Pathology - S2B2 - Kidney 4

Front 1

1. Adult Polycystic Kidney Disease
2. Autosomal dominant
3. APKD1 on chr. 16
4. HTN, Hematuria, palpable, renal masses, Secondary Polycythemia

Back 1

1.What is the diagnosis?
2.What is the inheritance?
3.What is the mutation?
4.What is the clinical presentation?

Front 2

Adult Polycystic Kidney Disease

Back 2

What disease?

Front 3

Polycystic Kidney Disease
-cysts lined by flattened epithelium that you cannot classify as proximal or distule tubule

Back 3

What is this?

Front 4

A 10-year old boy presents with red tinge to his urine. History reveals that he was diagnosed with mild nerve deafness 2 years earlier and also developed posterior cataracts 1 year ago. Lab studies confirm hematuria as well as the presence of erythrocyte mass.

Back 4

Alport Syndrome
-Nephritis
-Nerve deafness
-various Eye disorders

Front 5

What is the cause of Alport Syndrome?

Back 5

mutation of alpha-5 chain of Type IV Collagen

Front 6

What is the typical clinical presentation of Poststreptococcal Glomerulonephritis?

Back 6

1. Pharyngitis 2-3 wks ago
2. Periorbital edema
3. HTN
4. Hematuria

*Nephritic Syndrome

Front 7

Poststreptococcal Glomerulonephritis = Acute Proliferative Glomerulonephritis

Enlarged, hypercellular, swollen glomeruli with proliferation of mesangial and endothelial cells
-Basement membranes are not thickened

Back 7

What is this?

How do you know?

Front 8

Post-streptococcaly Glomerulonephritis

Hypercellular -> capillary lumen compression -> GFR decreases -> Blood pressure increases due to Renin secretion -> Angiotensis = constriction of arterioles and Aldosterone secretion = retention of sodium

Back 8

What is the cause of this?

What would be a consequence?

Front 9

Post-streptococcal Glomerulonephritis
-Subepithelial deposits of immune-complexes = electron dense HUMPs

Back 9

What disease is this?

Front 10

What is the significance of RBC casts in the urine?

Back 10

Indicates hematuria that is of Renal origin

*differentiates from urinary bladder or pelvis bleeds

Front 11

Crescentic Glomerulonephritis = Rapidly Progressive Glomerulonephritis

Back 11

What is this?

Front 12

Crescentic Glomerulonephritis = Rapidly Progressive GN

**worst type of GN

Back 12

What is this?

Front 13

Goodpasture Syndrome
-linear pattern

Back 13

What disease is this?

Front 14

Lupus

Skin, Kidney, Hematopoietic

Back 14

What typically would be the diagnosis?

What 3 organ systems are most frequently involved?

Front 15

Lupus Nephropathy = Proliferative GN

Back 15

What is this?

Front 16

Lupus Nephropathy

Wire-loops = thickening of the basement membrane
Capillary has thrombi on the inside which are aggregates of immune-complexes that have gelled

Back 16

What is this?

How do you know?

Front 17

Lupus Nephropathy

Wire-loops

Back 17

What is this?

Front 18

Lupus Nephropathy

Deposits are everywhere
-subendothelial, subepithelial, intramembranous, intramesangial

Back 18

What is this?

How do you know?

Front 19

Lupus Nephropathy

staining is everywhere

Back 19

What is this?

How do you know?

Front 20

What may Hyaline Casts indicate?

What are Lipid Casts associated with?

Back 20

Hyaline = Proteinuria (may also be normal)

Lipid = Hypercholesterolemia = Nephrotic syndrome

Front 21

Diabetic Nephropathy with Nodular Sclerosis (Kimmelsteil-Wilson nodules) = nodular accumulations of Mesangial Matrix material

Back 21

What is this?

How do you know?

Front 22

Diabetic Nephropathy with Diffuse Glomerulosclerosis

Back 22

What is this?

Front 23

What is seen here?

What will it cause?

Back 23

Papillary Necrosis

Piece will slough off and drop into the renal pelvis -> obstruction -> colic of the ureter

Front 24

Papillary Necrosis

1. Diabetes Mellitus
2. Acute Pyelonephritis
3. Chronic Phenacetin (Acetaminophen)
4. Sickle Cell Anemia

Back 24

What is seen here?

What 4 things is it associated with?

Front 25

Papillary Necrosis

The pale white areas involving some or all of many renal papillae are areas of papillary necrosis. This is an uncommon but severe complication of acute pyelonephritis, particularly in persons with diabetes mellitus. Papillary necrosis may also accompany analgesic nephropathy

Back 25

What is this?

Front 26

IgA Nephropathy
-Hematuria 1-6 days post-infection

**Post-strep GN is 2-3 wks post-infection

Back 26

Diagnosis?
Why?

Front 27

IgA Berger Disease

Mesangial widening & hypercellularity = focal proliferative GN with diffuse Mesangial widening

Back 27

What is this?
How do you know?

Front 28

IgA Nephropathy = Berger Disease

Mesangial deposition of IgA

Back 28

What is this?
How do you know?

Front 29

IgA Nephropathy = Berger Disease

IgA deposits in the mesangium which increases the cellularity

Back 29

What is this?

Front 30

Membranous GN (Nephrotic syndrome)

**thick capillary walls and basement membranes

Back 30

What is this?

Front 31

Spike-and-Dome appearance of Membranous Glomerulonephritis on Silver Stain

Back 31

What is this?

Front 32

Membranous Glomerulonephritis

Granular pattern of IgG or C3 deposits = Lumpy-bumpy

Back 32

What is this?
How do you know?

Front 33

Membranous Glomerulonephritis
-Subepithelial deposition

Back 33

This is an EM of what disease?

Front 34

Acute Pyelonephritis
-WBC casts are indicative

Back 34

What is the diagnosis?

Front 35

Hydronephrosis = dilation of renal pelvis or calyces

Back 35

What is shown here?

Front 36

Acute Pyelonephritis
-tubules are destroyed by Neutrophilic infiltration
-Glomeruli are spared

Back 36

What is this?

Front 37

Acute Pyelonephritis

Fever and Flank pain with CVA tenderness


**CVA = Costovertebral angle

Back 37

What is shown here?

How would the patient present clinically?

Front 38

Chronic Pyelonephritis

Corticomedullary Scarring

Back 38

What is this?

How do you know?

Front 39

Benign Nephrosclerosis

The smaller arteries in the kidney have become thickened and narrowed. Hyaline arteriolosclerosis with hypertension or diabetes mellitus is usually present. This leads to patchy ischemic atrophy with focal loss of parenchyma that gives the surface of the kidney the characteristic granular appearance as seen here

Most common renal disease associated with hypertension

Back 39

What is this?

Front 40

Renal Cell Carcinoma

Back 40

Diagnosis?

Front 41

Renal Cell carcinoma

Back 41

What is this?

Front 42

Renal Cell Carcinoma

Polygonal Clear Cells arising from Tubular epithelium

Back 42

What is this?

Front 43

Renal Cell Carcinoma has invades the Renal Vein and IVC

Back 43

Describe this picture

Front 44

WAGR complex
-Wilms tumor
-Aniridia = absence of iris
-GU malformation
-Mental-motor Retardation

Back 44

Discuss this case

Front 45

Wilms tumor

Back 45

What is this?

Front 46

Wilms tumor

Back 46

What is this?

Front 47

Wilms tumor
-immature fetal-like cells = Primitive Mesenchyme

Back 47

What is this?

Front 48

Diffuse Glomerulosclerosis in Diabetic Nephropathy

There is an increase in mesangial matrix, a slight increase in mesangial cellularity, and capillary basement membrane thickening. These changes gradually advance until the entire glomerulus is sclerotic.

Back 48

What is seen here?

Front 49

Most common renal disease in Essential HTN

Sclerosis of arterioles and intrarenal arteries

Back 49

Nephrosclerosis

Front 50

Chronic use of Acetaminophen plus Aspirin for 3 or more years

Back 50

Analgesic Nephropathy

*Acetaminophen --> free radicals damage renal tubules in medulla
*Aspirin -> inhibits renal synthesis of PGE2 leaving Angiotensin II unopposed = decreased blood flow to renal medulla

Front 51

Drug that commonly causes Acute drug-induced interstitial nephritis

Back 51

Penicillin derivatives --> Methicillin

Front 52

What is the cause of Bilateral Cortical Necrosis (Diffuse Cortical Necrosis)?

Back 52

Complication of an Obstetric emergency
-preeclampsia or abruption placentae

**due to DIC limited to the renal cortex
-fibrin clots in arterioles and glomerular capillaries
-bilateral, diffuse, pale infarct of the renal cortex

Front 53

A childhood kidney disease in which there is progressive symmetrical destruction of the kidneys involving both the tubules and glomeruli, characteristically resulting in anemia, polyuria, polydipsia, isosthenuria (decreased ability to concentrate the urine), progressive renal failure and death in uremia. Hypertension and proteinuria are conspicuous by their absence. The chronic kidney failure affects growth and leads to short stature. The age at death ranges from around 4 to 15 years.

Back 53

Nephronophthisis

Front 54

Fever and skin rash develop in a 32-year-old man. Several days later, he has rising serum levels of urea nitrogen and creatinine along with oligouria. Urinalysis reveals proteinuria, hematuria, no glucose, no ketones, and no nitrite. The leukocyte esterase result is positive. Urine microscopic examination shows RBC's and WBC's, some of which are Eosinophils.

Back 54

Drug ingestion --> Drug-induced Interstitial Nephritis