Goljan Renal Pathology Audio Lectures

Front 1

What are podocytes?

Back 1

visceral epithelial cells

Front 2

What are the spaces between the podocytes called?

Back 2

split pores

Front 3

Which cells synthesis the glomerular BM?

Back 3

visceral epithelial cells (podocytes)

Front 4

What keeps albumin out of urine?

Back 4

strong negative charge of Glomerular BM

Front 5

What is responsible for charge of GBM?

Back 5

Heparan Sulfate (strong negative charge)

Front 6

damage to visceral epithelial cell results in what?

Back 6

damage to BM and leaking of albumin into urine --> nephrotic syndrome

Front 7

linear pattern outlining BM on Immunofluorescence

Back 7

goodpasture syndrome

Front 8

subendothelial immune complex deposits in glomeruli on EM (granular)

Back 8

lupus

Front 9

subepithelial immune complex deposits in glomeruli EM (granular)

Back 9

post-strep glomerulonephritis

Front 10

only glomerulonephritis one can diagnose with IF

Back 10

IgA glomerulonephritis

Front 11

granular pattern on IF. what does it mean?

Back 11

immunocomplex type III disease

Front 12

anti BM antibodies is what type of immune complex disease?

Back 12

Type II

Front 13

RBC casts in urine is unique to what class of diseases

Back 13

nephritic syndromes

Front 14

serum ANA shows rim pattern. what does that mean?

Back 14

anti-DNA --> lupus

Front 15

crescentic glomerulonephritis is most commonly seen in what syndrome?

Back 15

goodpasture's syndrome

Front 16

cholesterol casts in urine that when polarized look like maltese crosses. what is the diagnosis?

Back 16

nephrotic syndrome

Front 17

why does lipoid nephrosis occur (Minimal change disease)?

Back 17

loss of negative charge of GBM

Front 18

Nephrotic syndrome associated with HIV

Back 18

FSGS

Front 19

glomerular problem in HBV

Back 19

diffuse membraneous glomerulonephritis

Front 20

glomerular problem in HCV

Back 20

Membranoproliferative glomerulonephritis

Front 21

vasculitis associated with HBV

Back 21

polyarteritis nodosa

Front 22

large golf-ball appearing glomeruli on H&E

Back 22

diabetic nephropathy

Front 23

what happens to the GFR and creatinine clearance in early diabetic nephropathy?

Back 23

hyalinization of efferent arterioles, so Cr clearance and GFR increase. Also nonenzymatic glycosylation of BM cause microalbuminuria

Front 24

ACE inhibitors do what to glomerular arterioles?

Back 24

less angiotensin II dilates efferent arteriole

Front 25

mesangial cells split BM on EM. C3 deposited adjacent to but not within dense deposits. serum C3 is very low. what is the diagnosis?

Back 25

Type II membranoproliferative glomerulonephritis

Front 26

properties of BUN

Back 26

blood urea nitrogen - secreted and reabsorbed in PCT

Front 27

properties of Creatinine

Back 27

end-product of creatine - only filtered in kidney, neither reabsorbed nor secreted in kidney (can be in other places in very high levels)

Front 28

normal BUN and Cr levels

Back 28

BUN - 9-10
Cr - 1 mg/dl

Front 29

normal BUN/Cr

Back 29

10

Front 30

pre-renal azotemia

Back 30

normal kidneys, but reduced Cardiac Output (e.g. CHF), ergo, GFR decreases. BUN/Cr >15

Front 31

renal failure (oliguria, renal tubular casts)

Back 31

affects BUN and Cr equally (increased BUN and Cr in equal proportion) BUN/Cr normal (10/1)

Front 32

most common cause of acute renal failure

Back 32

ischemic acute tubular necrosis

Front 33

Cardiac output decreases and oliguria, what do you worry about most?

Back 33

ischemic acute tubular necrosis

Front 34

most common cause of ischemic acute tubular necrosis

Back 34

not treating pre-renal azotemia

Front 35

BUN:Cr ~ 10:1 with oliguria and renal tubular casts

Back 35

acute tubular necrosis

Front 36

Why does acute tubular necrosis have such a bad diagnosis?

Back 36

ischemic cause also destroys basement membrane --> loss of structure --> can't regenerate renal tubular cell w/o BM. Even if one recovers, can never recover normal function

Front 37

What parts of nephron is most susceptible to ischemia?

Back 37

straight portion of proximal tubule and thick ascending limb (medullary part). Affects Na/K/Cl co-transport

Front 38

Nephrotoxic drugs...what are they and where do they affect? prognosis?

Back 38

gentamicin (aminoglycocides), dye from IV pyelograms; damages proximal tubule. prognosis good because they don't damage BM.

Front 39

How do you separate pyelonephritis from low UTIs?

Back 39

acute pyelonephritis is infection of kidney proper and has fever with flank pain (CVA tenderness) and WBC casts

Front 40

what is the mechanism of all UTIs

Back 40

ascending infection from introitus of urethra.

Front 41

scarred kidney with blunted calyces (beneath scarring)

Back 41

chronic pyelonephritis

Front 42

fever with rash, oliguria, eosinophiluria after starting drug

Back 42

acute drug-induced interstitial nephritis (methicillin)

Front 43

what kinds of hypersensitivity are associated with acute drug-induced interstitial nephritis?

Back 43

combination of type I and type IV hypersensitivities

Front 44

empty space on IV pyelogram

Back 44

analgesic nephropathy from acetaminophen and aspirin combo therapy long-term

Front 45

what is the mechanism of analgesic nephropathy?

Back 45

acetaminophen --> produces free radicals that damage tubular cells of medulla
aspirin blocks PGE2 so Angiotensin II is unopposed and peritubular capillaries have decreased blood flow causing ischemia in renal papillaries

Front 46

causes of renal papillary necrosis

Back 46

aspirin/acetaminophen long-term, diabetes, sickle-cell disease, acute pyelonephritis (from abscess formation)

Front 47

BUN/Cr >10 for more than 3 months. what is the diagnosis?

Back 47

Chronic renal failure

Front 48

results of chronic renal failure

Back 48

anemia, anion-gap metabolic acidosis, osteoporosis, osteomalacia, secondary hyperparathyroidism

Front 49

uncontrolled essential hypertension (over ten years) causes what?

Back 49

nephrosclerosis --> hyaline arteriolosclerosis (cobblestone appearance of kidney)

Front 50

person with uncontrolled HTN, wakes up with bad HA, dizzy, blurred vision, BP 240/140, papilledema and flamed hemorrhages, hard and soft exudates, BUN/Cr 80/8. what is diagnosis?

Back 50

malignant hypertension (shows petechia visible on surface of kidney)

Front 51

Treatment of malignant hypertension?

Back 51

IV nitroprusside

Front 52

pale, depressed-looking lesions on gross examination of kidney. what do you see on LM?

Back 52

pale infarction --> coagulation necrosis

Front 53

causes of pale infarcts in kidneys in a patient with irregular irregular pulse?

Back 53

A-fib, causes thromboemboli

Front 54

little white dots and microabscesses on gross exam of kidneys probably caused by what?

Back 54

pyelonephritis

Front 55

hydronephrosis and increased pressure have what affect on renal cortex and medulla?

Back 55

compression atrophy

Front 56

staghorn calculi, alkaline urine and smells of ammonia, what is the cause?

Back 56

urease (+) bacteria: proteus, klebsiella, staph

Front 57

most common cause of compression atrophy?

Back 57

stone

Front 58

what is the composition of staghorn calculi

Back 58

magnesium ammonium phosphate

Front 59

mass in kidney adult what is it?

Back 59

renal adenocarcinoma

Front 60

mass in kidney in kid with hypertension?

Back 60

wilm's tumor

Front 61

cause of renal adenocarcinoma?

Back 61

derived from proximal tubule; most common cause is smoking

Front 62

what are results of renal adenocarcinoma?

Back 62

produce ectopic EPO, PTH-like peptide, and like to invade renal vein

Front 63

why hypertension in kid with Wilm's tumor?

Back 63

the tumor makes renin

Front 64

findings in Wilm's tumor?

Back 64

embryonic kidney structures; aniridia and hemi-hypertrophy of an extremity --> sign that Wilm's tumor has genetic basis

Front 65

genetic abnormality in Wilm's tumor?

Back 65

WT-1 tumor-suppressor gene on chrom 11. AD

Front 66

most common organism in cystitis?

Back 66

E. coli

Front 67

patient with increased urinary frequency, has positive leukocyte esterase, dysuria, neutrophils in urine, negative bacterial culture, negative nitrites. what is diagnosis?

Back 67

Chlamydia

Front 68

causes of sterile pyuria?

Back 68

chlamydia, TB

Front 69

most common cause of transitional cell carcinoma of bladder?

Back 69

smoking

Front 70

cyclophosphamide is used to treat what?

Back 70

Wegener's

Front 71

cyclophosphamide toxicity is prevented by what?

Back 71

Mesna

Front 72

hypospadias is caused by what?

Back 72

failure of closure of urethral folds

Front 73

most common cancer of penis is what? What is most common cause?

Back 73

squamous cell carcinoma due to lack of hygiene in uncircumcised penis. (shmegma)

Front 74

what are two phases of testicular descent?

Back 74

tans-abdominal migration caused by mullerian inhibitory factor, and shortening of gubernaculum due to testosterone and dihydrotestosterone

Front 75

undescended testicles before 2 years increased risk for what?

Back 75

seminomas in both testicles (even if appears normal)

Front 76

streak ovaries put woman at risk for what?

Back 76

dysgerminomas

Front 77

epididymitis at age <35 due to what?

Back 77

neisseria gonorrhea, chlamydia

Front 78

epididymitis at ages >35 due to what?

Back 78

pseudomonas, E. coli

Front 79

vericocoeles on what side and why?

Back 79

left, due to the spermatic vein on left is connected to left renal vein.

Front 80

most common cause of male infertility

Back 80

vericocoele

Front 81

what would happen if you block left renal vein?

Back 81

increases pressure on spermatic vein and causes vericocoele.

Front 82

torsion of spermatic cord causes what?

Back 82

shortens the cord, so the testicle ascends into inguinal canal; pain; loss of cremasteric reflex

Front 83

what is cremasteric reflex?

Back 83

scratching of scrotum causes the cremaster muscle to contract

Front 84

hydrocoele is what?

Back 84

persistence of tunica vaginalis

Front 85

painless enlargement of testicle has what on it's differential?

Back 85

cancer, cancer, cancer, cancer

Front 86

most common cause of testicular cancer

Back 86

seminoma --> highly responsive to radiation

Front 87

where do seminomas metastacize?

Back 87

para-aortic LNs

Front 88

most common testicular tumor in kid? what's the tumor marker?

Back 88

yolk sac tumor (Alpha fetoprotein)

Front 89

25 y/o male presents with unilateral gynecomastia and dyspnea. X-ray of lung shows numerous nodular masses. Where is the primary tumor and what kind?

Back 89

choriocarcinoma of testicle

Front 90

why do choriocarcinomas develop gynecomastia?

Back 90

B-HCG is a leutinizing hormone analog --> acts like leutenizing hormone, so stimulates progesterone and causes duct growth in breast tissue

Front 91

most common cause of testicular cancer in older men?

Back 91

malignant lymphoma metastaces

Front 92

where in prostate gland does hyperplasia occur?

Back 92

periurethral area

Front 93

where in prostate gland is cancer located?

Back 93

periphery (that's why you can feel it with your finger on rectal)

Front 94

75 y/o man has urinary retention and massive bladder with dribbling urine. what is cause?

Back 94

BPH.

Front 95

what hormone is totally responsible for prostate?

Back 95

dihydrotestosterone

Front 96

BPH and prostate cancer is under the control of what hormone?

Back 96

dihydrotestosterone

Front 97

how do you treat prostate cancer and BPH

Back 97

5-alpha-reductase inhibitor

Front 98

most common cancer in men?

Back 98

prostate cancer