Kidney Pathology (Robbins Ed 8, Ch 20)

Front 1

Most common renal stone composition

Back 1

Calcium Oxalate (70%)

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True or false: most patients with calcium oxalate stones have hypercalcemia

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FALSE. Most do not

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Do uric acid and cystine stones tend to form in acidic or basic urine?

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Acidic

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Lung symptom seen with Goodpasture's

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Hemoptysis

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Amyloid deposition enlarging the kidneys?

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Multiple Myeloma

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"Wire loop" thickening of glomerular capillaries

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SLE

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Lens dislocation + kidney disease =

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Alport syndrome

Front 8

True or false: Hypertension almost always shows up in advanced renal destruction

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TRUE

Front 9

Age group and sex for urethral squamous cell carcinoma

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Older female

Front 10

Global dilation within the kidney usually results from?

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Hydronephrosis due to downstream obstruction

Front 11

Appearance of kidneys in benign nephrosclerosis

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Smaller with granular surfaces

Front 12

In IgA nephropathy (Berger's disease), initial episode of hematuria usually follows a ????

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URI

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Recurrent hematuria in young adult = ???

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IgA nephropathy (Berger's disease)

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Disease with co-morbidity for IgA nephropathy

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Celiac

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Type of antibody deposited in postinfectious glomerulonephritis

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IgG

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What is deposited in glomeruli in membranoproliferative glomerulonephritis?

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IgG + C3

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Usual outcome of poststreptococcal?

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Complete recovery w/o treatment (1% progress to rapid progressive glomerulonephritis)

Front 18

True or false: most uric acid stones are related to gout

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FALSE

Front 19

CBC abnormality with 5-10% of renal cell carcinoma

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Polycythemia (due to erythropoietin)

Front 20

Usual inheritence of Alport

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X-linked (autosomal recessive, dominant patterns do exist)

Front 21

Tubular epithelium foam cell are charcteristic of:

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Alport

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Genetic defect in Alport

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Mutation in alpha-5 chain of type IV collagen

Front 23

Dark urine + sensorineural hearing loss + corneal erosions

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Alport

Front 24

Name some drugs which can cause drug-induced interstitial nephritis

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Sulfonamides, penicillins, cephalosporins, floroquiniolones, anti-TB drugs, thizides, loop diuretics, H2 blockers, NSAIDS, and others

Front 25

Type of hypersensitivity with drug-induced interstitial nephritis

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Both type I (increased IgE) and type IV (skin test positivity)

Front 26

Likely cause of eosinophil in urine

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Drug induced interstitial nephritis

Front 27

Usual delay from use of drug to interstitial nephritis

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2 weeks

Front 28

Common cause of hemolytic-uremic syndrome

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Ingestion of verocytotoxin-producing E. Cole (usually O157:H7)

Front 29

Child eats meat then has dark urine/stool + glomerular thrombi. Dx?

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Hemolytic-uremic syndrome

Front 30

Child w/ nephrotic syndrome and NO other findings. Likely dx?

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Minimal change disease

Front 31

Alternate name for minimal change disease

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Lipoid nephrosis

Front 32

Variable basement membrane thickening is seen in?

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Alport

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Characteristic EM finding of minimal change disease

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Effacement/fusion of podocyte food processes

Front 34

IgG + C3 granular deposition and electron-dense subepithelial humps. Likely dx?

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Postinfectious

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Reason adult with postinfectious glomerularnephritis may have no infection hx

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Infectious was too mild to notice

Front 36

Postinfectious glomerulonephritis: worse outcome in kids or adults?

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Adults. 1 in 6 progress to chronic failure, kids almost all recover

Front 37

Effect of schistosomiasis on bladder

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Chronic inflammation and scarring

Front 38

Bladder outlet obstruction increases risk of?

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Infection (particularly E. Coli)

Front 39

Describe malacoplakia. What setting does it normally occur?

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Reaction to chronic bladder infection causes reduced macrophage function, which develop intracellelular concretions (Michaelis-Gutman bodies). Occurs in immunosupression.

Front 40

Typical causative organisms in malacoplakia

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E. Coli and Proteus

Front 41

Define: tubulorrhexis

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Rupture of tubular basement membrane

Front 42

Fibrinoid necrosis in kidney arterioles is typical of?

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Nakugbabt beogrisckerisus

Front 43

Name the three phases of acute tubular necrosis

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Initiation (1 day), maintenance, recovery

Front 44

Key features of maintenance phase of acute tubular necrosis

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Progressive oliguria, increasing BUN, salt/water overload

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Key features of recovery phase of acute tubular necrosis

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Stead increase in urine output (can be very high), hypokalemia

Front 46

Likely dx for painless hematuria in older adult

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Renal neoplasm

Front 47

Reason NSAID's decrease GFR

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Less prostaglandins = less afferent vasodilation

Front 48

UA findings with renal TB

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Sterile pyuria

Front 49

Presence of WBC casts means?

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Infection has gotten to kidney

Front 50

Classic lesions in diabetic nephropathy

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Nodular and diffuse glomerusclerosis

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Predictor of future nephropathy in type 1 diabetic

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Microalbuminuria

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Glomerular lesion seen with goodpastures

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Rapidly progressive glomerulonephritis

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C3 nephritic factor is present in

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Type II membranoproliferative glomerulonephritis (dense deposit disease)

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Alternate name for type II embranoproliferative glomerulonephritis

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Dense deposit disease

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Other organ possibly involved in autosomal-recessive PKD

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Liver

Front 56

Gene and encoded protein in ARPKD

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PKHD1, Fibrocystin

Front 57

Places PKHD1 is expressed

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Kidney, liver, pancreas

Front 58

Genes and encoded protein in ADPKD

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PKD1 and PKD2, Polycystin

Front 59

Most common renal cystic disease in fetus, infant

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Multicystic renal dysplasia (multicystic dysplastic kidney)

Front 60

Relative size of cysts in multicystic renal dysplasia

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Variable

Front 61

Easiest way to segregate ARPKD from multicystic renal dysplasia

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Liver involvement

Front 62

Pelvicaliceal dilation =

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Hydronephrosis

Front 63

Blunted calyces =

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Chronic pylenonephritis

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Most frequent cause of chronic pyelonephritis

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Reflux nephropathy

Front 65

Kidneys are shrunken, unequal with deep, irregular surface scars. Likely Dx?

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Chronic pyelonephritis

Front 66

Kidneys appearance in SLE nephritis

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Bilateral symmetric involvement, shrunken, finely granular

Front 67

Rash and decreased urine output after strep infection. Likely cause?

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Antibiotic sensitive (poststrep glomerulonephritis does not likely cause a rash)

Front 68

Most common renal neoplasm in children

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Wilms tumor

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Microscopic pattern of Wilms tumor

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Nephroblastoma (resembles fetal kidney nephrogenic zone)

Front 70

Renal cell carcinoma: adults or children

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Adults

Front 71

Transitional cell carcinoma: adult or child

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Adults

Front 72

Recurrent hematuria after a viral illness in child/young adult = ?

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IgA nephropathy

Front 73

Genetic defects in glomerular basement membrane structure = ?

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Hereditary nephritis

Front 74

Connection from bladder to umbilicus in child = ?

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Persistant urachus

Front 75

What is exstrophy?

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Lower abdomen wall does not develop, bladder has open defect

Front 76

Steroid responsive proteinuria in a child

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Minimal change disease

Front 77

Reason for name minimal change disease

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Kidney looks normal by light microscopy

Front 78

Most likely cause of foot process fusion in minimal change disease

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Injury to visceral epithelium by T cell derived cytokines

Front 79

Immune complex deposition in membranous glomerulopathy: steroid responsive?

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Nodular and diffuse glomerusclerosis

Front 80

Both postinfectious glomerulonephritis and membranous glomerulopathy can have IgG + C3 deposits. How can you differentiate?

Back 80

Postinfectious = electron dense subepithelial humps, membranous = diffuse basement membrane thickening

Front 81

Medullar sponge kidney: usually unilateral or bilateral?

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Bilateral in 70%

Front 82

Typical presenting age and symptoms of medullary sponge disease

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30's or 40's, can be stones (more than 50%), infections, or recurrent hematuria

Front 83

Small cysts in dilated collecting ducts = ?

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Medullary sponge disease

Front 84

Composition of staghorn calculi

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Magnesium ammonium phosphate

Front 85

Recurrent UTI with urea-splitting organisms (i.e. Proteus) can lead to formation of which stone?

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Staghorn (Magnesium ammonium phosphate)

Front 86

This stone is large and projects into calyces

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Staghorn (Magnesium ammonium phosphate)

Front 87

Necrotizing papillitis with paillary necrosis is a complicaiton of?

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Acute pyelonephritis

Front 88

Dz giving increased predisposition to papillary necrosis following acute pyelonophritis

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Diabetes

Front 89

Papillary necrosis can occur with long term use of?

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Analgesics

Front 90

Nephropathy occuring with AIDS resembles?

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Focal segmental glomerusclerosis

Front 91

Two infection that can cause membranous glomerulopathy

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Hepatitis, malaria (note 85% is still idiopathic)

Front 92

Exposure to arylamines (ex: aniline dyes, beta-naphthylamine) increases risk of?

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Bladder cancer (urothelial carcinoma)

Front 93

SLE: Nephritic or nephrotic syndrome?

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Nephritic

Front 94

RBC casts: nephritic or nephrotic?

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Nephritic

Front 95

Both thickening and thinning and glomerular basement membrane = ?

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Alport syndrome

Front 96

Oval fat bodies: nephritic or nephrotic?

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Nephrotic syndrome

Front 97

Likely cause of unexpected death in ADPKD

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Ruptured berry aneurysm (present in 10-30%)

Front 98

Cancer with increased risk in analgesic nephropathy patients

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Transitional cell carcinoma of renal pelvis

Front 99

Likely dx in patient with HTN, bilaterally small kidneys, and no significant history of symptoms

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Chronic glomerulonephritis - can develop insiduously w/o preceding acute episodes

Front 100

Type of antibody in goodpastures

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IgG

Front 101

Type of glomerular lesions in SLE

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Diffuse proliferative (more common) or crescentic (less common) glomerulonephritis

Front 102

Typical cause of hyaline arteriolosclerosis in kidneys

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Benign hypertension

Front 103

Urine finding in multiple myeloma? Why is this tricky for test questions?

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Bence Jones proteinuria. This is NOT detected by standard dipsticks

Front 104

"Stop sign" shaped crystals in urine

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Cysteinuria

Front 105

Type of casts seen in multiple myeloma

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Amorphous blue-to-pink casts

Front 106

Type of necrosis occuring in renal infarction

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Coagulative

Front 107

Cause of scattered petechial hemorrhage + edema in kidneys

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Hyperplastic arteriolosclerosis associated with malignant HTN

Front 108

Give the three types of crescentic glomerulonephritis

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Type I - Anti-GBM, Type II - Immune complex, Type III - neither

Front 109

Causes of type II crescentic glomerulonephritis

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SLE, Henoch-Schonlein purpura, postinfectious

Front 110

Causes of type III crescentic glomerulonephritis

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Wegener's granulomatosis, microscopic polyangiitis

Front 111

Renal complication in rheumatoid arthritis

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NONE

Front 112

Renal manifestation of chronic hypercalcemia (as with malignancy)

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Initial loss of concentrating ability followed by progressive loss of function

Front 113

Renal manifestation of Wegener granulomatosis

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Rapidly progressive (crescentic) glomerulonephritis

Front 114

Kidney problems + positive C-ANCA?

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Wegener's granulomatosis

Front 115

Alternate name for crescentic glomerulonephritis

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Rapidly progressive glomerulonephritis

Front 116

Membranous glomeruonephritis: more likely nephritic or nephrotic?

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Nephrotic

Front 117

Name the two distinctive vascular lesions of malignant HTN

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Necrotizing arteriolitis, hyperplastic arteriolosclerosis

Front 118

Two most likely causes of papillary necrosis

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Diabetic or analgesic nephropathy

Front 119

Focal segmental: presents with nephritic or nephrotic?

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Nephrotic

Front 120

Child with steroid-responsive nephrotic syndrome. Likely dx?

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Minimal change disease (lipoid nephrosis)

Front 121

Membranoproliferative glomerulonephritis: more likely nephritic or nephrotic?

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Nephritic

Front 122

Membranoproliferative glomerulonephritis: more likely adult or child?

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Adult

Front 123

Greatest risk factor for urothelial carcinoma of the bladder

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Smoking

Front 124

Schistosomiasis is a risk factor for which bladder cancer?

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Squamous cell

Front 125

Term used when sclerosis of many glomeruli is present with no clear cause

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Chronic glomerulonephritis

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Most often presenting age range for clear cell carcinoma

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60's or 70's

Front 127

Gene lost in 80% of sporadic clear cell carcinomas

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VHL

Front 128

Mutation associated with papillary variant of renal cell carcinoma

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MET gene (chromosome 7)

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Most common cause of nephrotic syndrome in adults

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Focal segmental glomerusclerosis

Front 130

Dysfunction of podocyte slit diaphragm apparatus is seen with which glomerular lesion?

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Focal segmental glomerusclerosis