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Pathology 2 - Final - Part 1

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davidwurbel7's version from 2016-08-05 16:11

Renal

Question Answer
This part of the kidney is susceptible to ischemia due to reduced blood supplyMedulla
Site where blood constituents are filtered through to the kidney tubules for excretion or reabsorptionGlomerulus
Produces the enzyme reninJuxtaglomerular Apparatus
The presence of increased creatinine and urea nitrogen in the blood is an indication of thisImpaired Kidney Function
Increased creatinine and urea nitrogen in the blood is called thisAzotemia
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(Insert 19-24)
Question Answer
This gets partly reabsorbed in the proximal tubuleBUN
BUN gets partly reabsorbed hereProximal Tubule
This is filtered in the kidney and not reabsorbed or secretedCreatinine
The cause of acute renal failure is before the kidneyPrerenal Azotemia
The cause of acute renal failure is in the kidneyIntrarenal Azotemia
The cause of acute renal failure is after the kidneyPostrenal Azotemia
Urine production is a day is < 100 mLAnuria
Urine production in a day is < 400 mLOliguria
Prerenal azotemia is usually due to thisDecrease Blood Flow
Post renal azotemia is usually due to thisUreter Obstruction (Stone)
Increased tubular pressure forces BUN (not creatinine) into the blood. Disproportinate increase in urea increases ratio (serum BUN:Cr ratio >15)Early Stage Obstruction
Tubular function remains intact at this stageEarly Stage Obstruction
Tubular damage occurs, resulting in decreased absorption of BUN (serum BUN:Cr ratio <15). Decreased re-absorption of Na (FE Na>2%) and inability to concentrate urine (Urine Osm <500)Late Stage Obstruction
The most common cause of intra-renal azotemiaAcute Tubular Necrosis
Tubular necrosis due to lack of blood flowIschemic Tubular Necrosis
Tubular necrosis due to highly toxic substancesNephrotoxic Tubular Necrosis
Characterized by injury and necrosis of tubular epithelial cells. Necrotic cells plug tubules causing obstruction which leads to a decrease in GFRAcute Tubular Necrosis
The necrotic tubular plugs are seen as this in the urineBrown Granular Casts
Most often caused by Reduced renal perfusion. Decreased blood supply results in necrosis of tubular epithelial cells. Often preceded by pre-renal azotemiaIschemic Tubular Necrosis
The most common cause of nephrotoxic acute tubular necrosisAminoglycosides (Gentamycin)
Causes of this include Aminoglycosides, Heavy metals (lead, mercury), Myoglobinuria, Ethylene glycol and UrateNephrotoxic Tubular Necrosis
Proximal tubules and medullary segment of thick ascending limb are susceptible to this type of damageIschemic Damage
Clinical features include an abrupt rise in BUN and creatinine after a hypotensive episode, sepsis, rhabdomyolysis or administration of a nephrotoxic drug, Oliguria with brown granular cast, Hyperkalemia and Metabolic acidosisAcute Tubular Necrosis
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Labs
Question Answer
Normal range of this is 7 to 18mg/dLBUN
Normal range of this is 0.6 to 1.2mg/dLCreatinine
Normal ratio is 15 or lessSerum BUN:Creatinine Ratio
FENa: <1 U Na (mEq/L): <40 Uosm (mOsm/kg: >500 BUN:Cr ratio: >15 Urinalysis: Few hyaline casts Pre-renal Azotemia
FENa: <1 U Na (mEq/L): <40 Uosm (mOsm/kg: >500 BUN:Cr ratio: >15 Urinalysis: RBC casts, hematuriaAcute Glomerulonephritis
FENa: >1 U Na (mEq/L): >40 Uosm (mOsm/kg: <350 BUN:Cr ratio: <15 Urinalysis: Renal tubular cast, renal tubular cellsAcute Tubular Necrosis
FENa: >1 U Na (mEq/L): >40 Uosm (mOsm/kg: <350 BUN:Cr ratio: <15 Urinalysis: Renal tubular cells, no castsPostrenal Azotemia
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Congenital Kidney Disorders

Question Answer
Features seen here are abnormal ear lobation, micrognathia, and flattened nasal tip, pulmonary hypoplasia and musculoskeletal anomaliesRenal Agenesis
Hypo-plastic lungs, flat face with low set ears, and developmental defects of the extremitiesPotter sequence
Fusion of the kidneys. Majority are fused at the lower pole. Kidney is abnormally located in the lower abdomen. The kidney gets trapped behind the inferior mesentric arteryHorseshoe Kidney
This structure traps the horseshoe kidney in the lower abdomen as it tries to ascendInferior Mesentric Artery
Increased incidence with Turner’s syndrome. Danger of infection and stone formationHorseshoe Kidney
Cystic disease in which the majority of cysts are present in the medullaMedullary Cystic Kidney Disease
An inherited defect leading to bilateral enlarged kidney with cysts in renal cortex and medullaPolycystic Kidney Disease
Polycystic kidney disease inherited in an autosomal dominant mannerAdult polycystic kidney disease
Polycystic kidney disease inherited in an autosomal recessive mannerJuvenile polycystic kidney disease
Mutation of PKD1 gene on chromosome 16Adult polycystic kidney disease
Massive bilateral kidney enlargement due to presence of cysts. Cysts replace the normal renal parenchyma. Bilaterally palpable kidneysAdult polycystic kidney disease
In adult polycystic kidney disease the origin of the cyst is thisRenal Tubular Dilatation
Clinical findings include asymptomatic with normal renal function until adulthood and then present with, hypertension, hematuria and worsening renal failure. Flank mass, flank pain by 40-60 years Chronic renal failure developsAdult polycystic kidney disease
Extrarenal manifestations include Cysts in liver and pancreas. Berry aneurysms due to hypertension. Sigmoid diverticulosis ( diverticulitis / hematochezia). Mitral valve prolapseAdult polycystic kidney disease
The most common extrarenal manifestation of Adult polycystic kidney disease is thisLiver Cyst
Patients with Adult polycystic kidney disease are at risk for developing thisRenal Cell Carcinoma
Clinical manifestations present in infancy with hypertension and progressive renal failure. Oligohydraminos is present in the mother. Newborns have Potters faciesJuvenile polycystic kidney disease
The most common renal cystic disease in childrenRenal dysplasia
Congenital malformation of the renal parenchyma characterized by cysts and presence of cartilage and immature collecting ductsRenal Dysplasia
Most cases presents as unilateral flank painRenal Dysplasia
The presence of this in the kidney suggests renal dysplasiaCartilage
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Renal Tumors and Obstructive Disorder

Question Answer
Are hamartomas composed of Blood vessels, smooth muscle and adipose tissueAngio-myolipoma
Angio-myolipoma occurs in patients with this condition which has the features of Mental retardation, Multisystem hamartomas, Skin lesions and Rhabdomyoma of heartTuberous Sclerosis
a malignant tumor arising from epithelial cells of renal tubulesRenal cell carcinoma
Renal cell carcinoma is also called thisRenal Cell Adenocarcinoma
Hereditary form of renal cell carcinoma is associated with this genetic conditionvon-Hippel-Lindau Syndrome
Clinical findings include Hematuria, flank mass and costovertebral angle pain. Fever, weight loss and paraneoplastic syndromes may also occurRenal cell carcinoma
The single most common presenting sign of renal cell carcinoma is thisHematuria
Renal cell carcinoma producing EPO will produce this paraneoplastic syndromeSecondary Polycythemia
Renal cell carcinoma producing Parathyroid hormone related peptide (PTHrP) will produce this paraneoplastic syndromeHypercalcemia
Renal cell carcinoma producing renin will produce this paraneoplastic syndromeSecondary Hypertension
Renal cell carcinoma of the left kidney may present with this due to blockage of the left renal veinLeft Testicular Varicocele
Composed of sheets of cells trying to form tubules. Cells have a clear cytoplasmRenal Cell Carcinoma
Renal cell carcinoma most commonly arises from this part of the kidneyUpper Pole of the Kidney
Renal cell carcinoma most commonly spread to this vesselRenal vein
Renal cell carcinoma most commonly spread to this organLung
Renal cell carcinoma can spread to the bone causing this type of bone lesionsOsteolytic Lesion
The most common type of cancer of the renal pelvisTransitional Cell Carcinoma
Cancer of the renal pelvis due chronic infection and long standing renal stonesSquamous Cell Carcinoma
Malignant tumor of the kidney presenting in childrenWilms Tumor
Wilms Tumor is also called thisNephroblastoma
Malignant tumor comprised of blastema (immature kidney mesenchyme), primitive glomeruli and tubules and Stromal cellsWilms Tumor
Clinical findings presents as a large, Unilateral palpable flank mass in a child with hypertension and hematuriaWilms Tumor
Wilms Tumor most common site for metastasis is hereLungs
Associated with WT1 gene mutationWilms Tumor
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Labs
Question Answer Column 3
Red cell mass: Elevated RBC Count: Elevated EPO: Decreased Plasma VolumeElevatedPolycythemia Vera
Red cell mass: Elevated RBC Count: Elevated EPO: Increased Plasma VolumeNormalRenal Cell Carcinom
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Obstructive Disorders
Question Answer
Dilatation of renal pelvis and calyces with atrophy of the kidney due to obstruction to flow of urineHydronephrosis
The most common cause of Hydronephrosis is thisRenal Stones
Dilated ureter and renal pelvis with compression atrophy of renal medulla and cortexHydronephrosis
Hydronephrosis that is frequently asymptomaticUnilateral Obstruction
Hydronephrosis that presents as acute renal failure (postrenal azotemiaBilateral Obstruction
The most common type of stones in adults is this type of stonesCalcium Oxalate Stones
The most common type of stones in children is this type of stonesCalcium Phosphate Stones
These stone are radiolucentUric Acid Stones
These crystals look like little envelopes or tetrahedrons, depending upon your point of viewCalcium Oxalate Crystals
Usually fill the pelvis and calyces to form a cast of these spaces called Stag-horn calculusMagnesium ammonium phosphate stones
This stone is most commonly caused by infection of ProteusMagnesium ammonium phosphate stones
Urine smells like ammonia and has an alkaline pHMagnesium ammonium phosphate stones
These crystals look like rectangles, or coffin lidsMagnesium ammonium phosphate crystals
Risk factors include Hot arid climate, low urine volume and acidic pH. Most common stone seen in patients with gout. Hyperuricemia increases riskUric Acid Stone
Can only be seen with ultrasound or CT scanUric Acid Stone
These crystal have a rhomboid shapeUric Acid Crystal
Very rare. Most commonly seen in children and is associated with hereditary cystinuriaCysteine stones
These crystal have a hexagonal shapeCysteine Crystals
Clinical findings include colicky flank pain with radiation into ipsilateral groin and HematuriaRenal Stones
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Glomerular Structure

Question Answer
Primary function is support of the glumerular capillaries. Contractile- help control blood flow. Can proliferateMesangial cells
One of the cells of glomerular filtration barrier. Help form the filtration apparatus due to fenestrations. Contribute to production of glomerular basement membraneCapillary endothelial cells
One of the cells of glomerular filtration barrier. Help form the filtration apparatus due to their interdigitating foot process that form slit pores. Serve as distal barrier for preventing protein loss in the urine.. Primarily responsible for production of GBMVisceral epithelial cells (podocytes)
Lines the interior of Bowman’s capsule. Proliferation of these cells results in formation of crescents that destroy the glomerulusParietal epithelial cells
Composed of type IV collagenGlomerular basement membrane
Characteristic finding in anti-GBM disease for example - Goodpasture syndrome. Antibodies line up against evenly distributed antigens in the GBMLinear pattern Immunofluorescence
Linear pattern Immunofluorescence is diagnostic of this conditionGoodpasture Syndrome
Granular irregular deposits in the capillaries. Usually indicates immunocomplex (IC) deposition in the glomerulusGranular Pattern Immunofluorescence
Granular Pattern Immunofluorescence is suggestive of thisImmunocomplex (IC) Deposition
Used to detects submicroscopic defects in the glomerulus. Detects the site of IC depositionElectron microscopy
Deposition between the endothelium and the GBM closer to the endotheliumSubendothelial
Deposition between the endothelium and the GBM closer to the podocytesSubepithelial
Deposition within the GBMIntramembranous
Deposition between the mesangial cells and the basement membrane Mesangial
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