Pathology - S2B2 - Kidney 1

Front 1

Outer zone of the kidney that contains Glomeruli and Tubules

Back 1

Cortex

Front 2

Part of Kidney that contains tubules, loops of henle, and collecting ducts

Back 2

Medulla

Front 3

Blood enters the glomerulus through the __1__ and exits through the __2__

Back 3

1. Afferent arteriole

2. Efferent arteriole

Front 4

What do Afferent arterioles originate from?

Back 4

Interlobular arteries

**which originate from Larger Lobar and Arcuate Arteries

Front 5

What is another name for Visceral Epithelial Cells of the Glomerulus?

Back 5

Podocytes which have foot processes

Front 6

Describe the Endothelial Cells of the Glomerulus

Back 6

Form the capillary and are FENESTRATED, allowing filtration of plasma

Front 7

Where are Mesangial Cells located?

Back 7

central portion of the Glomerulus in the area where several loops meet; they are surrounded on all sides by mesangial matrix

Front 8

Modified smooth muscle cells in the media of the Afferent arteriole that secrete Renin

Back 8

Juxtaglomerular Cells

**Renin converts Angiotensin I -> Angiotensi II --> Vasoconstriction --> Aldosterone secretion from Adrenal Cortex = increased Sodium and Water reabsorption in distal tubules

Front 9

Cells of the distal tubule near the afferent arteriole; sense Sodium concentration in the tubule fluid; provide first impulse for the secretion of Renin

Back 9

Macula Densa

Front 10

Contractile and phagocytic cells of the Glomerulus

Back 10

Mesangial cells

Front 11

This is the most common form of Acute Renal Failures

What is the cause?
What pathology is seen?

Back 11

Prerenal Failure

Hypoperfusion
-Heart failure
-Shock from surgery
-Trauma

Tubular Necrosis

Front 12

What are the 4 causes of Renal Failure?

Back 12

1. Glomerular disease due to Acute Glomerulonephritis
2. Tubulointerstitial Nephritis due to a drug reaction
3. Vasculitis due to Wegener Granulomasotis
4. Toxic tubular necrosis due to Mercury poisoning

Front 13

What are 4 causes of Postrenal Failure?

Back 13

1. Intratubular obstruction due to Acute Urate Nephropathy
2. Renal-pelvic obstruction due to Nephrolithiasis
3. Ureteric obstruction due to Urinary stones
4. Bladder/Urethral obstruction due to Prostatic hyperplasia

Front 14

What are the 4 progessive steps to Chronic Renal Failure?

Back 14

1. Diminished Renal Reserve
2. Renal Insufficiency
3. Renal Failure
4. End-stage Renal Failure

Front 15

GFR that is 50% of normal

Back 15

Diminished Renal Reserve

Front 16

List the characteristics of Renal Insufficiency

Back 16

1. GFR 30-50% of normal fxn
2. Azotemia = elevated blood nitrates (BUN & Creatinine)
3. Anemia = decreased EPO release = Normocytic, Normochromic
4. HTN
5. Reduced concentrating capacity

Front 17

List the characteristic of Renal Failure

Back 17

1. GFR 20-25% of normal
2. Kidney cannot regulate solutes and fluid volume
3. Edema
4. Metabolic Acidosis

Front 18

What are the characteristics of End-stage Renal Disease?

Back 18

Uremia

GFR is less than 5% of normal

Front 19

List the features of Uremia

Back 19

1. Fluid and Electrolyte abnormalities = edema, acidosis, K+ increases
2. Phosphate increases and cannot be excreted = causes Ca+ imbalance = Hypercalcemia -> Parathyroid stimulation to secrete PTH -> Secondary Hyperparathyroidism
3. Bleeding time is prolonged due to abnormal platelets
4. GI effects = NVD, esophagitis, gastritis, colitis
5. Neuromuscular disorders -> Hypercalcemia = impulses cannot be transmitted b/c of imbalance b/w free and IC Ca+

Front 20

Describe Potter Syndrome

Back 20

Renal agenesis resulting in Oligohydramnios (low amniotic fluid b/c baby cannot excrete it)
-Potter facies = flattened nose, low-set ears, recessed chin

Front 21

Where is the most common place for Ectopic Kidney?

Back 21

Pelvis (pelvic brim)

**b/c of abnormal location, kinking or tortuosity of ureters may cause some obstruction to urinary flow

Front 22

Fusion of the kidneys, usually at the lower pole; may cause Urinary tract obstruction b/c of impingement on the Ureters

Back 22

Horseshoe Kidneys

Front 23

Describe the Adult form of Polycystic Kidney Disease

Back 23

1. Autosomal Dominant
2. incidence of 1:1000
3. due to PKD-1 mutation
4. Bilaterally enlarged kidneys
5. Symptoms appear in adult life
6. Renal failure 5-10 years thereafter

Front 24

Explain the pathogenesis of the cysts in Adult Polycystic Kidney Disease

Back 24

1. Mutation in PKD-1 gene
2. Polycystin-1 protein is a transmembrane protein that keeps cell anchored to eachother = mutated

Front 25

What are the associated conditions of Adult Polycystic Kidney Disease?

Back 25

1. Liver Cysts (30%)
2. Splenic Cysts (10%)
3. Pancreatic cysts (5%)
4. Berry aneurysms (20%)
5. Diverticulosis coli
6. MITRAL VALVE PROLAPSE

Front 26

HTN, hematuria, and bilateral palpable renal masses in a patient with Mitral Valve Prolapse

Back 26

Autosomal Dominant Polycystic Kidney Disease

Front 27

List the 6 clinical findings in Nephritic Syndrome

Back 27

1. Hematuria = inflammation causes the glomerulus to rupture thru the BM and leack blood into Bowman's Capsule = "smoky brown urine" or "bouillon-soup like"
2. Proteinuria = increased permeability of GBM
3. Hypoalbuminemia = causes Edema due to loss of oncotic pressure
4. Oliguria = due to reduced GFR
5. Edema = due to Salt and Water retention = Periorbital edema; Somnolence of affected kids is related to Brain Edema
6. Hypertension = due to reduced GFR -> Macula Densa -> JG apparatus -> Renin secretion

Front 28

List 3 general causes of Nephritic Syndrome

Back 28

1. Immune-complexes deposit in the capillary of Glomeruli
2. Anti-GMB Ab's
3. Planted antigens from endogenous or Exogenous organisms = Strep antigen stuck in kidney

Front 29

Define Acute Postinfectious Glomerulonephritis

Back 29

Acute NEPHRITIC syndrome 1-2 weeks after infection with Group A Beta-hemolytic Streptococci

Front 30

A 10 year old girl presents to the clinic complaining of eye swelling. You remember this child from 3 weeks ago when she was seen for Pharyngitis. Upon taking a history and performing a physical, you find that the patient has pronounced periorbital edema, has been urinating very little despite adequate fluid intake, and has a blood pressure of 150/9. Lab findings include Azotemia, Hematuria, Red Cell Casts in the urine, and increased ASO Ab titer.

Back 30

Acute Postinfectious Glomerulonephritis

**Immune-complex disease

Front 31

What age group does Acute Postinfectious Glomerulonephritis usually occur in?

Back 31

Children
-90% recover
-9% persistent hematuria, proteinuria
-1% chronic renal disease

Front 32

What pathology is seen under the light microscope in ACUTE POSTINFECTIOUS GN

Back 32

Hypercellularity
-Endothelial cells
-Mesangial cells
-PMNs

Front 33

What pathology is seen in Immunofluorescence in ACUTE POSTINFECTIOUS GN?

Back 33

Irregular coarse granular Lumpy-bumpy pattern = deposits of IgG or C3
-deposits are in the Mesangium and along the Basement Membrane

Front 34

What pathology is seen on EM in ACUTE POSTINFECTIOUS GN?

Back 34

Electron-dense Humps on the EPITHELIAL side of the basement membrane = Subendothelial localization

Front 35

Lupus is a systemic disease that is more common in __1__ and __2__

Back 35

1. Women

2. African-americans

Front 36

In Lupus Glomerulonephritis, what is there a deposition of?

Back 36

Immune-complexes

Front 37

Lupus Glomerulonephritis is associated with deposits in these places

Back 37

1. Blood vessels
2. Tubular Basement Membrane
3. Interstitium

**can basically cause deposition anywhere in the kidney

Front 38

What test is used to judge the activity of Lupus?

Back 38

Total Serum Complement
-low in lupus b/c it has been consumed

Front 39

Only disease that we know that causes deposits on the Subendothelial side

Back 39

Lupus Glomerulonephritis

Front 40

A = RBC
B = Endothelial cell
C = Epithelial Cell
D = Mesangial cell
E = Bowman capsule

Back 40

Label the letters

Front 41

Autosomal Dominant Polycystic Kidney Disease
-both kidneys have large cysts

Back 41

What is this showing?

Front 42

Autosomal Dominant Polycystic Kidney Disease

Back 42

What is this picture showing?

Front 43

Autosomal RECESSIVE PKD
- small cysts

Back 43

What is this picture showing?

Front 44

Acute Postinfectious GN

Back 44

What would cause this pathology?

Front 45

Capillary Lumens are occluded -> low GFR
-hypercellularity of Endothelial cells, Mesangial cells, PMN's

Postinfectious GN

Back 45

What is the obvious pathology here?

What is the cause?

Front 46

Subepithelial humps of immune complex deposits

Acute Postinfectious GN

Back 46

What pathology do you see here?

What is the cause?

Front 47

Acute Postinfectious GN

"lumpy-bumpy" IF = IgG, IgM, and C3 deposits throughout glomerulus

Back 47

What is the cause of this?

Front 48

Lupus Glomerulonephritis

Back 48

What would be the cause of these pathologies?

Front 49

Subendothelial deposits

Lupus Glomerulonephritis

Back 49

What is seen here?

What is the cause?

Front 50

Subepithelial Deposits
capillary is occluded

Lupus Glomeruonephritis

Back 50

What is seen here?

What is the cause?

Front 51

BUN/Cr ratio is greater than 15: Pre-renal or Renal failure?

Back 51

Pre-renal

Front 52

What is Azotemia largely related to?

Back 52

decreased GFR

Front 53

When azotemia becomes associated with a constellation of clinical signs and symptoms

Back 53

Uremia

Front 54

Prerenal azotemia is encountered when there is _______ that impairs renal function in the ABSENCE of parenchymal damage

Back 54

Hypoperfusion

Front 55

When is Postrenal Azotemia seen?

Back 55

whenever flow is obstructed below the level of the kidney

Front 56

X-linked dominant disease with a defect in the synthesis of the alpha5-subtype of collage type IV in the GBM

Back 56

Alport's Syndrome

Front 57

A patient presents with hereditary nephritis, sensorineural hearing loss, and ocular defects. What is the diagnosis?

Back 57

Alport Syndrome

Front 58

A 10-year-old boy presents to the clinic complaining of a red tinge to his urine. A more detailed history reveals that he was diagnosed with mild nerve deafness 2 years earlier and also developed cataracts 1 year ago. Lab studies confirm hematuria as well as the presence of RBC casts

Back 58

Alport syndrome

Front 59

Development abnormality that may be uni- or bilateral. Results from irregular differentiation and morphogenesis of the Metanephros. Parenchyma of these abnormal kidneys consists of immmature nephrons, often showing signs of Cystic dilation

Back 59

Cystic Renal Dysplasia

Front 60

A child presents with an enlarged, unilateral flank mass. Biopsy shows abnormal structures persisting in the kidney (i.e. cartilage, immature collecting ductules, striated muscle)

Back 60

Cystic Renal Dysplasia

Front 61

Heavy proteinuria (> 3.5 grams/day)

Nephritic or Nephrotic?

Back 61

Nephrotic

Front 62

Hematuria
Azotemia (BUN:Cr > 15)
Proteinuria (<3.5 g/day)
Oligouria
Edema = periorbital
HTN

Back 62

Nephritic Syndrome

Front 63

RBC casts

Nephritic or Nephrotic?

Back 63

Nephritic

Front 64

Generalized edema
Hyperlipidemia
Lipiduria


Nephritic or Nephrotic?

Back 64

Nephrotic

Front 65

Nephrotic

Back 65

Fatty casts with Maltese crosses and Oval Fat bodies

Nephritic or Nephrotic?

Front 66

Why is there HTN in Nephritic Syndrome?

Back 66

reduced GFR causes a release of renin