Path: Kidneys

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1

what are the types of renal pathologic features that are common

congenital abnormailitiess
cysts
glomerular path
tubular/interstitial path
BV path
obstructions
tumors

2

what system develops into the human kidney and what are the general stages of that development

metanephric system (pronephros to mesonephros to mesonephric duct to metanephric (nephrons)

3

what organ does the kidney weigh about the same as

spleen

4

how much more does the liver weigh than the kidney or spleen

10x

5
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what are each of the labeled things

1. renal vein
2. renal artery
3. renal calyx
4. medullary pyramid
5. renal cortex
6. segmental artery
7. interlobar artery
8. arcuate artery (interlobular)
9. arcuate vein
10. interlobar vein
11. segmental vein
12. renal column
13. renal papillae
14. renal pelvis
15. ureter

6

what parts of the kidney are lined by transitional epithelium

none; this is urethra, bladder area epithelium

7

what type of carcinomas develop from the renal pyramids

renal cell carcinomas or clear celll carcinomas

8
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what are the different places where kidney disesaes can start

BV
glomeruli
tubules

9

if you see a linear array of dark cells in the kidney near the distal convoluted tubules, what should you think about

macula densa

10

where do glomerulonephropathies take place

basal lamina/basement membrane between podocytes (epithelial foot processes) and fenestrated capillary processes (endothelial cell processes)

11

what type of collagen is in the GBM?

type IV collagen

12

what comprises the visceral epithelium in the glomeruli

podocytes

13

what separates the vascular pole form the urinary pole of the glomerulus

basement membrane

14

where are mesangial cells likely to be found in the glomerulus

vascular pole

15

what is a secondary role of mesangial cells

contractility

16

what types of cells do you expect to see near the urinary pole

parietal epithelial cells

17

what cells are found within the glomerulus

mesangial cells
podocytes
epithelial cells
endothelial cells

18

what would fluid and electrolytes show in chronic renal failure

dehydration
edema
hyperkalemia
metabolic acidosis

19

what happens in calcium phosphate and bone in chronic renal failure

hyperphosphatemia
hypocalcemia
secondary hyper parathyroidism
renal osteodystrophy

20

what would hematologic effects look like in chronic renal failure

anemia
bleeding diathesis

21

what are the cardiopulmonary signs in chronic renal failure

hypertension
CHF
pulmonary edema
uremic pericarditis

22

what are GI signs of chronic renal failure

nausea and vomiting
bleeding
esophagitis
gastritis
colitis

23

what are the neuromuscular signs of chronic renal failure

myopathy
peripheral neuropathy
encephalopathy

24

what are dermatologic signs of chronic renal failure

sallow (greenish yellow color)
pruritis
dermatitis

25

what are the congenital renal defects common

agenesis
hypoplasia
ectopic
horseshoe

26

is renal agenesis compatible with life

no

27

what effect does renal hypoplasia have on the other kidney

it will be bigger to compensate

28

where is an ectopic kidney almost always located

pelvis (pelvic kidney)

29

what does the kidney look like at birth

lobulated

30
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what is shown abnormally in thie bone scan

ectopic/pelvic kidney

31

is a pelvic kidney more or less likely to be obstructed

mroe

32

what fuses in horseshoe kidney

lower poles

33

what would a horseshoe kidney look like histologically

continuous

34

are horseshoe kidneys normally asymptomatic? what is increased in icidence in horseshoe kidneys?

yse

incidence

35

what are the cystic diseases of the kidney inheritability-wise in adults and children

adults: autosomal dominant
kids: recessive

36

where are cystic diseases in the kidney

medulla

37

what are two kidney cystic diseases

medullary sponge kidney
nephronopthisis-medullary

38

are cystic diseases acquired

can be

39

what is characteristic of cystic renal dysplasia

enlarged kidneys either bilateral or unilateral with cysts

40

what gene mutations are associated with multicystic renal dysplasia

EYA1 or SIX1

41

what tissue is going to be present in cytsic renal dysplasia

mesenchyme

42
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what are these big clear areas

cysts

43

what are the modified genes of autosomal dominant cystic kidney disease

PKD1 and 2

44

when do people with autosomal dominant cystic kidney diseases experience renal failure

50s

45

when does autosomal recessive cystic renal dysplasia take place

childhood

46

what gene is altered in autosomal recessive cystic renal dysplasia

PKHD1

47

what do patients who survive childhood cystic renal dysplasia often develop

hepatic fibrosis

48
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what is this and what is the problem with it

medullary sponge kidney

49
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what is shown here

medullary sponge kidney

50

wher edoes nephronopthisis take place

corticomedullary junction

51

what does nephronopthsis normally result in

renal failure

52

what types of patienst usually have acquired cysts in the kidneys

patients on dialysis

53

what is another name for acquired cysts

retention cysts

54

where are simple cysts located

cortical region of kidney

55

are simple cysts acquired and also called retention cysts

yes

56

what leads to formation of a cyst

any obstruction (so as you get older, you will more commonly develop cysts

57

what is a glomerulonephropathy

any disease of the glomerulus

58

does glomerulonephritis always have inflammatory cells

no

59

what is almost always changed in a patient with glomerulonephritis

basement membrane (podocytes or endothelial changes)

60

what are some clinical manifestations of glomerular disease

acute nephrotic syndrome
rapidly progressing glomerulo
nephrotic syndrome
chronic renal failure
asymptomatic hematuria or proteinuria

61

what is the more common form of nephrotic syndrome

acute

62

what can rapidly progressing glomerulonephritis lead to

quick renal failure

63

what constitiues massive proteinura and indicates nephrotic syndrome

3 g proteinuria/day

64

what are the pathological manifestateinos of glomerulonephropathies

cellular proliferation
leukocyte inflammatino
crescents
basement membrane thickening
hyalinization
sclerosis

65

what is characteristic of rapidly progressing glomerulonephropathies

crescents

66

where is the key place to look for glomerulonerphropaties

basement membrane (thickenings, lumpy, spikes, hyalinization and sclerosis if bad enough)

67

what is the pathogenesis of glomerulonephropathies

Abs vs. inherent GBM
Ab vs. planted antigens
trapping of Ag-Ab complexes
Ab vs glomerular cells (mesangial cells, podocytes)
cell mediated immunity (sensitivtize T cells like in TB)

68

what would the antibody of the GBM be against

type 4 collagen

69

what would the trapping of the Ag-Ab complexes in glomerulonephropathies be an example of

type 3 hypersensitivity

70

besides the GBM, where else is an attractive place for the Ag-Ab complexes to accumulate

synovium
BVs
skin

71
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what are the extended processes on the side of the basement lamina

podocytes

72

where can glomerulonephropathies work

podocytes
BMs
endothelium

73

what are the mediators of glomerulonephropathies

neutrophils and monocytes
MP, T cells, NKCs
platelets
mesangial cells

74

what are mesangial cells related to in origin

MPs

75

what are mesangial cells related to in function

smooth muscle

76

what are the soluble mediators of glomerulonephropathies

cytokines
chemokines
coagulation factors

77

what glomerulonephropathy usually follows strep

acute glomerulonephritis

78

what can be signs of acute glomerulonephritis in post strep children

hematuria, azotemia, oliguria

79

what type of cellular changes will proceed in acute glomerulonephritis

hypercellular glomeruli
increaesd endothelium and mesangium

80

what will be present along GBM of acute glomerulonephritis afflicted people

IgG, IgM, C3 (focally)

81

how many people do NOT make a fully recovery from acute glomerulonephritis

5%

82

what leaks through GBM in people with acute glomerulonephrtisis

leakge of blood and protein

83

what is a visually descriptive word for acute glomerulonephritis

BUMPY

84
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what is this classic for

glomerulonephritis (inflammatory cells in glomeruli)

85
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what does this TEM show

bumps of Ig and complement deposits

86
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what is this indicative of and why

rapidly progressive glomerulonephritis because of the crescents on the outsid eof the glomerulus' urinary pole

87

what could cause rapidly progessive glomerulonephritis and thus be int he crescent looking thing aroud the glomerulus

anti-GBM Ab
immune complexes
anti-neutrophil Abs

88

what is characteristic of nephrotic syndrome

massive proteinuria
hypoalbuminemia
edema
lipidemia/lipidura

89

what is the key diagnostic of nephrotic syndrome

massive proteinuria=hypoalbuminemia

90

why do pepole with hypoalbuminemia get lipidemia

because they try to use lipids to pull fluids into the blood

91

what ar ehte three main things that cause nephrotic syndrome

membarnous, minimal change, focal segmental glomerulonephropathies

92

what things can sause membraneous glmoerulonephropathies

drugs
tumors
SLE
infections

93

what actually causes membranous glomerulonerphropathies

deposition of Ag-Ab complexes

94

what does indoletn

causing littlle or no pain, inactive or relativelyl benign

95

how many membraneous glomerulonephritis go to nephrotic syndrome

15%

96

what will post strep glomerulonephrotisi show in the basal lamina

lumpy bumpy Ag-Ab complexes

97

what will membranous glomeurlonephritis show in the basal lamina

spiky

98

what is the most common cause of nephrotic syndrome in children

minimal change glomerulonephritis

99

what is another name of minimal change glomerulonephritis

lipoid nephrosis

100

what will minimal change glomerulonephritis show in the basal lamina

effecement of foot processes

101

what is focal segmental glomerulo-sclerosis

focal, segmental and glomerulosclerotis

102
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what is going on here

focal-segmental glommerulosclerosis

103

what usually brings on focal segmental glomerulosclerosis

HIV
heroine
sickle cell
obesity

104

what is the most commmon cause of adult nephrotic syndrome

focal segmental glomerulo sclerosis

105

what can cause membranoproliferative glomerulonephritis

idiopathic
secondary to chronic immune diseases like Hep C, alpha 1 antitrypsin, HIV, malignancies

106

what happens with membranoproliferative glomerulonephritis

GBM and subendothelial alteraions
leukocyte infiltrations
predominant mesangial involvement

107

what happens with membranoproliferative glomerulonephritis' mesangium

hyperclellular

108

what is another name for IgA nephropathy

Berger Disease

109

what are the synmptoms of IgA nephropathy

mild hematuria and proteinuria
IgA deposits in mesangium

110

when does IgA nephropathy happen

a day or two after upper respiratory infection

111

what does IgA nephropathy damage

basement membrane

112

what is IgA nephropathy's damage mostly due to

deposits of IgA in mesangium

113
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what is this

IgA nephropathy

114

is the vascular or urinary pole more mesangial-concentrated

vascular

115

what are some hereditary hematuria syndromes

alport syndrome and thin GBM

116

what happens in alport syndrome

progressive renal failure
nerve deafness
various eye disorder
defective collagen IV

117

what happens in thin GBM disese

basement membrane is about half as uniformly thin as it should be

118

what does chronic glomerulonephritis result from

just about any of the previously described acute ones

119

what are the symptoms of chronic glomerulonephritis

thin cortex
hyalinized glomeruli
often seen in dialysis patients

120

what are a few secondary glomerulonephropaties

SLE
Henoch-Scholein purpura
bacterial endocarditis
diabetes
amyloidosis
goodpasture
wegener
myeloma

121

what are three main secondary glomerulonephropaties

SLE
diabetes
amyloidosis

122

what is amyloidosis of the kidney

deposits of proteins

123

what happens in goodpastrues

BM attacked in lung and kidney by Abs

124

what happens in SLE

many circulating Ag-Ab complexes sucked up by GBM

125

what does Wegener's disease involve

lung and URT (C-enca anti neutrophil Ab)

126

what cancers predispose the kidney to amyoloidis

multiple myeloma

127

histologically does kidney interstituum exist

no

128

what are the tubular disease of the kidney

acute tubular necrosis
tubulointerstitial nephritis
urate nephropathy
hypercalcemia/nephrocalcinosis
multiple myeloma

129

what part of the kidney is affected in ATN

tubules only

130

what immune cells are involved in acute pyelonephritis

neutrophils

131

what immune cells are involved in chronic pyelonephritis

MPs

132

what can happen in the kidneys with hyperparathyroidism

calcification

133

what proteins build up in the kidney tubules in multiple myeloma

bence-jones proteins (light chain kappa)

134

what is destroyed in ATN

renal tubular epithelium

135

what is lost in ATN

renal function (50% of acute renal failure)

136

what are the two types of acute tubular necrosis

ischemic
nephrotoic

137

what can cause nephrotoxic ATN

aminoglycosides
amphotericin B
contrast agents

138

where does transitional epithelium start in the urinary system

minor calyzes

139

are ischemic and nephrotoxic ATN mutually exclusive

no

140

what is more sensitive to ischemia, cortex or medulla

cortex

141
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what percentage of these tubules are PCT rather than DCT

98%

142
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what is the disease

acute tubular necrosis (karyolytic)

143

what is ATN pathogenesis for ischemic

blood flow

144

what is ATn pathogenesis for nephrotoxic

tubular injury

145

what is the clinical course of ATN

initiation, maintenance, and recovery

146

what do the clinical courses of ATN involve in the initiation and maintenance phases with urine and its composisiton

mild oliguria and azotemia to mroe oliguria and azotemia

147

when do you start needing dialysis in ATN

maintenance stage

148

what is the main problem in recovery of ATN

hypokalemia

149

what returns to normal in ATN

BUN and creatinie

150

what can cause tubulo/interstitial nephritis

infections (pyelonephritis)
toxins, heavy metals, chemo, NSAIDs
metabolic urates, Ca, oxalates
physical, obstruction, radiation
immunlogic

151

what is pyelonephritis

inflammation of tubules of kidney

152

what are renal transplant problems usually related to

tubular problems

153

where do renal cancers arise

tubules

154

what usually causes pyelonephritis

GI gram negavie bacteria (E coli, proteus, klebsiella, enterobacter, strep faecalis (normal flora))

155

is ascending infection the cause of pyelonephritis or descending

ascending

156

what is present in acute pyelonephritis

neutorphils

157

what is present in chronic pyelonephrotis

lymphocytes ands scars

158

where do renal infections arise

colon, lower UT, biliary tract

159
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what is this

acute pyelonephritis

160

what is the hallmark of chronic pyelonephritis

geographic pitting scars

161

what does pitting do to the cortex of chronic pyelonephritis

thins it out

162
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whats going on here

thyroidization in chronic pyelonephritis

163

what three non thyroid things can look like thyroid

chronic pyelonephritis in kidney
pars intermedia of anterior pituitary
lactation breast lobule

164

what is inspesation

hardening/gelification of the fluid (normally supposed to be in the tubules and has become proteinaceous

165

what are the main factors of urinary tract obstruction

congenital/acquried
instrumentation
vesicoureteral reflux
pregncny
age, sex
previous lesions
immunosuppression or immunodeficiency

166

what are the areas most susceptible to ureteric obstruction

ureteropelvic junction
pelvic brim
bladder inlet

167

what urine has a lot of bacteria in it

bladder

168

what is the problem with vesicoureteral reflux

it eventually will get to the kidneys

169

what drugs/toxins cause interstitial nephritis

synthetic penicillins
rifampin
thiazides

170

what hapens after intersitial nephritis

fever, eosinophilia, rash, and acute renal failure type of picture

171
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where is the primary inflamatory focus

interstituum, but it doesn't really mean anything because tubules and interstitum pretty freely exchange

172

what can cause analgesic nephropathy

aspirin
tylenol
nsaids

173

what kind of nephropathies are caused by analgeiscs

tubulointerstitial nephritis and papillary necrosis

174
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where does the necrotis process start here

in the papilae's proiminent dark area

175
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what has happened here

papillary necrosis

176

what happens in urate nephropathy

precipitation of uric acid crystals in the tubules, espeiclaly in a lower than usual pH situation (mini-tophus)

177
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how is this prepared

fixed in alcohol, then polarized filter, the bright blue shows sodium biurate

178

where do urate nephropathies build up

toe or kidney tubules (glomerulus)

179

what is hypercalcemic nephrocalcinosis due to

in extreme or uncontrolled or chronic hypercalcemia, calcium stones from the tubulo-insterstitum of the kidney, which can eventually lead to tubular obstruction and loss of function

180

what is metastatic calcification

tissue calcification due to hypercalcemia

181

what type of metastatic disease could also lead to hypercalcemia

metastatic diseaes involving the skeletal system (from bone lysis)

182

what is multiple myeloma's characteristics

Bence-Jones Proteinuria
amyloidosis

183
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what is boinb on here

amyloidosis

184

where will Bence Jones proteins be deposited in multiple myeloma

plated in tubules

185
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what type of stain is this and what is it trying to show

congo red stain (turns candy apple gree)

polarized light shows amyloidosis

186

what are the vascular diseases of the kidney

benign nephrosclerosis
malignant nephrosclerosis
renal artery stenosis
thrombotic microangiopatheis
thrombi, emboli, infarcts

187

what will just about all of the primary vascular diseases of the kidney result in

hypertension

188

if there is a more chronic pattern of hyalinizatino and fibrosis without active changes to the endothelium, is the disease likely to be benign or malignant

benign

189

where is renal artery stenosis likely to be located

near origin of renal artery

190

what is benign nephrosclerosis

sclerosis/hyalinzation of arterioles and small arteries

191

is benign nephrosclerosis common

yes very common

192

does benign nephrosclerosis lead to a clinical acceleration of hypertension or CNS incident correliation or morbidity or mortality

no

193
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what's going on here

benign nephrosclerosis

194
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what's going on here

benign nephrosclerosis

195

how much hypertension is associated with malignant nephrosclerosis

1-2%

196

what type of necrosis is associated with malignant nephrosclerosis

fibrinoid necrosis

197

what is the characteristic look of malignant nephrosclerosis

onion skinning, significant lumenal narrowing

198

are there extreme blood vessel elevations in malignant nephrosclerosis

yes

199

what gives malignant nephrosclerosis the look of an onion skin

disruption of endothelium and subendothelial tissues

200

what are the differences in cellularity of malignant and beningn nephorsclerosis

malignant: acellular and irregular
benign: still has fibroblasts

201
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what's going on here

malignant nephrosclerosis' fibrinoid necrosis and onion skinning

202
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what's going on here

malignant nephrosclerosis' fibrinoid necrosis and onion skinning

203

when someone has a smaller kidney what is a suspicion

renal artery stenosis

204

what is the usual cause of renal artery stenosis

atherosclerosis

205

what are the fibromuscular dysplasia growths of renal artery steonosis

intimal hyperplasia
medial hyperplasia
adventitial hyperplasia

206

who is fibromuscular dysplastic renal artery stenosis common in

younger women

207

will people with renal artery stenosis make aldosternoe

yes of course

208
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what type of renal stenosis is here

plaque/atherosclerosis

209
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what type of renal stenosis is here? what are the black stains?

fibromuscular dysplasia

external and internal elastic lamina

210
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how is the elastic lamina different in this picture than what should be

drastically increased in size

211

is there any calcium in fibromuscular dysplastic renal stenosis

no

212

what are some microangiopathies

hemolytic-uremic syndrome

thrombocytopenic purpura (idiopathic)

213

what are the types of hemolytic-uremic syndrome

familial
childhood
adult

214

what happens in hemolytic-uremic syndrome

small thrombi in the small BV of kidney especially around glomeruli which result in renal failure (from hemolytic process where RBCs lyse and platelets react to it

215

what is the platelet situation with hemolytic uremic syndrome

more of this, more platelet consumption

216

how does childhood hemolytic uremic syndrome start

kids usually have E. coli or diarrheal infection before this starts up

217

what happens to platelets in thrombotic thrombocytopenic pupura

platelets are consumed by small thrombi

218

what are teh common processes in microangiopathies

hemolysis
thromboses in renal capillaries
thrombocytopenia (consumption coagulopathy)
fibrin plugs

219

can fibrin plugs in small vessels be easily missed if a fibrin stain si not done, thinking it is blood

yep

220
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what is going on here in the upper left corner

atheroembolism

221

is sickle cell disease releated to vascular diseases of the kidney

yes

222
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what is going on in this picture

diffuse cortical necrossi

223

is a kidney's cortex or medulla mroe susceptible to ischemia

cortex

224
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what is going on here

diffuse cortical necrosis

225

what shape are most renal infarcts

wedge shaped and well delineated

226

what color are renal infarcts

white (anemic) and maybe a little yellow

227

do renal infarcts heal?

yes, with a scar

228

what is an anemic infarct

infarct that is grossly pale in the acute stage due to lack of collateral circulation

229

why would a renal infarct be a little yellow

MP infiltration

230
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what is different on either side of the yellow line

left is nucleated, east is not

231
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no nucleation, what is the diagnosis

acute cortical necrosis

232

what are the types of obstruction

urolithiasis
congenital
prostate enlargement
tumors
inflammatino
sloughed clots, papillae
pregnancy
neurogenic

233

upstream vs downstsream of the obstruction

upstream: buildup of pressure
downstream: doesn't get fed, can become atrophic, necrotic, or inflamed

234

how much of urolithiasis is calcium oxalate or phosphate

70% (increased Ca)

235

how much of urolithiasis is magnesum

20%

236

what usually provides the magnesum urolithiasis

bacterial infection

237

besides calcium and magnesiuum what can cause urolithiasis

increased uric acid

238

what are the benign tumors of the kidney

papillary adenoma
fibroma/hamartoma
angiomyolipoma
oncocytoma

239

what are the malignant tumors of the kidney

renal cell carcinoma
urothelial carcinoma

240

what do adenomas normally look like

papillary configuration and not huge; 2 cm or more differentiates benign from malignant

241

why do oncocytomas end up big and red

rich in mitochondria (think of chief cells and oxyphils of thyroid)

242
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how would you describe this tumor

papillary

243
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what type of tumor is this

angiolyomipoma

244
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what type of tumor is this

fibroma

245
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what type of tumor is this

oncocytoma

246

what is renal cell carcinoma related to

tobacco, hereditary, familila

247

what are most renal cell carcinomas

clear cell

248

what do clear cells look like grossly

yellow

249

where do renal cell carcinomas invade

strongly tend to invade renal vein early, because they kidney doesn't have lymphatics

250

what are the two commonest symptoms of renal carcinomas

pain and hematuria

251

would a renal cell carcinoma or urothelial carcinoma show earlier blood

urothelial

252
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what is going on here

clear cell carcinoma

253
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what is the abnormality here

left kidney is huge with a density

254

what is rule about renal cell carcinoma

very vascular

255

where does urothelial renal carcinoma start

in renal pelvis

256

are renal cell carcinomas or urothelial carcinomas more common

renal cell carcinomas

257

what do urothelial carcinomas look like compared to lower UT carcinomas

exactly the same

258

are urothelial carcinomas or renal cell carcinomas more likely to obstrcut and cause hematuria

urothelial

259

what other cancers are urothelial carcinomas associated with

ureter and bladder carcinomas

260

what is the origin of renal cell carcinomas

tubular in origin

261
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what is this

transitional carcinoma

262

where is the most likely place for transitional carcinoma

in the hilum

263

what is a primary pelvic tumor of the kidney until proven otherwise

transitional cell carcinoma

264

what are most transitional cell carcinomas

papillary

265
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what type of tissue is this

kidney tissue

266
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what kind of tissue is this? are there more proximal or distal tubules and how can you tell

kidney
proximal (MV)

267
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what pole is the vascular pole? what are the cells of the kidney

topmost part is the vascular pole

cells: podocytes, endothelial cells, mesangial cells

268
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what is going on here

benign nephrosclerosis: not malignant because no onion

269
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what possibly happened here

this is acute transplant rejection (remember acute cliincally

270
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what is going on here

acute tubular necrosis: normal glomeruli, tubules look acellular so this is acute tubular necorsis

271

are proximal or distal tubules more likely to be dead

proximal

272
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what is this tissue and what is wrong with it

kidney but infarcted (not many cells)

you can see a kind of a line between infarct and non-infarct

273
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what's up with this artery

narrow artery

dead glomerulus also present along iwth dead tubules

274
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what is going on here

tons of calcification: metastatic calcification

275
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what is this

rapidly progressing glomerulonephritis: glomerulus with a purple flower (not H and E stain)

276
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what type of tissue is this? diagnosis?

skin

scleroderma

277
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what is this diagnosis

cystic disease of kidney

278
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what is going on here

neutrophils everywhere: acute inflammation

279
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what is the weird area up top

could be necrotic crud or hematogenous pyelonephritis

280
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what is going on here

nephrocalcidosis due to metastatic calcium (microscopic calcifications)

281
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what are the black parts here

classical calcification

282
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what is this

renal cell carcinoma