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Pathology
Pathology
135
Pathology
Professional
10/02/2011

Additional Pathology Flashcards

 


 

Cards

Term

Lec 1

What role does the mesangium have?

 

What role does the juxtaglomerular apparatus have?

How does the JGA control this?

Definition

1. holds together the glomerular capillaries

2. place where immune complexes get deposited usually

 

 

1. controlls blood pressure, body homeostasis, renal blood flow, glomerular filtration

--blood pressure is controlled by renin containing cells in the afferent arteriole

Term

Lec1

What special structure does the proximal tubule have to increase salt and water reabsorption?

 

What are the roles of the PT?

 

 

Definition

1. microvilli

 

2. absorb Na, regulate acid-base balance

Term

Lec 1

What is the main role of the thin limb of henle?

 

What is the main role of the thick limb of henle?

 

What is the main role of the distal convoluted tubule?

Definition

1. countercurrent exchange with medulla to excrete concentrated urine

 

2. hypertonic extrusion of salt-- create a medullary concentration gradient (dilutes urine)

 

3. regulate acid-base balance

 

 

Term

Lec1

What are collecting ducts used for?

Definition

Principal cells- respond to ADH to allow water inside

Intercalated cells- regulate acid-base via chloride-bicarbonate exchangers and proton ATPases

Term

Lec 2

What can you diagnose with a urinalysis?

 

What does a positive nitrite show?

Definition

glomerulonephritis

UTI

Diabetic ketoacidosis

 

E. coli infection

Term
What's the differential for hematuria?
Definition

First ask-- What do the RBCs look like?

Normal biconcave --> bleed in urinary tract

Spherical blebs--> injured capillary in kidney (=glomerular disease)

 

Upper UT disease: think KIDNEY

glomerular injury (glomerulonephritis), kidney injury, kidney malignancy, pyelonephritis

 

Lower UT disease: think BLADDER

bladder malingancy or infection, stone

 

Or it could just be a contaminant

Term

Lec2

When do the following casts form?

 Hyaline

RBC

WBC

Tubular epithelial

Fatty

Granular

Broad-waxy

Definition

Hyaline- after excercise, dehydrated

RBC- nephrItic syndrome

WBC- acute pyelonephritis

Tublar epithelial- tubular necrosis

Fatty- nephrOtic syndrome

Granular- renal disease- nonspecific

Broad-waxy- chromic renal failure

Term

Lec2

What 4 symptoms point to nephrotic syndrome?

 

What path/phys causes nephrotic syndrome?

 

Name 9 causes of nephrotic syndrome?

Definition

hyperlipidemia, hypoalbuminemia, edema, proteinuria

 

increased permeability of the glomerular capillary

 

Abbs: MCD, FSGS, MGN, MPGN

Systemic: Diabetes, Amyloidoses, Lupus

Other: NSAIDs, Infection (HIV + Hep B, C)

Term

Lec2

Minimal change disease

 

More common in___

 

Presents with ___

 

Is the toxicity reversible?

 

What does the EM look like?

Definition

children

 

edema, SELECTIVE proteinuria

 

Yes

 

Diffuse effacement of visceral epithelial cell foot proceses

 

 

Term

Lec2

Focal Segmental Glomerulosclerosis (FSGS)

More common in__

Presenting symptoms

Is it reversible?

EM

Immunofluorescence

Definition

Hispanics and African Americns

 

NONselective proteinuria, hematuria, hypertension

 

No

 

detachment of foot processes from BM (in addition to diffuse effacement of foot processes)

 

IgM, C3 in course clumps in sclerotic segments

Term

Lec2

Membranous Nephropathy (MGN)

 

Presents with____

 

Immunofluorescence

 

Causes of secondary MGN

Definition

NONselective proteinuria, hematuria, mild hypertension

 

IgG, C3 granular in capillary loop pattern on GBM

Mesangial staining is negative in idiopathic MGN but positive in secondary MGN

 

Lupus, tumors, drugs, infection, metabolic disorders

Term

Lec 3

What 6 symptoms point to nephrItic syndrome?

 

What is the hallmark of an inflamed glomerulus?

 

Name 8 types of nephritic syndromes:

Definition

hematuria, azotemia, oliguria, hypertension, edema, proteinuria

 

Hypercellular glomerulus

 

Primary- acute postinfectious glomerulonephritis, IgA nephropathy, RPGN

 

Systemic- Cryoglobulinemic glomerulonephritis, Henoch-schonlein purpura, RPGN (Goodpasture and wegener), lupus

 

Mixed- membranoproliferative glomerulonephritis I and II

Term

Lec 3

Acute Poststreptococcal Glomerulonephritis

More common in___

 

IF studies:

Definition

Children

 

IgG and C3 lumpy-bumpy

Term

Lec3

Membranoproliferative Glomerulonephritis MPGN

More common in___

 

Difference between type I and II

 

IF studies

 

Light microscopy

Definition

Older children

 

Type I- alternative + classic complement activated (C3 + C1q)= "broken curvilinear"

Type II- ONLY alternative activated (C3)= "rings"

 

shows cauliflowers due to endocapillary proliferation and influx of inflammatory cells

silver stain shows duplicate GBM= tram-track

Term

Lec3

Cryoglobulinemic Glomerulonephritis (CGN)

 

Type 1 vs Type 2 vs Type 3

 

Clinical features

 

EM

Definition

Type 1- monoclonal IgGk- multiple myeloma

Type 2- polyclonal IgG, mono IgMk

Type 3- polyclonal IgG, poly IfM

 

Both 2 and 3 caused by hepC, lupus, RA

 

skin purpura, arthralgias, low serum complement

 

Thumbprint appearance- due to microtubular structure of deposits

Term

Lec3

 

Name 2 immune complex glomerulopathies associated with recurrent hematuria:

 

Hint-- they both usually follow an upper respiratory tract infection

Definition

IgA nephropathy (Berger's disease)

 

Henoch-Schonlein Purpura (HSP)

Term

Lec3

IgA Nephropathy (Berger's Disease)

 

More common in___

 

What 2 diseases is secondary IgA nephropathy associated with?

 

IF studies

Definition

older children

 

 

celiac disease, chronic liver disease

 

IgA, C3 granular deposits

 

Term

Lec3

Henoch-Schonlein Purpura (HSP)

More common in___

Name 5 Symtpoms

Definition

children

 

Purpuric skin rash, abdominal pain, melena, vomiting, arthralgias

Term
Name 2 syndromes of isolated hematuria
Definition

Alport's syndrome

Thin basement membrane disease (TBMD) (Benign Familial Hematuria)

Term

Lec3

Alport's syndrome

 

inheritence

 

4 symptoms

 

Which gene is mutated?

 

EM

Definition

x-linked

 

hematuria, proteinuria, nerve deafness, eye disorders

 

a5 chain of collagen type IV

 

GBM shows splitting and a "basket woven" appearance

Term

Lec3

Thin Basement Membrane Disease (TBMD)

 

Inheritence

 

Mutated gene

 

EM

Definition

Autosomal dominant

 

a3 or a4 of collagen type IV

 

GBM thinning

Term

Lec4

Rapidly Progressive Glomerulonephritis (RPGN)

 

Main feature

 

Name types I, II, and III RPGNs

Definition

Crescents in most glomeruli

 

I = Anti-GBM antibody- idiopathic, goodpasture

 

II = immune complex- idiopathic, postinfectious glomerulonephritis, lupus, Diffuse IgA nephropathy/Henoch Schonlein, membranoprolif. glom.

 

III= pauci-immune- idiopathic, microscopic polyangitis, Wegener's

Term

Lec4

Type I RPGN

What's the main difference between goodpasture & idiopathic?

 

Goodpasture is most common in ____ and also causes ___ symptoms.

 

IF studies

Definition

Idiopathic is only in kidney, goodpasture is in lungs also

 

young men: hemoptysis, pulmonary hemorrhage

 

strong linear staining of IgG and C3

 

EM- NO immune complex deposits present

Term

Lec4

Type II RPGN- immune complex mediated glomerulonephritis-- usually idiopathic

 

What's special about glomerulus (compared to type 1 & 3)

 

IF studies

Definition

it's hypercellular

 

granular staining - IgA & C3 for IgA nephropathy, full-house staining for lupus

Term

Lec4

Type III RPGN- Pauci immune- idiopathic, microscopic polyangitis, wegener granulomatosis

 

What type of autoantibodies is made?

 

What other symptoms does microscopic polyangitis cause?

What does the skin biopsy show?

 

 

Definition

P-ANCA- myeloperoxidase-- microscopic polyangitis

C-ANCA- PR3-- Wegener's

 

skin purpura, hemoptysis, arthralgias, abdominal pain

necrotizing vasculitis

 

 

Term

Lec4

What is the triad for Wegener Granulomatosis?

Most common in___

 

What other symptoms do they get?

Definition

necrotizing granulomas in lung, vasculature, glomerulus

50 year old males

 

pneumonitis and sinusitis

 

 

Term

Lec5

Diabetic Glomerulosclerosis= Diabetic nephropathy (DN)

 

What are happens during the 5 stages of DN?

 

Which finding is diagnostic of DN?

Definition

1. GFR increases, kidney/glomerulus enlarges

2. GBM thickens

3. Microalbuminuria, selective proteinuria, hypertension, normal renal function

4. IRREVERSIBLE- kimmelstiel-wilson nodules (PAS+), dipstick +, nonselective proteinuria, nephrotic syndrome, decreased GFR, increased creatinine, retinopathy, CAD

5. End-stage renal disease

 

Hyalinization of afferent and efferent arterioles

Term

Lec5

Amyloidoses

 

Diagnostic lab test?

Definition

Congo red+

 

 

Term

Lec5

 

AL

 

Precursor Protein?

Clinical Features?

Definition

mainly λ

 

1. primary amyloidoses- MGUS- NO bone lesions

2. myeloma assoc.- multiple myeloma- bone lesions etc

 

Term

Lec5

 

AA

 

Precursor Protein?

Clinical Features?

Definition

SAA

(acute phase protein), precursor for fibrils

 

Secondary Amyloidosis-hepatosplenomegaly, renal insufficiency

due to inflammatory condition (Crohn's, RA), heroin

Term

Lec5

 

ATTR

 

Precursor Protein?

Clinical Features?

Definition

Abnormal TTR--> Familial ATTR amyloidosis- midlife onset of peripheral neuropathy, cardiomyopathy, vitreous opacities

 

Normal TTR--> Senile Systemic Amyloidosis- heart & kidney

Term

Lec5

 

Aβ2m

 

Precursor protein?

Clinical features?

 

Diagnostic study?

Definition

β2microglobulin

 

Hemodialysis- associated- β sheets deposited in tendons, joints, synovium

 

EM shows fibrils forming feathery spikes like "fringe on a rug"

Term

Lec5

 

Monoclonal Immunoglobulin Light Chain Deposition Disease- LCDD

   - nephrotic syndrome which is Congo Red -

   - also in pt's w/ MGUS or MM

 

Where do the monoclonal light chains get deposited?

IF studies

EM

Definition

kidney, heart, liver

 

nodules are very PAS+

 

κ light chain in smooth linear pattern

 

nonfibrillar powdery punctuate deposits in mesangium (resembles a pencil line)

Term

Lec6

 

Which 2 antibodies are diagnostic for SLE?

 

What type of study/lab/procedure is essential for classifying and treating lupus?

 

IF studies for SLE

What is the clinical course for SLE?

Which classes of lupus get treated?

Definition

dsDNA, Smith (Sm)

 

renal biopsy

 

"Full House" staining= IgG, A, M, C3, C1q

 

I > II > V > III > IV

 

3, 4, 5

Term

Lec7

What's the difference between primary and secondary HTN?

 

What's the difference between benign and malignant HTN?

Definition

Secondary HTN has a known cause but primary doesn't

 

Benign is slow, malignant progresses rapidly

Term

Lec7

What causes benign HTN?

 

What does the kidney look like in someone w/ benign HTN?

 

What are the 3 main histological changes that occur during benign HTN?

Definition

a renal lesion called benign nephrosclerosis

 

finely granular on outside

 

1. intimal thickening of arteries

2. hyalinization of arterioles

3. renal parenchyma ischemia

Term

lec7

Which 4 events occur during intimal thickening due to benign HTN?

 

What symptoms are associated with benign HTN?

Definition

1. medial hypertrophy

2. myointimal cellular proliferation

3. reduplication of the internal elastic membrane

4. fibrosis

 

trick question! it's asymptomatic

Term

Pic of benign HTN

 

notice granular surface

Definition
[image]
Term

Lec7

 

Name 3 complications of benign HTN:

 

Name 3 groups that are at greatest risk of developing renal failure:

 

 

Definition

1. CHD= Coronary heart disease

2. Cerebrovascular accidents

3. Left ventricular hypertrophy

 

1. African Americans

2. super high blood pressure

3. diabetes

Term

Lec7

 

What does the kidney look like in someone with malignant HTN?

 

Why?

 

What type of microscopic changes to arteries, arterioles, and glomeruli does malignant HTN cause in the kidney?

Definition

Flea-bitten pinpoint hemorrhages

 

Due to glomerular necrosis and rupture

 

narrow arteries due to layering of collagen and accumulation of proteoglycans= 'onion skinning'

arterioles + glomeruli show fibrinoid necrosis and thrombosis.

glomeruli also show neutrophilic infiltrate

 

Term

Lec7

 

Name 4 clinical features of malignant HTN:

Definition

REDS

Retinopathy

Encephalopathy

Diastolic >130

Stroke

Term

Lec7

 

What do HUS and TTP have in common?

 

What can cause thrombotic microangipathy?

Definition

both cause:

Microangiopathic hemolytic anemia

Thrombocytopenia

Acute renal failure

Identical renal lesions (same as malignant HTN)

 

Shiga-like toxin in E. coli, complement mutations, lupus anticoagulant, pregnancy complications, malignant HTN, TTP

Term

Lec7

 

Is secondary HTN due to renal artery stenosis curable?

 

What are the 2 main causes of RAS?

Definition

Yes, if you have surgery

 

More common:

1. MEN- atheromatous plaque stenoses RA ostium- more likely in old diabetics

 

2. FEMALE- fribromuscular dysplasia- fibromuscular thickening, medial fibroplasia is most common- 30-40yo

 

Term

Lec7

 

What causes the Goldblatt kidney?

 

What type of features does the Goldblatt kidney show?

Definition

secondary HTN due to renal artery stenosis

 

decreased: blood flow, BP, GFR

stimulates: renin-ang system

renal ischemia

Term

Lec7

 

Which factors in renal artery stenosis cause vasoconstriction and hypertension?

 

What does a Goldblatt kidney look like?

 

What microscopic changes occur to a Goldblatt kidney?

 

What does the non-ischemic kidney look like?

Definition

Sodium retention

producing endothelin- a vasoconstrictor

losing NO- a vasodilator

 

smooth, small (due to ischemic atrophy)

 

Hyperplasia of the glomerular JGA

Increased renin granules

Interstitial fibrosis

 

granular or flea-bitten- depending on type of HTN

Term

Lec7

 

Name 4 causes of vasculitis

Definition

1. Immune complex- lupus and croglobulinemia

2. Microscopic polyangitis- ANCA

3. Polyarteritis nodosa

Term

Lec7

 

Where does polyarteritis nodosa NOT go?

 

What virus often causes polyarteritis nodosa?

 

During the acute phase of polyarteritis nodosa, what does the weakened arterial wall lead to?

 

Who usually gets PN?

Definition

pulmonary

 

hepB

 

Aneurysmal dilatation, thrombosis, rupture

 

Young adults

Term

Lec7

 

Name 5 causes of diffuse cortical necrosis:

Definition

1. pregnancy

2. septic shock

3. pancreatitis

4. NSAIDS

5. wrong blood transfused

 

Extra-- ONLY Cortex in infarcted. Medulla, juxtamedullary cortex, and cortex under capsue is spared.

 

Scarring and calcification necessitates dialysis

Term

Lec7

 

1. Where do most renal infarcts come from?

 

2. What's the difference between recent infarcts and healed infarcts?

 

3. Name 2 symptoms of renal infarction:

Definition

1. Mural thrombi- Left atrium (atrial fibrillation) or Right ventricle (myocardial infarction)

 

Septic infarcts- Infective endocarditis

 

2. recent ones show ischemic coagulation necrosis while healed infarcts show interstitial fibrosis and tubular atrophy

 

CVA tenderness and hematuria

 

Term

Lec10

 

What are 3 signs that a tubule is defective?

Definition

1. can't concentrate urine (polyuria)

2. salt wasting

3. can't excrete acids- metabolic acidosis

Term

Lec10

 

What are some clinical signs of Acute Kidney Injury (AKI)?

 

Is AKI reversible?

 

 

Definition

oliguria, rapid onset azotemia, dilute urine, hyaline or granular pigmented casts

 

Yes

Term

Lec10

 

Name 3 types of ATN (acute tubular necrosis) and what can cause them:

Definition

1. Pre-renal ischemia= decr. blood to kidney due to hypotension, shock, malignant HTN

 

2. Direct toxic injury= nephrotoxicity due to drugs and dyes

 

3. Post-renal disease= obstruction, stones

Term

Lec10

 

What 2 things cause ischemic and nephrotoxic ATN?

 

Name 3 things that lead to oliguria during acute tubular necrosis:

Definition

1. tubular cell injury- loss of polarity leads to activation of caspases which results in apoptotic cells (IRREVERSIBLE)

 

2. altered blood flow- due to renin from tubuloglomerular feedback, endothelic release and decreased vasodilators

 

incr. tubulogomerular feedback, incr. intratubular pressure, decr. tubular flow leading to decr. GFR

 

Term

Lec10

 

What are the early features of ischemic ATN?

 

Name 3 toxins that can cause nephrotoxic ATN?

Definition

cell swelling, blebbing, and loss of brush border

 

Gentamycin, ethylene glycol, radiocontrast dye

 

Term

Lec10

 

What happens during the 3 stages of nephrotoxic ATN?

Definition

1. initiation- decr. urine output, incr. BUN & Cr

 

2. maintenance- oliguria, salt/water overload, more BUN & Cr increase, metabolic acidosis

 

3. recovery- incr urine output, BUN & Cr normalize

Term

Lec10

 

How does acute pyelonephritis present?

Definition

sudden CVA tenderness

 

pyuria and positive urine culture

 

leukocyte casts

 

big kidneys, abscesses

Term

Lec10

 

What are the hallmarks of pyelonephritis due to reflux?

 

 

Definition

pelvic inflammation

 

patchy interstitial neutrophilic inflammation

 

neutrophils in collecting ducts

 

abscess formation

Term

Lec10

 

Chronic pyelonephritis is an important cause of ______

 

What are the 2 types of chronic pyelonephritis?

Definition

end-stage kidney disease

 

1. chronic reflux nephropathy- in kids w/ a UTI and reflux

hallmark- polar scarring

 

2. chronic obstructive pyelonephritis- due to stones or anatomic anomalies

hallmark- scars all over

 

Extra-- hydronephrosis occurs in both types

Term

Lec10

 

What type of casts occur in chronic pyelonephritis?

 

 

What does scarring from chronic pyelonephritis lead to?

 

Definition

 

hyaline casts (thyroidization)

 

focal segmental glomerulosclerosis

Term

Lec10

 

When do people get polyoma virus?

 

What do the infected cells look like?

 

How do you diagnose it?

Definition

the virus gets reactivated in renal transplant patients by immunosuppression

 

enlarged nuclei with viral inclusions

 

immunostain shows parallel crystalline arrays of viral particles

 

 

Term

Lec10

 

WHen do people get ATIN (Acute Drug-Induced Interstitial Nephritis)?

 

What is the ATIN triad of symptoms?

Definition

15 days after drug exposure

 

fever, eosinophilia, rash

 

 

Extra-- see eosinophils in urine, rising creatinine, acute renal failure with oliguria, increased IgE, + skin test for drug haptens, both kidneys swollen, inflammatory cell infiltrate

 

REVERSIBLE

Term

Lec10

 

What cause analgesic nephropathy? Be specific

 

How does analgesic nephropathy present?

Definition

acetaminophen and aspirin

 

chronic tubulointerstitial nephritis, papillary necrosis, urinary infection, stones

Term

Lec8

 

What is Potter syndrome?

Definition

decreased amniotic fluid results in lack of kidneys and pulmonary hypoplasia

 

oligohydramnios

bilateral agenesis

facies

results in stillbirth

 

Term

Lec8

 

Name the different types of renal cysts:

Definition

1. Dysplasia

2. APKD

3. ARPKD- recessive

4. Dialysis-associated

5. Medullary sponge kidney

Term

Lec8

 

Name 5 characteristics of cystic renal dysplasia (CRD):

Definition

sporadic

unilateral

irregular structure

cystic

cartilage islands

Term

Lec8

 

Pic of cysts

Definition
[image]
Term

Lec8

 

Cystic Diseases:

 Compare CRD, ADPKD, ARPKD

Definition

 

CRD ADPKD ARPKD
unilateral bilateral bilateral
metanephric problem PKD1 mutation chr 16 PKHD1 in chr. 6
Irregular shape, grapes Kidney shape Kidney shape- smooth surface, sponge
kids adults infants
cartilage in kidney leads to liver CYSTS & berry aneurysms

leads to liver FIBROSIS, portal HTN, splenomegaly

 

Term

Lec8

 

What is the clinical presentation of medullary sponge kidney?

 

What is the clinical presentation of nephronophtisis?

 

What is the clinical presentation of dialysis assoc. cystic disease?

Definition

hematuria, UTI, stones

benign/asymptomatic, normal renal function,

smooth contours on cyst

in older adults

 

kid w/ polydypsia & polyuria

NPH1 gene makes nephrocystins

small kidneys w/ multiple cysts

 

asymptomatic, uremic, develop renal cell carcinoma

tubules obstructed by fibrosis or oxalate crystals

Term

Lec8

 

What is the main pediatric renal tumor?

 

Name 1 other benign pediatric tumor and 2 malignant tumors.

Definition

Wilms' tumor (WT)

 

Mesoblastic nephroma- benign

Clear cell sarcoma & rhabdoid tumor- malignant

Term

Lec8

 

Name 3 benign adult renal tumors and decribe them

 

Definition

Papillary adenoma- most common, so small that it can't metastasize

 

Angiomylolipoma- seen in pt's w/ tuberous sclerosis benign but has complications- hemorrhage, CNS (seizures), giant yellow tumor w/out capsule. 3 elements: fat, large vessels & muscle bundles. pt's can have angiofibromas, cysts in liver, kidney, cardiac rhabdomyomas

 

Oncocytoma- pink oncocytes due to lots of mitochondria- come from intercalated cells of collecting ducts

Term

Lec8

 

Name the 4 types of adult renal cancers

Definition

1. renal cell carcinoma-"clear"=classic- most common

2. papillary carcinoma-

3. chromophobe carcinoma-

4. collecting duct carcinoma-

Term

Lec8

 

Renal cell carcinoma

Type of pt___

What is the classical clinical triad?

 

What is the classic type of renal cell carcinoma?

 

What are the variants of renal cell carcinoma?

Definition

60+yo male

 

hematuria, CVA pain, flank mass

 

Clear cell carcinoma

 

papillary RCC, chromophobe carcinoma (prominent pink membrane), ductal renal carcinoma (channels lined by irregular cells, fibrosis, osteoblastic bone metastases)

Term

Lec8

 

What is Von Hippel Lindau syndrome?

Definition

tumor suppressor VHL gene is inactivated- inherited

results in up-regulation of hypoxia-induced factor

metastases to 3 places ("Let's Buy Land")

Lungs, brain, liver

can lead to multifocal clear renal cell carcinoma

Term

Lec8

 

Papillary renal carcinoma-

what kind of histo changes occur?

what causes it?

Definition

psammoma bodies (calcifications)

foam cells

 

trisomy 7

Term

Lec8

 

Wilm's tumor

 

What do you know about it?

Definition

derived from nephrogenic blastema cells

 

presents as large abdominal mass (unilateral)

responds to treatment

triphasic combo- epithelium + stroma + blastema

nephrogenic rests -- precursors to Wilm's tumor

sometimes found in kids with WAGR genitourinary synd. (WT1), Beckwith wiedmann synd (WT2 mutation,NO anaplasia)

IGF2 overexpressed)

Term

Lec8

 

things emphasized in cyst lecture

Definition

 

Potter sequence---- oligohydramnios

 

Dysplasia: abnormal kidney, mass, unilateral, cartilage

 

Adult polycystic disease: Berry, liver cysts, heart valve anomaly

 

Recessive cystic disease: many neonatal dead, portal fibrosis

 

Acquired dialysis cystic disease: common, high risk papillary carcinoma

 

Adenoma: benign

 

Oncocytoma: benign , oncocytes (pink cells: mitochondria)

 

Renal  clear carcinoma (RCC): 85% renal carcinomas in adult

 

RCC commonly metastasize

 

RCC: 96% sporadic, 4% familial

 

Variants: second most common renal  carcinoma papillary

 

Cytogenetics; RCC -3p, papillary : trisomy 17

 

Wilms : W triad  Angiomyolipoma: triad

 

Term

 

·         MCD

 

Definition

 

o   Puffy baby (legs and eyes!)

 

o   Normal LM

 

o   EM = effacement

 

o   Selective proteinuria

 

Term

 

·         FSGS

 

Definition

 

o   IgM + C3 entrapment (NOT complex)

 

o   EM = effacement + detachment

 

o   Secondary = HIV (collapsed) or heroin?

 

Term

MGN

Definition

 

o   IgG +C3 (immune complex)

 

o   Phospholipase A2R

 

o   Secondary = HBV

 

o   GBM thickening!

 

o   Spikes

 

Term

 

·         Acute Post-Strep GN

 

Definition

 

o   Hypercellular (oat meal raisin cookie, extra raisins!)

 

o   IgG + C3 = Lumpy – bumpy – humpy

 

Term

 

·         MPGN

 

Definition

 

o   Hypocomplimentemia!

 

o   Cauliflower! (glomerulus)

 

o   Tram – track (GBM)

 

o   Type I = IgG + C3 + C1q

 

§  Immune complex deposits

 

o   Type II = C3 only

 

§  Dense ribbon-like material (in btw tram track)

 

Term

 

·         Cryoglobulinemic GN

 

Definition

 

o   3 types

 

o   Type II/III = SLE, RA, Hep C

 

o   Purpura + arthralgias!

 

o   EM = Thumbprint!

 

Term

IgA Nephropathy – MOST COMMON!

Definition

 

o   Recurrent hematuria (often post infxn, like flu)

 

o   Deposits OR Complexes (IgA obvs)

 

o   IgA + C3 in mesangium

 

Term

Henoch – Schonlein Purpura

Definition

 

o   Childhood!

 

o   LE pupura, abdominal pain, melena, vomiting, arthralgia

 

o   IgA!

 

Term

Alport’s

Definition

 

o   X-linked = A5 chain of collagen IV!!!

 

o   AR = A3 & 4

 

o   5-20 y/o

 

o   Nerve deafness + eye probs!

 

o   IF = negative

 

o   EM = basket woven!

 

Term

Thin BM Disease

Definition

 

o   AD = A3 & 4

 

o   Asymptomatic microscopic hematuria

 

o   IF = negative

 

o   EM = thin GBM!

 

Term

 

·         RAPID! = crescents!

 

Definition

 

o   Type I

 

§  Anti-GBM @ A3

 

§  Goodpasture’s

 

§  Linear staining IgG + C3

 

§  Hemoptysis!

 

§  Young adult male

 

o   Type II

 

§  Immune complex-mediated!

 

§  Post-infectious GN, SLE (IV), IgA GN, HSP, MPGN

 

·         So…hypercellular!

 

·         IF specific to disease

 

o   Type III = Pauci! (negative IF)

 

§  Microscopic Polyangiitis

 

·         P-ANCA (myeloperoxidase)

 

·         Purpura, hemoptysis, arthralgia, abdominal pain

 

§  Wegener

 

·         C-ANCA (PR3)

 

·         Triad: lung/sinus, necrotizing/granulomatous vasculitis, crescenteric GN

 

Term

 

·         Diabetic Nephropathy

 

Definition

 

o   5 stages

 

o   Stage I = increased GFR (Stage IV = decreased)

 

o   Stage II = GBM thickening

 

o   Stage III = Mesangial thickening; selective proteinuria

 

§  Capsular drop (diagnostic for II/III)

 

o   Stage IV

 

§  KW nodules

 

§  Hyaline caps = IgM + C3 entrapment

 

§  Non-selective proteinuria

 

§  HTN

 

§  10-20 yrs after DM diagnosis

 

o   Stage V (ESRD)

 

§  Globally sclerotic glomeruli, severe interstitial fibrosis, tubular atrophy

 

o   Hyalinization of Afferent AND Efferent arterioles

 

Term

Amyloidosis

Definition

 

o   Insoluble non-branching fibrils!

 

o   Congo Red POSITIVE!

 

o   Fringe on a rug!

 

o   AL (primary)

 

o   AA (secondary)

 

§  Acute phase proteins

 

§  Chronic inflam conditions

 

o   ATTR

 

§  Transthyretin (TTR)

 

§  Familial = peripheral neuropathy

 

§  Senile = heart & kidney

 

o   AB2M

 

§  Hemodialysis >20 yrs!

 

Term

Monoclonal Ig Light Chain Deposition Disease (LCDD)

Definition

 

o   Kidney, heart, liver

 

o   Congo red NEGATIVE!

 

o   Kappa rather than Lambda (AL)

 

§  Smooth LINEAR deposition

 

o   EM = pencil line

 

Term

 

·         SLE

 

Definition

 

o   Wire loops = subendothelial deposits

 

§  Bright red!

 

§  Begin in Class III

 

§  Prominent in Class IV

 

o   Class IV à tubulointerstitial nephritis OR vascular probs.

 

§  Vascular probs = non-inflam (complexes), inflam, or thrombotic microangiopathy (onion skinning!)

 

o   Class V = membranous = spikes

 

Term

 

·         Primary Benign HTN

 

Definition

 

o   Old, black, DM

 

o   Grain leather surface

 

o   Arterionephrosclerosis

 

§  Internal elastic membrane squiggly trichrome/elastic stain

 

o   V-shaped scars

 

Term

 

·         Primary Malignant

 

Definition

 

o   Flea-bitten

 

o   Onion skinning

 

o   Fibrinoid necrosis = acute damage

 

o   Black males

 

o   Retinopathy, encephalopathy, stroke

 

o   Fucking absurd BP

 

Term

 

·         Thrombotic Microangiopathy - HUS/TTP

 

Definition

 

o   Renal lesions identical to malignant HTN

 

Term

 

·         Secondary HTN (due to Renal Artery Stenosis)

 

Definition

 

o   Goldblatt kidney = problem child!

 

§  Decreased blood flow

 

§  Decreased BP

 

§  Decreased GFR

 

§  Stim’d ARS

 

§  Smooth & tiny

 

§  Not affected by HTN

 

o   Other kidney

 

§  Leather grain or flea bitten (benign or malignant)

 

§  Vessels manifest FULL EFFECT of HTN

 

Term

 

·         Vasculitis – Polyarteritis Nodosa

 

Definition

 

o   Small & medium sized muscular arteries!

 

o   Hep B!

 

o   Acute = inflam cells + aneurysmal dilatation + lots of rupturing

 

o   Chronic = fibrous/nodular thickening of vessel wall

 

o   Young adults!

 

Term

 

·         Diffuse Cortical Necrosis

 

Definition

 

o   Pregnancy

 

o   Shock, etc.

 

o   Pancreatitis

 

o   NSAIDS, contrast, poisons, snake bites

 

o   Arteriolar + glomerular thrombosis and necrosis

 

o   Cortical scarring + calcification = dialysis!

 

Term

Agenesis

Definition

 

o   Characteristic facies, limb defects, hypoplastic lungs

 

Term

 

·         Cystic Renal Dysplasia

 

Definition

 

o   Histo = cartilage and immature collecting ducts

 

o   Assoc. w/ UPJ obs.

 

o   Flank mass?

 

Term

 

·         ADPKD (adult)

 

Definition

 

o   Crunch grapes!

 

o   Bilateral, enlarged

 

o   Liver cysts! (also spleen, pancreas, lung)

 

o   Berry aneurysms

 

o   Mitral valve prolapse

 

Term

 

·         ARPKD (childhood)

 

Definition

 

o   Sponge!

 

o   Dead babies

 

o   Bilateral, enlarged

 

o   Hepatic fibrosis!

 

Term

 

·         Dialysis associated cystic disease

 

Definition

 

o   Can lead to RCC (papillary)

 

Term

 

·         Wilms’ Tumor (WT)

 

Definition

 

o   2-5 y/o

 

o   Solitary tan tumor

 

o   Triphasic: blastema (small blues), stroma, epithelium

 

o   Large abdominal mass

 

o   WAGR

 

§  Wilms’, Aniridia, GU abnorms, Retardation

 

o   Beckwith-Wiedemann Syndrome (BWS)

 

§  Large organs, macroglossia, renal cysts, adrenal cytomegaly

 

o   Nephrogenic rests (NR)

 

§  Precursors!

 

Term

Angiomyolipoma

Definition

 

o   Huge, hemorrhagic

 

o   Assoc. w/ tuberous sclerosis (retarded/seizing)

 

Term

Oncocytoma

Definition

 

o   Large pink epithelial cells (from intercalated cells of CD)

 

o   Packed with mitochondria!

Brown tumor

Term

Renal Cell Carcinoma (RCC)

Definition

 

o   Hematuria, CVA pain, flank mass

 

o   Unilateral solitary yellow tumor (w/ hemorrhage or necrosis)

 

o   LUNG BONE LIVER

 

o   Clear Cell

 

§  VHL (3p)

 

o   Papillary

 

§  Foam cells

 

§  Trisomy 7 and 17

 

§  Assoc. w/ dialysis

 

o   Chromophobe

 

§  Hot pink plant cell w/ perinuclear halo

 

§  From intercalated cells (like oncocytoma)

 

o   Collecting duct = AGGRESSIVE. BONE. DIE.

 

Term

 

·         UPJ

 

Definition

 

o   Hydronephrosis in babies/kids

 

Term

 

·         Vesicoureteral reflux

 

Definition

 

o   Most common cause of pyelonephritis

 

Term

 

·         Hemorrhagic cystitis

 

Definition

 

o   Cyclophosphamide

 

o   Adenovirus

 

Term

 

·         Interstitial (Hunner ulcer)

 

Definition

 

o   No bacterial infxn.

 

o   Inflam only

 

Term

 

·         Malacoplakia

 

Definition

 

o   Raised yellow plaques!

 

o   Foam cells!

 

o   Michaelis Gutmann bodies (bulls-eye)

 

o   Neg. urine culture + not responding to tx + woman (immunosuppressed transplant pt)

 

Term

 

·         Urothelial (Transitional Cell) Neoplasm

 

Definition

 

o   Tobacco, dyes, arylamines, schisto (Egypt), long term analgesic, cyclophosphamide, radiation

 

o   Painless hematuria

 

o   Flat = CIS if no invasion

 

§  Tx. w/ BCG if invasion

 

o   Papillary

 

§  High grade: severe atypia, anaplasia, frequent mitoses, lack of polarity!!!

 

§  LUNG BONE LIVER

 

o   Squamous Cell

 

§  Egypt

 

§  Schistosomiasis

 

§  Invasive

 

§  Abundant keratin

 

o   Adenocarcinoma

 

§  Urachal remnants

 

§  Intestinal metaplasia

 

Term

 

·         Acute Tubular Necrosis (ATN)

 

Definition

 

o   Oliguria

 

o   Dilute urine, mild proteinuria, microhematuria, hyaline, granular or pigmented casts

 

o   Pre-renal, renal, post-renal

 

o   RAS, endothelin (vasoconstrictor), decreased NO, PGI2

 

o   Pre-renal (ischemic)

 

§  Patchy tubular necrosis

 

§  Normal glomeruli and vessels

 

§  Blebbing!

 

§  Loss of brush border!

 

§  Dilated tubules!!!

 

·         w/ necrotic epithelial cells

 

§  Regeneration

 

o   Renal (nephrotoxic)

 

§  Extensive, uniform tubular necrosis

 

§  3 stages

 

·         Osmotic diuresis in recovery stage

 

Term

 

·         Acute Pyelonephritis

 

Definition

 

o   CVA pain, fever, chills, dysuria, frequency, pyuria, WBC casts

 

o   LM = inflammation of renal pelvis

 

Term

 

·         Chronic Pyelonephritis

 

Definition

 

o   Reflux

 

§  Child, UTI, congenital VUR

 

§  Upper and lower poles only

 

o   Obstructive

 

§  Poles and midzones

 

o   Hydronephrosis in both

 

o   Hyaline casts à thyroidization

 

o   Globally sclerotic glomeruli + thickened vessels (from HTN)

 

o   Polyuria; nocturia

 

Term

 

·         Polyoma Virus (PV) Nephropathy

 

Definition

 

o   Immunosuppressed pt!

 

o   Inflam, epi cell necrosis, tubulitis, enlarged nuclei w/ viral inclusions

 

o   Immunostains red!

 

Term

 

·         Acute Drug-Induced Interstitial Nephritis (ATIN)

 

Definition

 

o   Triad: fever, eosinophilia, rash

 

o   IgE + T-cell mediated

 

o   HUGE SWOLLEN KIDNEYS!

 

Term

Analgesic Nephropathy

Definition

 

o   Papillary necrosis

 

o   Tubular atrophy

 

o   No inflam cells

 

o   Chronic tubulointerstitial nephritis

 

Term

 

·         Granulomatous prostatitis

 

Definition

From BCG used to tx bladder cancer

Term

 

·         BPH

 

Definition

 

o   Old dudes

 

o   5-alpha-reductase à DHT

 

o   Transitional zone (periurethral)

 

o   Increased PSA!!!

 

o   Nocturia, dysuria, start/stop probs.

 

Term

 

·         Prostate cancer!

 

Definition

 

o   Familial

 

o   Black dudes

 

o   Peripheral part of posterior zone

 

o   Adenocarcinomas w/ good gland formation; LACK BASAL CELLS!

 

o   Perineural invasion

 

o   Gleason!

 

o   BONE!

 

o   PIN = precursor lesion; HAS BASAL CELLS!

 

o   PSA > 4ng/ml might be bad maybe?

 

o   Free PSA >25% lowers risk of cancer

 

Term

Seminoma

Definition

 

§  + PLAP, c-KIT, OCT4

 

§  Sometimes + BHCG

 

§  Pale, soft, fleshy

 

§  30s-40s

 

§  Big clear cells w/ big nuclei

 

§  Fibrous septa!

 

Term

Spermatocytic Seminoma

Definition

 

§  Old dude

 

§  Small, Medium, Giant cells

 

§  Does NOT metastasize

 

Term

Embyronal Carcinoma

Definition

 

§  20s-30s

 

§  Hemorrhage, necrosis

 

§  Blue sheets (undifferentiated cells)

 

Term

 

o   Yolk Sac (endodermal sinus)

 

Definition

 

§  Babies! = pure

 

§  Adults = mixed (w/ embryonal)

 

§  Lacelike network of flat/cuboidal cells

 

§  Schiller Duval bodies = Saturn

 

§  AFP!!!

 

Term

Choriocarcinoma

Definition

 

§  Cytotrophoblast + Syncitiotrophoblast

 

§  BHCG!!!

 

§  Most aggressive! (Syncitio’s invade!!!)

 

§  Hemorrhage, necrosis

 

§  LUNG BRAIN

 

§  Aphrodite = orchiectomy

 

§  Athena = metastasis

 

Term

 

o   Teratoma

 

Definition

 

§  >1 germ layer

 

§  Mature elements = muscle, cartilage, squamous and glandular epithelium, brain (brain balls!)

 

Term

 

o   Leydig

 

Definition

 

§  Big balls and big boobs

 

§  Brown tumor

 

§  Pink granular cells

 

§  Reinke crystalloids

 

Term

Sertoli

Definition

 

§  Firm white nodules

 

Term

 

o   Condyloma accuminatum

 

Definition

 

·         Penis Tumors?

 

§  HPV 6, 11

 

§  Koilocytes

 

 

Term

CIS

Definition

Penis Tumors

 

§  HPV 16

 

Term

 

oPenis Tumors  Carcinoma

 

Definition

 

§  HPV 16, 18

 

§  Tobacco hurts!

 

§  Circumcision helps!

 

§  40s-70s

 

§  Squamous carcinomas

 

·         Papillary or flat

 

Term

 

·   

 

o   Verrucous

 

Definition

Penis Tumors

 

§  Giant

 

§  HPV 6, 11

 

§  Verrucous eats the penis!

 

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