Renal - Kidney Pathology

Front 1

Untreated, this leads to "Tiny Tim's disease":

collecting duct doesn't respond to ADH:

RBC casts indicate ______ damage.

name for cholesterol-rich cells/casts in urinary sediment of nephrotic syndrome:

Back 1

RTA Type 1

nephrogenic DI

glomerular

hot cross buns, Maltese crosses

Front 2

Narrowing of arteries/arterioles supplying kidney leads to:
systemic ____.

too _____ filtrate produced, too _____ Na+, H2O resorbed

too _____ renin.

Back 2

systemic HTN

too little filtrate
too much Na+, H2O

too much renin

Front 3

hematuria, RBC casts, mild-moderate proteinuria, oliguria, HTN, mild edema:

What kidney diseases cause nephritic syndrome?

excessive permeability of filtration membrane to plasma proteins:

nephrotic syndrome = loss of _______ protein from podocytes

Back 3

nephritic syndrome

all DPGN, mild-early RPGN, bad IGA, bacterial endocarditis, MPGN

nephrotic syndrome

nephrin

Front 4

Causes include amyloidosis, diabetic glom disease, MCD, FSGS, membranous GP, MPGN:

Nephrotic syndrome - pts are at risk for thrombosis because of loss of ______.

GBM ruptured, crescents of fibrin and cells form in Bowman's space:

RPGN I, II, III and immunofluoroescence pattern:

Back 4

nephrotic syndrome

AT-III

RPGN

I - Anti-GBM (Goodpasture's, if it includes lung problems) - linear
II - immune complex deposits - lumpy, bumpy fluorescence
III - vasculitis - Wegeners, polyarteritis nodosa - no fluorescence

Front 5

Mostly likely cause of asymptomatic hematuria:

has a mutated ________.

endothelial damage, platelet microthrombus formation in renal vascular bed --> RBC fragmentation (schistocytes) and renal failure:

bacteria infection of kidney --> flank pain, fever, proteinuria, pyuria:

Back 5

thin-GBM disease

collagen IV

HUS

pyelonephritis

Front 6

ARF usually presents as _____ and ______. Also causes hyper________.

Renal HTN results from _____ GFR and ______ renin.

PCKD: genetic defect on chromosome ____.

pathology of PCKD?

group of diseases, with cysts at the corticomedullary junction, severe damage to the cortex:

Back 6

oliguria and azotemia, hyperkalemia

decrease GFR, increased renin

PCKD - chromosome 16

hundreds of cysts form throughout kidney, crowd normal tissue (undergoes apoptosis)

uremic medullary cystic diseases

Front 7

Diffuse vs focal GN:

Global vs segmental GN:

Global is usually _____, segmental usually _____, except for _______.

Back 7

diffuse - all gloms, focal - <80%

global - entire glom, segmental - part of the glom

global - diffuse, segmental - focal, except for glom damage from HTN - focal global.

Front 8

What causes mesangial cell proliferation?

foot process fusion is common cause of _________, and characteristic finding in _____, ________.

changes in the glom from ischemia?

Back 8

platelet derived growth factor

cause of nephrotic syndrome
characteristic in MCD, FSGS

corrugation/thickening of GBM and Bowman's basement membrane (crumpling) --> whole glom replaced with collagen - tuft is PAS+ at the vascular pole

Front 9

immunofluorescence pattern for:
Anti-GBM (Goodpasture's) -

immune complex:

Most common etiology of DPGN:

immune response to what antigen? Lab findings of post-strep GN?

other causes of DPGN?

Back 9

Anti-GBM - linear

immune complex - coarse granular

post-strep GN

M protein, ASO+, C3 decreased

bacterial endocarditis, infected shunts, sepsis

Front 10

Anti-GBM disease with RPGN and lung hemorrhages:

drug that causes Goodpasture's:

Anti-GBM - what type of immunofluorescence?

Causes of RPGN II?

Causes of RPGN III?

Back 10

Goodpasture's

penicillamine

linear

bad immune complex diseases - post strep, etc

no immune deposits - systemic vasculitis (Wegeners, Churg-Strauss, bad RA)

Front 11

Tx of RPGN III, segmental necrotizing GN?

major IG in mesangial proliferative GN?

immunofluorescence pattern?

most common cuase of nephrotic syndrome in adults:

immunofluorescence pattern?

Back 11

cyclophosphamide, prednisone

IGA

"tree in winter"

membranous GP

finely granular IGG

Front 12

causes of membranous GP?

commonest cause of nephrotic syndrome in children:

many adults with MCD usually have _______.

Diffuse loss of foot processes, non-selective proteinuria, oliguria, HTN --> CRF:

Effect on vessels?

Back 12

SLE, NSAIDs, infections - Hep B, syphilis, gold, post-transplant, cancer

MCD

Hodgkin's

FSGS

always hyaline arteriolar sclerosis

Front 13

Common causes of FSGS?

Membranoproliferative GN Type I:
immunofluorescence pattern?
GBM appearance?

Difference in MPGN Type II?

most common serious glomerular disease?

treatment for IGA nephropathy?

Back 13

AIDS nephropathy, heroin nephropathy, reflux

MPGN Type I:
coarse granules
GBM - train tracks

MPGN II - C3 only, no IG, "worms" on immuno

idiopathic IGA nephropathy

glucocorticoids, fish oil

Front 14

purpuric dermal lesions on LE, butt, abd pain, GI bleed, arthalgia, renal abnormalities:

Renal failure is the cause of death in 30-40% of people with ______.

Lupus class with immune-complex deposits in mesangial space, maybe mesangial proliferation:

Lupus with no renal lesion:

Back 14

Henoch-Schonlein purpura

SLE

Lupus Class II

Lupus Class I

Front 15

Lupus with massive deposits of wire-loop immune complexes, necrosis of gloms, pts typically have acute nephritic syndrome:

Lupus with immune complexes in various places, focal/segmental proliferation:

Lupus with nephrotic syndrome, mixed histology:

Back 15

Lupus Class IV

Lupus Class III

Lupus Class V

Front 16

Most common cause of ESRD?

changes in kidney?

amyloidosis pts often get __________.

mild, common family of illnesses, usually present as asymptomatic hematuria during childhood:

presence of marginally soluble proteins the gel in cold or local hemoconcentration of a glom:

Back 16

diabetic GS

hyperfiltration, thickened GBM, increased mesangial matrix (diffuse GS)

nephrotic syndrome

thin GBM disease (NOWELL'S LAW)

cryoglobulinemia

Front 17

X-linked, deafness, progressive nephritis, defect in collagen IV:

tiny kneecaps, hypoplasia of the fingernails, chunks of Type III collagen in glom, mutant LMX1B gene:

What causes Pierson's syndrome? (congenital nephrotic syndrome)

Back 17

Alport's

nail-patella syndrome

mutant B-2 laminin

Front 18

Major causes of nephrotic syndrome?

most common cause of urine turning red?

Common systemic cause of Fanconi's syndrome?

Defective Na/K/2Cl cotransporter in ascending limb, low K+, metabolic alkalosis, normal BP:

Back 18

diabetes, amyloidosis, membranous GP, FSGS/MCD, MPGN

exercise

Wilson's disease

Bartter's

Front 19

Super-avid Na-Cl co transporter in DCT, low Ca++, K+, metabolic alkalosis:

Super-avid Na+ retention, K+ loss, distal nephron - bad HTN

ARF caused by damage to tubular epithelial cells:

two types of ATN?

Back 19

Gitelman's

Liddle's

acute tubular necrosis

ischemic: hemorrhage, septic shock, contrast media
nephrotoxic: heavy metals (Hg), organic solvents (CCl4, ethylene glycol), antimicrobials

Front 20

fever, flank pain, PMN's and WBC casts in urine:

What drug can cause papillary necrosis?

Most common cause of acute drug-induced nephritis? Other drugs?

Most common cause of outpatient renal shutdown?

Back 20

acute pyelonephritis

ASA

most common: methicillin
others: Sulfa, rifampin, cyclosporine, PCN, Lasix, TZ's

NSAID use

Front 21

hydropic change in PCT cells, microcalcifications, giant mitochondria, necrosis of smooth muscle: Which drug?

Hypokalemic nephropathy: Pt can't ________ urine.

proteins found in tubules that precipitates in plasma cell myeloma:

Back 21

cyclosporine

hypoK+: pt can't concentrate urine

Bence-Jones protein

Front 22

rapidly progressive interstitial nephritis, occurs in well-defined areas of Romania, Yugoslavia, Bulgaria:

collecting duct can't respond to ADH:

Gout occurs when a pt has high ________ in the body.

Treatment drug for gout?

Back 22

Balkan nephropathy

nephrogenic DI

gout: high uric acid

colchicine

Front 23

Major mechanism for essential HTN?

What protein is often elevated in HTN, regardless of etiology?

essential HTN is the most common cause of ___________ in the kidney.

Appearance of kidney in HTN?

Back 23

general arteriolar vasoconstriction, inability to get rid of salt load

endothelin

Arteriolar nephrosclerosis

"sandpaper"

Front 24

HTN causing papilledema and necrosis of vessels:

What two diseases often end in malignant HTN?

What drug can easily cause it?

How does renal artery stenosis cause HTN?

Back 24

malignant HTN

Scleroderma, adult HUS

cocaine

increased renin secretion

Front 25

platelet clumping in small renal vessels --> microangiopathic hemolysis, thrombocytopenia, ARF:

Difference between HUS and DIC?

most important cause of renal shutdown in kids?

bacterial known for causing HUS?

Back 25

HUS

HUS - normal fibrinogen, PT, PTT

childhood HUS

EHEC O157:H7

Front 26

Kidney stones usually form in ______.

Most common?

hypercalcemia in pt first presenting with kidney stone is probably due to _______.

Mg/NH4+/PO4 stones usually indicative of:

Back 26

renal pelvis

Ca oxalate

parathyroid adenoma

Proteus infection - urea-splitting

Front 27

Which gene is almost always deleted in clear-cell RCC?

Where do RCC's develop?

Why is it unusual for a carcinoma?

about 50% of RCC's mets to the renal vein to the _________, causing RHF:

Back 27

VHL anti-oncogene (Von Hippel Landau)

PCT cell

mets by the bloodstream

triscuspid valve

Front 28

common pediatric tumor, WT1 deletion:

explain "nuclear unrest" in Wilms tumors:

Back 28

Wilm's tumor

nuclei appear anaplastic, but no abnormal mitotic figures