29

Which type of nephrotic syndrome is associated with the following LM findings: thickened "tram tracks"?

Back 29

Membrano-Proliferative Glomerulonephritis (Type 1)
- Left: PAS stain
- Right: H&E stain

Front 30

Which type of nephrotic syndrome is associated with the following EM findings: effacement of foot processes?

Back 30

- Focal Segmental Glomerulosclerosis
- Minimal Change Disease (Lipoid Nephrosis) = picture

Front 31

Which type of nephrotic syndrome is associated with the following EM findings: "spike-and-dome" appearance with subepithelial deposits?

Back 31

Membranous Nephropathy

Front 32

Which type of nephrotic syndrome is associated with the following immunofluorescence findings: granular as a result of immune complex deposition?

Back 32

Membranous Nephropathy

Front 33

What is the most common cause of nephrotic syndrome in African Americans and Hispanics?

Back 33

Focal Segmental Glomerulosclerosis

Front 34

What is the most common cause of nephrotic syndrome in Caucasian adults?

Back 34

Membranous Nephropathy

Front 35

What is the most common cause of nephrotic syndrome in children?

Back 35

Minimal Change Disease (Lipoid Nephrosis)

Front 36

Which type of nephrotic syndrome is associated with HIV infection?

Back 36

Focal Segmental Glomerulosclerosis

Front 37

Which type of nephrotic syndrome is associated with sickle cell disease?

Back 37

Focal Segmental Glomerulosclerosis

Front 38

Which type of nephrotic syndrome is associated with heroin abuse?

Back 38

Focal Segmental Glomerulosclerosis

Front 39

Which type of nephrotic syndrome is associated with massive obesity?

Back 39

Focal Segmental Glomerulosclerosis

Front 40

Which type of nephrotic syndrome is associated with interferon treatment?

Back 40

Focal Segmental Glomerulosclerosis

Front 41

Which type of nephrotic syndrome is associated with chronic kidney disease due to congenital absence or surgical removal?

Back 41

Focal Segmental Glomerulosclerosis

Front 42

How do you treat Focal Segmental Glomerulosclerosis? Efficacy? Prognosis?

Back 42

- Inconsistent response to steroid therapy
- May progress to chronic renal disease

Front 43

What type of disease is Focal Segmental Glomerulosclerosis? What changes occur in this disease?

Back 43

Nephrotic Syndrome:
- Segmental sclerosis and hyalinosis
- Effacement of foot processes similar to in minimal change disease

Front 44

Which type of nephrotic syndrome is associated with antibody to phospholipase A2 receptor?

Back 44

Membranous Nephropathy

Front 45

Which type of nephrotic syndrome is associated with drugs like NSAIDs and penicillamine?

Back 45

Membranous Nephropathy

Front 46

Which type of nephrotic syndrome is associated with infections like HBV and HCV?

Back 46

Membranous Nephropathy

Front 47

Which type of nephrotic syndrome is associated with Systemic Lupus Erythematosus?

Back 47

Membranous Nephropathy

Front 48

Which type of nephrotic syndrome is associated with solid tumors?

Back 48

Membranous Nephropathy

Front 49

How do you treat Membranous Nephropathy? Efficacy? Prognosis?

Back 49

- Poor response to steroid therapy
- May progress to chronic renal disease

Front 50

What type of disease is Membranous Nephropathy? What changes occur in this disease?

Back 50

Nephrotic Syndrome
- Diffuse capillary and GBM thickening
- Granular immunofluorescence as a result of immune complex deposition
- "Spike and dome" appearance on EM with subepithelial deposits

Front 51

Which type of nephrotic syndrome may be triggered by a recent infection, immunization, or other immune stimulus?

Back 51

Minimal Change Disease (Lipoid Nephrosis)

Front 52

Which type of nephrotic syndrome is associated with Hodgkin Lymphoma (eg, cytokine-mediated damage)?

Back 52

Minimal Change Disease (Lipoid Nephrosis)

Front 53

How do you treat Minimal Change Disease (Lipoid Nephrosis)? Efficacy? Prognosis?

Back 53

Excellent response to corticosteroids

Front 54

What type of disease is Minimal Change Disease (Lipoid Nephrosis)? What changes occur in this disease?

Back 54

Nephrotic Syndrome:
- Normal glomeruli (lipid may be seen in PCT cells)
- Effacement of foot processes

Front 55

Which type of nephrotic syndrome is associated with chronic conditions like multiple myeloma, TB, or Rheumatoid arthritis?

Back 55

Amyloidosis

Front 56

Amyloidosis most commonly affects what organ?

Back 56

Kidney is the most common organ involved in systemic amyloidosis

Front 57

What type of disease is Amyloidosis that affects the kidney? How do you make diagnosis?

Back 57

Nephrotic Syndrome
- Congo red stain shows apple-green birefringence under polarized light

Front 58

What are the types of membrano-proliferative glomerulonephritis?

Back 58

- Type I: subendothelial immune complex (IC) deposits with granular immunofluorescence - "tram-track" appearance
- Type II: intramembranous IC deposits - "dense deposits"

Front 59

Which type of nephrotic syndrome is associated with HBV and HCV? What type of deposits? Appearance?

Back 59

Type I Membrano-Proliferative Glomerulonephritis
- Subendothelial immune complex (IC) deposits
- Granular IF
- "Tram-track" appearance due to GBM splitting caused by mesangial ingrowth

Front 60

Which type of nephrotic syndrome is associated with C3 nephritic factor? Function? What type of deposits are seen in this type of nephrotic syndrome?

Back 60

Type II Membrano-Proliferative Glomerulonephritis
- C3 nephritic factor stabilizes C3 convertase → ↓ serum C3 levels
- Intramembranous immune complex (IC) deposits
- "Dense deposits"

Front 61

What type of renal disease is Membrano-Proliferative Glomerulonephritis?

Back 61

Nephritic syndrome that can also present with nephrotic syndrome

Front 62

What causes the renal damage in Diabetic Glomerulonephropathy?

Back 62

- Non-enzmatic glycosylation of GBM → ↑ permeability, thickening
- Non-enzymatic glycosylation of efferent arterioles → ↑ GFR → mesangial expansion

Front 63

What type of disease is Diabetic Nephropathy? What changes occur in this disease?

Back 63

Nephrotic Syndrome
- Mesangial expansion
- GBM thickening
- Eosinophilic nodular glomerulosclerosis (Kimmelstiel-Wilson lesion)

Front 64

What makes a renal disease a "Nephritic syndrome"?

Back 64

"I"nflammatory process
- When it involves glomeruli, it leads to hematuria and RBC casts in the urine
- Associated with azotemia (abnormally high levels of nitrogen-containing compounds in blood), oliguria, hypertension (d/t salt retention), and proteinuria (<3.5 g/day)

Front 65

How do Nephrotic Syndromes and Nephritic Syndromes compare in terms of the proteinuria?

Back 65

- Nephrotic Syndrome: >3.5 g/day
- Nephritic Syndrome: <3.5 g/day

Front 66

How do Nephrotic Syndromes and Nephritic Syndromes compare in terms of the urine casts?

Back 66

- Nephrotic Syndrome: fatty casts
- Nephritic Syndrome: RBC casts

Front 67

Which type of nephritic syndrome is associated with the following LM findings: glomeruli enlarged and hypercellular?

Back 67

Acute Post-Streptococcal Glomerulonephritis

Front 68

Which type of nephritic syndrome is associated with the following LM findings: crescent-moon-shape consisting of fibrin and plasma proteins (eg, C3b) with glomerular parietal cells, monocytes, and macrophages?

Back 68

Rapidly Progressive (Crescentic) Glomerulonephritis (RPGN)

Front 69

Which type of nephritic syndrome is associated with the following LM findings: wire looping of capillaries?

Back 69

Diffuse Proliferative Glomerulonephritis (DPGN)

Front 70

Which type of nephritic syndrome is associated with the following LM findings: mesangial proliferation?

Back 70

IgA Nephropathy (Berger Disease)

Front 71

Which type of nephritic syndrome is associated with the following EM findings: subepithelial immune complex (IC) humps?

Back 71

Acute Post-Streptococcal Glomerulonephritis

Front 72

Which type of nephritic syndrome is associated with the following EM findings: subendothelial and sometimes intramembranous IgG based immune complexes often with C3 deposition?

Back 72

Diffuse Proliferative Glomerulonephritis (DPGN)

Front 73

Which type of nephritic syndrome is associated with the following EM findings: mesangial immune complex deposits?

Back 73

IgA Nephropathy (Berger Disease)

Front 74

Which type of nephritic syndrome is associated with the following immunofluorescence findings: "starry sky" granular appearance ("lumpy-bumpy) due to IgG, IgM, and C3 deposition along GBM and mesangium?

Back 74

Acute Post-Streptococcal Glomerulonephritis

Front 75

Which type of nephritic syndrome is associated with the following immunofluorescence findings: crescent-moon-shape consisting of fibrin and plasma proteins (eg, C3b) with glomerular parietal cells, monocytes, and macrophages?

Back 75

Rapidly Progressive (Crescentic) Glomerulonephritis (RPGN)

Front 76

Which type of nephritic syndrome is associated with the following immunofluorescence findings: granular?

Back 76

Diffuse Proliferative Glomerulonephritis (DPGN)

Front 77

Which type of nephritic syndrome is associated with the following immunofluorescence findings: IgA based immune complex deposits in mesangium?

Back 77

IgA Nephropathy (Berger Disease)

Front 78

What type of renal pathology is Acute Post-Streptococcal Glomerulonephritis? Who is more likely to have this kind of damage? Cause?

Back 78

Nephritic Syndrome
- Most frequently in children
- Occurs ~2 weeks after group A streptococcal infection of pharynx or skin; type III hypersensitivity reaction
- Resolves spontaneously

Front 79

What type of reaction mediates Acute Post-Streptococcal Glomerulonephritis?

Back 79

Type III Hypersensitivity reaction (antigen-antibody complexes) to group A streptococcal infection of pharynx or skin

Front 80

What renal pathology presents with peripheral and periorbital edema, dark urine (cola-colored), and hypertension? What lab values would you check?

Back 80

Acute Post-Streptococcal Glomerulonephritis:
- ↑ Anti-DNase B titers
- ↓ Complement levels

Front 81

What type of renal pathology is Rapidly Progressive Glomerulonephritis (RPGN)? What disease processes may result in this pattern?

Back 81

Nephritic Syndrome:
- Goodpasture Syndrome
- Granulomatosis with Polyangiitis (Wegener)
- Microscopic Polyangiitis

Front 82

What type of renal pathology is caused by Goodpasture Syndrome? What findings are associated with this syndrome?

Back 82

Rapidly Progressive Glomerulonephritis (RPGN)
- Type II hypersensitivity (antibodies produced by the immune response bind to antigens on the patient's own cells)
- Abs to GBM and alveolar basement membrane → linear immunofluorescence
- Presents with hematuria and hemoptysis

Front 83

What type of renal pathology is caused by Granulomatosis with Polyangiitis (Wegener)? What findings are associated with this syndrome?

Back 83

Rapidly Progressive Glomerulonephritis (RPGN)
- PR3-ANCA / c-ANCA

Front 84

What type of renal pathology is caused by Microscopic Polyangiitis? What findings are associated with this syndrome?

Back 84

Rapidly Progressive Glomerulonephritis (RPGN)
- MPO-ANCA / p-ANCA

Front 85

What is the prognosis for Rapidly Progressive Glomerulonephritis (RPGN)?

Back 85

- Poor prognosis
- Rapidly deteriorating renal function (days to weeks)

Front 86

What is the most common cause of death in patient with SLE? What type of pathology is this?

Back 86

Diffuse Proliferative Glomerulonephritis (DPGN)
- Can present as nephrotic syndrome and nephritic syndrome concurrently

Front 87

Which type of renal pathology often presents or flares with a URI or acute gastroenteritis? Signs?

Back 87

IgA Nephropathy (Berger Disease) = Nephritic Syndrome
- Episodic hematuria with RBC casts

Front 88

Which type of renal pathology is caused by a mutation in type IV collagen? Implications?

Back 88

Alport Syndrome = Nephritic Syndrome
- Thinning and splitting of glomerular BM
- Presents with glomerulonephritis, deafness, and less commonly, eye problems

Front 89

What is the cause of Alport Syndrome?

Back 89

- Mutation in type IV collagen → thinning and splitting of glomerular BM
- Most commonly X-linked

Front 90

Which type of renal pathology presents with glomerulonephritis, deafness, and less commonly eye problems?

Back 90

Alport Syndrome

Front 91

What type of disease is Acute Post-Streptococcal Glomerulonephritis? What changes occur in this disease?

Back 91

Nephritic Syndrome
- Glomeruli enlarge and become hypercellular
- IgG, IgM, and C3 deposition along GBM and mesangium leads to "Starry sky" granular appearance ("lumpy-bumpy) on immunofluorescence
- Subepithelial immune complex (IC) humps

Front 92

What type of disease is Rapidly Progressive Glomerulonephritis? What changes occur in this disease?

Back 92

Nephritic Syndrome
- Crescent-moon shape consists of fibrin and plasma proteins (eg, C3b) with glomerular parietal cells, monocytes, and macrophages

Front 93

What type of disease is Diffuse Proliferative Glomerulonephritis (DPGN)? What changes occur in this disease?

Back 93

Nephritic Syndrome
- "Wire looping" of capillaries
- Subendothelial and sometimes intramembranous IgG-based immune complexes, often with C3 deposition
- Granular appearance on immunofluorescence

Front 94

What type of disease is IgA Nephropathy? What changes occur in this disease?

Back 94

Nephritic Syndrome
- Mesangial proliferation
- Mesangial immune complex deposits
- IgA based immune complex deposits in mesangium
- Seen with Henoch-Schönlein purpura

Front 95

What type of disease is Alport syndrome? What changes occur in this disease?

Back 95

Nephritic Syndrome
- Glomerulonephritis - thinning and splitting of glomerular BM
- Deafness
- Eye problems (less commonly)