Renal Exam 1 Image Questions

A. Benign prostatic hyperplasia Nodular would suggest cancer

An 80-year-old male presents with complaints of increased urinary urgency and frequency. A DRE reveals an enlarged, non-nodular prostate. What is the most likely diagnosis at this point? A. Benign prostatic hyperplasia B. Prostate cancer C. Diabetes insipidus D. Hyperthyroidism E. Urinary tract infection

D. Decreased glomerular capillary hydrostatic pressure

A renal artery stenosis causes a narrow renal artery. As a result which of the following changes would most likely take place? A. Increased renal blood flow B. Decreased renin release C. Increased glomerular filtration rate D. Decreased glomerular capillary hydrostatic pressure E. Decreased mean arterial pressure

A. Scarpa's B. Dartos C. Buck's D. Dartos E. Colle's F. Deep Perineal Facia G. Deep Perineal Pouch H. Superficial Perineal Space I. Superficial Perineal Fascia J. Deep Perineal Fascia

Label

C. This disease is associated with Anti-Nuclear Cytoplasmic Antibodies (ANCA)

Look at biopsy slides below. Which statement about this disease is INCORRECT: A. Plasmapheresis should be started to remove circulating antibodies B. This disease can be associated with pulmonary hemorrhage C. This disease is associated with Anti-Nuclear Cytoplasmic Antibodies (ANCA) D. This disease clinically presents as RPGN

Focal segmental glomerulosclerosis (FSGS) Sclerosis of some but not all of the glomerulus. In the affected glomeruli, a portion of the capillary tuft (segmental) is involved

Diagnose

High NaCl Intake

Diagnose

IgA Nephropathy (Berger Disease) Mesangial deposition

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IgA Nephropathy (Berger Disease) Mesangial deposition of IgA & C3

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Infusion of Isotonic NaCl

Diagnose

Kidney Stone

Diagnose

Left Kidney Stone

Diagnose

Membranoproliferative glomerulonephritis (MPGN) Double contour/ "tram-track" appearance of basement membrane

Diagnose

Membranoproliferative glomerulonephritis (MPGN) Glomeruli appear lobulated, large, & hypercellular

Diagnose

Membranous Glomerulonephritis (MGN) By light microscopy, diffuse thickening of the capillary wall

Diagnose

Membranous Glomerulonephritis (MGN) EM shows subepithelial GBM deposits, which eventually incorporate into the GBM & assume an intramembranous location

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Membranous Glomerulonephritis (MGN) Immunofluorescence reveals diffuse granular GBM staining for IgG

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Minimal Change Disease (MCD) Diffuse foot process fusion of podocytes

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Multicystic Dysplastic Kidney Presence of islands of undifferentiated mesenchyme with cartilage and immature collecting ducts

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Nephrotoxic acute tubular necrosis (ATN) -- AKI Tubular epithelial cells show extensive cytoplasmic vacuolar change

Diagnose

Obstruction in proximal left ureter

Diagnose

Oncocytoma Granular eosinophilic cytoplasm and a benign nucleus

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Oncocytoma markedly increased number of mitochondria

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Papillary Necrosis

Diagnose

Papillary type Renal Cell Carcinoma Papillary configuration lined by cuboidal columnar cells with psammoma bodies (round collection of calcium)

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Post-streptococcal glomerulonephritis Electron Microscopy shows characteristic subepithelial hump=shaped electron-dense deposits

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Post-streptococcal glomerulonephritis Enlarges & hypercellular glomeruli on light microscopy with interstitial edema & inflammation and red cell casts in the tubular lumen

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Post-streptococcal glomerulonephritis Immunofluorescence Microscopy shows glomerular C3 deposition in a "lumpy-bumpy" pattern

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Rapidly Progressive (Crescentic) Glomerulonephritis Note crescent formation

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Rapidly progressive (crescentic) glomerulonephritis

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Renal Cortical Adenoma papillary pattern

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SIADH (excessive ADH)

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Thin basement membrane disease Marked thinning of the glomerular basement membrane

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Type I Membranoproliferative glomerulonephritis (MPGN) Sub-endothelial immune complex deposition on electron microscopy

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Type I Rapidly Progressive (Crescentic) Glomerulonephritis (Goodpasture's) Immunofluorescence reveals linear depositions of IgG & C3 along the basement membrane

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Type II Membranoproliferative glomerulonephritis (MPGN) Linear dense deposit along the basement membrane

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Urate Nephropathy Finely fibrillar appearance of the uric acid crystals with adjacent fibrosis & atrophy of the renal parenchyma

Diagnose

Ureteric Stone

Diagnose

Vesicoureteral reflux

Diagnose

Water deprivation

Diagnose

A. 60, 40, 20

Which of the following sets of values correctly depicts the blood pressure (in mmHg) found at the arterial end of the glomerular capillary, a skeletal muscle capillary, and a peritubular capillary. (in that order) A. 60, 40, 20 B. 60, 20, 40 C. 20, 40, 60 D. 20, 60, 40 E. 40, 60, 20 F. 40, 20, 60

Acute tubular necrosis (ATN) -- AKI Dark pink regions showing ischemia

Diagnose

Autosomal dominant polycystic kidney (adult) Between the cysts there are relatively normal renal structures

Diagnose

Autosomal recessive polycystic kidney disease (childhood) Cysts are oriented with their long axis at right angles to the renal capsule

Diagnose

Bladder Stones

Diagnose

Bladder stone

Diagnose

Chromophobe Type Renal Cell Carcinoma Cells with pale eosinophilic cytoplasm around blood vessels

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Chronic Glomerulonephritis Global glomerular sclerosis with interstitial inflammatory cell infiltration

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Chronic interstitial nephritis Marked degree of interstitial fibrosis with mononuclear cell infiltration and tubular atrophy

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Chronic pyelonephritis Thyroidization of the kidney

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Clear Cell Type Renal Cell Carcinoma Rounded or polygonal cells with clear cytoplasm

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Collecting duct (Bellini duct) Renal Cell Carcinoma Tumor cells embedded in dense fibrous stroma

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Diarrhea

Diagnose

Diffuse Proliferative Glomerulonephritis Wire Looping of Capillaries

Diagnose

A. Superficial pouch Urine is accumulating on the shaft of the penis and into the scrotum.

A 21-year-old male presents to the ED after being pursued by the police following a DUI incident. While running from the police he fell and landed straddling a metal hand bar. Physical exam findings reveal contusions to his external genitalia. Imaging is attached. Where is the fluid most likely accumulating? A. Superficial pouch B. Deep perineal pouch C. Pelvic cavity D. Shaft of the penis E. Ischioanal fossa

D. 13 L

A 26-year-old male arrives at the emergency department with chief complaint of no longer being able to "Tank for Tua" and explains that being a Miami Dolphins fan is adversely affecting his life. Physical exam reveals no abnormalities. He is of average height and weight. What is the most likely interstitial fluid volume of this patient? A. 1 L B. 3 L C. 6 L D. 13 L E. 17 L

B. Varicocele Tortuous veins-- left testicular vein drains into the left renal vein. If there is HTN, there is a back up of blood into the testicle

A 30-year-old male presents to his primary care physician with the major complaint of difficulty conceiving with his wife. Physical examination reveals left testicular pain, a feeling of heaviness, and a clinically small left testis. A semen analysis reveals oligospermia. An ultrasound of the testes is shown below. What is the most likely diagnosis? A. Testicular torsion B. Varicocele C. Hydrocele D. Direct hernia E. Cancer

1. A. Perforated ulcer in the duodenum Black tarry stool indicates an upper GI bleed 2. IVC, Renal Vein/Artery

A 30-year-old male presents with the chief complaint of hematemesis and burning pain in his abdomen. History reveals there have been several episodes about 2 hours after eating for the past three days. When asked about his bowel habits he relates he has experienced black, tarry stools recently. Physical exam reveals the pain to be localized in the epigastric region. 1. What is the most likely diagnosis? A. Perforated ulcer in the duodenum B. Internal hemorrhoids C. Cholecystitis D. Appendicitis E. Diaphragmatic hernia 2. Endoscopy reveals an ulcer in the descending duodenum. If this perforates posteriorly, what is at immediate risk?

A. Normal glomerular filtration rate

A 43-year-old male is involved in a motor vehicle accident and loses a significant volume of blood. Paramedics record his blood pressure as 90/60 mmHg. His heart rate is 150 beats/min and his respiratory rate is 25 breaths/min. Which of the following physiological changes would you most likely anticipate (compared to his pre-injury status)? A. Normal glomerular filtration rate B. Increased peritubular capillary pressure C. Decreased Na+ reabsorption D. Increased renal blood flow E. Decreased glomerular filtration rate

D. Hydronephrosis Note fluid build up in the ureters bilaterally

A 43-year-old male presents to the clinic with the major complaint of increased urination. History is significant for increased urinary frequency, urgency, nocturia, for the last month. Imaging reveals the MRI below. What is the most likely diagnosis? A. Perinephric abscess B. Kidney stone C. Tumor D. Hydronephrosis E. Polycystic kidney disease

1. B. Psoas major 2. Yes, this is a Psoas Abscess, and it can compress the ureter as well as affect the fascia which is continuous with the renal fascia

A 45-year-old male presents to the clinic with left flank pain of 3 months duration. Physical examination reveals tenderness in the lower abdominal quadrant and left flank and a temperature of 101֯F. Attempted flexion of the left hip against resistance results in severe pain. Manual pressure at the left lower quadrant results in worsening of the pain in the left lower quadrant. 1. What structure is most likely exhibiting dysfunction? A. Aorta B. Psoas major C. Left kidney D. Stomach E. Spleen 2. Could this affect the urinary system?

B. DRG, T10-L1 Pain comes from the DRG and the kidney is innervated by T10-L1. The patient is in pain due to a left kidney stone

A 50-year-old male presents with the chief complaints of intermittent flank pain over the past 3-weeks. History reveals he does not drink water and drinks 12 cups of coffee a day. Urinalysis reveals hematuria. A radiograph of the abdomen reveals the image to the right. Where are the cell bodies located that are carrying the pain fibers? A. DRG, T1-L2 B. DRG, T10-L1 C. DRG, S2,3, 4 D. Aorticorenal ganglion E. Dorsal motor vagal nucleus

A. Lumbar The CT shows kidney cancer (lumpy kidneys), and the kidneys will drain to the Lumbar lymph nodes

A 55-year-old male presents to the clinic with the major complaint of hematuria. History is significant for weight loss. Physical examination reveals slight abdominal pain. An ultrasound reveals hydronephrosis. MRI reveals the accompanying image. What lymph nodes will most likely exhibit lymphadenopathy? A. Lumbar B. Internal iliac C. Celiac D. Superior mesenteric E. Phrenic

A. Perinephric abscess The renal fascia can get infected around the kidney

A 65-year-old male presents to the ED with left sided flank pain. Physical examination reveals a temperature of 102֯F. History is significant for a urinary tract infection in the last month and the patient reports dysuria over the last two weeks. Imaging reveals the MRI below. What is the most likely diagnosis? A. Perinephric abscess B. Kidney stone C. Kidney Tumor D. Hydronephrosis E. Pancake kidney

B. Hyperkalemia

A 67-year-old female arrives at her physician's office to be evaluated for a complaint of difficulty walking and carrying objects. She explains that she is often tired. EKG reveals tall peaked T-waves. Cognitive function is normal and no edema is noted. Which of the following electrolyte disturbances is most likely causing this patient's symptoms? A. Hypokalemia B. Hyperkalemia C. Hyponatremia D. Hypernatremia E. Hypercalcemia

Drug-induced interstitial nephritis

Diagnose

Filling defect in the left bladder (possible neoplasm or thrombus)

Diagnose

Filling defect in the left kidney (possible neoplasm or thrombus)

Diagnose

Acute tubular necrosis (ATN) -- AKI Focal loss of tubular epithelial cells (arrows) & partial occlusion of the tubular lumen by cellular debris (D)

Diagnose

Adrenal Insufficiency

Diagnose

Alport's syndrome On Electron microscopy, note irregular thickening of the basement membrane, and splitting of the lamina densa

Diagnose

Alport's syndrome On electron microscopy, Glomeruli show irregular thickening & splitting of basement membranes with basket-weaving

Diagnose

Angiomyolipoma mixture of thick walled vessels, smooth muscle & fat cells with a pleomorphic appearance

Diagnose

Acute pyelonephritis Massive inflammatory cell infiltration

Diagnose

Acute pyelonephritis Micro-abscesses

Diagnose

Accessory Renal Arteries

Diagnose

Acute Post-Streptococcal Glomerulonephritis (PSGN) "Lumpy-bumpy, starry sky, granular" Immunofluorescence

Diagnose

Acute interstitial nephritis Focal immune cell infiltrates, granuloma formation, & tubulitis

Diagnose

Female Urethra Lined by transitional epithelium with a thick and irregularly arranged muscle fiber bundles and loose connective tissue externally

Identify the Tissue

Male Urethra Lined by stratified columnar epithelium surrounded by dense connective tissue

Identify the Tissue

A. Gallbladder B. Kidney C. Kidney D. Renal Pelvis Light Blue Arrow: Pancreas Yellow Arrow: Renal Vein Red Arrow: Renal Artery Green Arrow: Inferior Vena Cava Diagnosis Megaureter: obstruction by accessory renal artery (this is why D is so large)

Identify the labels and diagnose

Macula Densa

Identify the region of the Juxtaglomerular Apparatus

Distal Convoluted Tubule No brush border, few microvilli with cell margins that are indistinct. Nucleus will be located along to apical surface and cells bulge into the lumen

Identify the region of the kidney

Proximal Convoluted Tubule Lines with simple cuboidal epithelium with central nucleus and contains a brush border with closely packed microvilli. There are large amounts of mitochondria

Identify the region of the kidney

Collecting Tubule and Duct A. Light cells: single cilium with short microvilli B. Dark (intercalated) Cells: dense cytoplasm with microplicae on apex

Identify the region of the kidney and the cells labelled

Renal Corpuscle (composed of the glomerulus and Bowman's Capsule)

Identify the region of the kidney shown

Renal Papilla (Medulla): apical portion of the pyramid

Identify the region of the kidney shown

A. Capsule: outer layer composed of dense connective tissue with inner layer composed of myofibroblasts (contractile tissue) B. Cortex: contains tubules

Identify the regions of the kidney shown

A. Kidney Lobe B. Cortex C. Medulla

Identify the regions of the kidney shown

Ureter and Urinary Bladder Transitional epithelium (umbrella cells) with a smooth muscle layer and tunica adventitia

Identify the tissue

Hyperacute Rejection Thrombi located in the glomerulus

What is the type of rejection is shown?

Hyperacute Rejection small artery is almost completely occluded by a fibrin thrombus

What is the type of rejection is shown?

Acute CELLULAR rejection Inflammatory cells in the interstitium & between epithelial cells of the tubules

What type of rejection is shown?

Acute HUMORAL rejection Necrotizing vasculitis with endothelial cell necrosis and proliferation of the smooth muscle cells in the intima

What type of rejection is shown?

Chronic rejection Arterial lumen is replaced by an accumulation of smooth muscle cells & connective tissue in the intima

What type of rejection is shown?