Bright's Disease and Kidney Pathologies

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Questions and Answers

Which of the following is NOT a type of glomerulopathy mentioned in the text?

  • Idiopathic nephrotic syndrome
  • Glomerulonephritis
  • Acute renal failure (correct)
  • Diabetic glomerulosclerosis

What is the primary characteristic of tubulopathies?

  • Lesions in the interstitial tissue of the kidney
  • Disturbances in glomerular filtration
  • Malformations of the kidney structure
  • Disturbances in the concentration, reabsorption and secretory functions of the tubules (correct)

Which of the following is an example of an acquired tubulopathy mentioned in the text?

  • Hereditary nephrotic syndrome
  • Alport syndrome
  • Familial nephropathic amyloidosis
  • "Myeloma kidney" (correct)

Which of the following is NOT mentioned as a type of kidney disease in the text?

<p>Renal artery stenosis (B)</p> Signup and view all the answers

What often completes the course of many kidney diseases and underlies chronic renal failure?

<p>Nephrosclerosis (A)</p> Signup and view all the answers

Which of the following is an example of a hereditary glomerulopathy mentioned in the text?

<p>Alport syndrome (A)</p> Signup and view all the answers

What group of kidney diseases is characterized by malformations of the kidney structure?

<p>Polycystic kidney malformations (B)</p> Signup and view all the answers

Which of the following statements is NOT true according to the text?

<p>Interstitial nephritis is a type of glomerulopathy. (D)</p> Signup and view all the answers

Which of the following is a characteristic of kidney diseases classified as tubulopathies?

<p>Disturbances in the concentration and reabsorption functions of the tubules (C)</p> Signup and view all the answers

Which one of the following was the main characteristic of Bright's disease according to the traditional classification?

<p>Dystrophy and necrobiosis of the renal tubule epithelium (D)</p> Signup and view all the answers

What was the main reason for the inability of the traditional Volgard-Fahr classification to meet the needs of modern nephrology?

<p>All of the above (D)</p> Signup and view all the answers

What was the main pathological process underlying nephrosis in most cases?

<p>Inflammation of the glomeruli (C)</p> Signup and view all the answers

Which of the following was not a component of the traditional Bright's disease classification?

<p>Pyelonephritis (D)</p> Signup and view all the answers

What was the main reason that glomerulonephritis was recognized as not being a single disease, but a group of diseases?

<p>All of the above (D)</p> Signup and view all the answers

Which of the following was not a traditional category of Bright's disease according to the Volgard-Fahr classification?

<p>Hypertrophy (A)</p> Signup and view all the answers

What was the main reason for the increased recognition of interstitial nephritis among kidney diseases?

<p>Improved understanding of the role of the renal interstitium (D)</p> Signup and view all the answers

What was the main new finding regarding the pathogenesis of nephrosis?

<p>Nephrosis is caused by primary damage to the glomerular filter (B)</p> Signup and view all the answers

What is the main role played by the β-hemolytic streptococcus in the causation of glomerulonephritis?

<p>Its nephritogenic types are the main causative agents. (C)</p> Signup and view all the answers

What is the most common way in which bacterial glomerulonephritis develops?

<p>As an allergic reaction to the infectious agent (A)</p> Signup and view all the answers

What is the main characteristic of hereditary glomerulonephritis or Alport's syndrome?

<p>Predominantly productive glomerular changes (A)</p> Signup and view all the answers

What is the role of cooling in the development of glomerulonephritis according to the text?

<p>Cooling increases the risk of developing glomerulonephritis after an infection. (A)</p> Signup and view all the answers

Which of the following is NOT mentioned as a causative agent of glomerulonephritis in the text?

<p>Enterococcus (C)</p> Signup and view all the answers

What is the main mechanism by which non-infectious agents like ethanol can cause glomerulonephritis?

<p>Through direct toxic effects on the glomeruli (A)</p> Signup and view all the answers

What is the main pathogenetic mechanism underlying immunologically caused glomerulonephritis?

<p>Deposition of immune complexes in the glomeruli (A)</p> Signup and view all the answers

Which of the following is NOT mentioned in the text as a common clinical presentation of hereditary glomerulonephritis (Alport's syndrome)?

<p>Acute nephritic syndrome (D)</p> Signup and view all the answers

What is the main reason for the seasonal variation in the incidence of glomerulonephritis according to the text?

<p>Increased incidence of infectious diseases in winter and spring (D)</p> Signup and view all the answers

What is the main reason why ethanol is mentioned as a causative agent of glomerulonephritis in the text?

<p>Ethanol can directly damage the glomerular structures (D)</p> Signup and view all the answers

Which term describes glomerulonephritis characterized by the presence of blood in the urine?

<p>Hematuric glomerulonephritis (D)</p> Signup and view all the answers

What is the primary difference between primary and secondary glomerulonephritis?

<p>Primary is unknown etiology, while secondary is known etiology. (B)</p> Signup and view all the answers

Which characteristic is used to classify glomerulonephritis according to its pathogenesis?

<p>Immunological determination (B)</p> Signup and view all the answers

What is a common extrarenal symptom associated with glomerulonephritis?

<p>Oliguria (B)</p> Signup and view all the answers

Which form of glomerulonephritis is characterized by high blood pressure?

<p>Hypertensive glomerulonephritis (B)</p> Signup and view all the answers

Which term refers to the presence of abnormal amounts of protein in the urine?

<p>Proteinuria (D)</p> Signup and view all the answers

What is the primary factor used to classify the course of glomerulonephritis?

<p>Chronology (B)</p> Signup and view all the answers

Which etiological factor is NOT associated with primary glomerulonephritis?

<p>Fungi (B)</p> Signup and view all the answers

Which feature distinguishes the hypertensive form of glomerulonephritis?

<p>Arterial hypertension (B)</p> Signup and view all the answers

What sign indicates the presence of abacterial glomerulonephritis?

<p>No relationship to infection (C)</p> Signup and view all the answers

What type of immune complexes are associated with the development of immune inflammation in the kidneys, reflecting an immediate hypersensitivity reaction in glomerulonephritis?

<p>Heterologous immune complexes (B)</p> Signup and view all the answers

Which type of hypersensitivity reaction occurs in renal glomeruli when the composition of immune complexes contains antigens from the body's own organs and tissues?

<p>Delayed-type hypersensitivity (D)</p> Signup and view all the answers

How are mesangial forms of glomerulonephritis primarily expressed in the context of hypersensitivity reactions?

<p>Delayed-type hypersensitivity (A)</p> Signup and view all the answers

Which mechanism is associated with the development of autoimmunity due to the presence of antirenal autoantibodies in glomerulonephritis?

<p>Antibody mechanism (C)</p> Signup and view all the answers

What is the most common morphology observed in glomerulonephritis associated with the antibody mechanism according to the text?

<p>Extracapillary proliferative (D)</p> Signup and view all the answers

In glomerulonephritis, what term is used to describe the development of autoimmunity as a result of the presence of antirenal autoantibodies?

<p>Autologous nephropathy (B)</p> Signup and view all the answers

Which form of glomerulonephritis is most frequently associated with the development of autoimmunity from antirenal autoantibodies?

<p>Membranous glomerulonephritis (D)</p> Signup and view all the answers

What type of morphological manifestations occur in renal glomeruli when exposed to autologous immune complexes in glomerulonephritis?

<p>Delayed-type hypersensitivity reactions (B)</p> Signup and view all the answers

What characteristic pathology is indicative of a delayed-type hypersensitivity reaction in mesangial forms of glomerulonephritis according to the text?

<p>Increase in inflammatory cells (B)</p> Signup and view all the answers

Which form of glomerulonephritis is less frequently associated with antirenal autoantibodies?

<p>Focal segmental glomerulosclerosis (A)</p> Signup and view all the answers

What is the primary morphological characteristic of intracapillary proliferative (productive) glomerulonephritis?

<p>Proliferation of endothelial and mesangial cells leading to enlarged, palmate glomeruli (D)</p> Signup and view all the answers

What is the main difference between intracapillary and extracapillary forms of glomerulonephritis?

<p>Intracapillary forms involve inflammation within the glomerular capillaries, while extracapillary forms involve inflammation in the glomerular capsule (B)</p> Signup and view all the answers

What is the primary histological characteristic that distinguishes extracapillary proliferative glomerulonephritis from other forms?

<p>Proliferation of cells of the glomerular capsule with formation of characteristic crescents (A)</p> Signup and view all the answers

Which of the following is NOT mentioned as a potential component of the pathological anatomy of glomerulonephritis?

<p>Glomerular component (D)</p> Signup and view all the answers

Which of the following is NOT a type of extracapillary glomerulonephritis mentioned in the text?

<p>Membranous (D)</p> Signup and view all the answers

What is the main morphological difference between intracapillary exudative and intracapillary proliferative glomerulonephritis?

<p>Intracapillary exudative involves infiltration with neutrophils, while intracapillary proliferative involves proliferation of mesangial cells (A)</p> Signup and view all the answers

What is the primary morphological characteristic that differentiates diffuse from focal glomerulonephritis?

<p>Diffuse forms involve the entire kidney, while focal forms are limited to certain areas (C)</p> Signup and view all the answers

Which of the following is NOT mentioned as a component of the pathological anatomy of glomerulonephritis?

<p>Neurological component (D)</p> Signup and view all the answers

What is the main difference between acute and chronic forms of glomerulonephritis according to the text?

<p>The pathological anatomy of acute and chronic forms are fundamentally different (C)</p> Signup and view all the answers

Which of the following is NOT mentioned in the text as a potential cause or contributing factor for glomerulonephritis?

<p>Streptococcal infection (C)</p> Signup and view all the answers

What is the primary mechanism underlying the development of acute glomerulonephritis according to the text?

<p>Antibody-mediated immune complex deposition (D)</p> Signup and view all the answers

Which characteristic cellular response is observed in the exudative phase of acute glomerulonephritis?

<p>Infiltration of neutrophils into the glomeruli (A)</p> Signup and view all the answers

What is the primary morphological feature that distinguishes the necrotizing form of acute glomerulonephritis?

<p>Fibrinoid necrosis of glomerular capillaries and arterioles (A)</p> Signup and view all the answers

What is the primary reason for the enlargement and swelling of the kidneys observed in acute glomerulonephritis?

<p>Inflammation and edema of the renal parenchyma (D)</p> Signup and view all the answers

Which phase of acute glomerulonephritis is characterized by a combination of glomerular cell proliferation and leukocyte infiltration?

<p>Exudative-proliferative phase (A)</p> Signup and view all the answers

What is the primary reason for the seasonal variation in the incidence of glomerulonephritis according to the text?

<p>Fluctuations in the prevalence of streptococcal infections (C)</p> Signup and view all the answers

Which type of immune complexes are typically involved in the pathogenesis of glomerulonephritis according to the text?

<p>Antigen-antibody complexes containing foreign antigens (A)</p> Signup and view all the answers

What is the primary histological feature that distinguishes extracampillary proliferative glomerulonephritis from other forms?

<p>Crescent formation in Bowman's space (B)</p> Signup and view all the answers

Which of the following is NOT mentioned in the text as a potential cause or contributing factor for glomerulonephritis?

<p>Environmental toxins (B)</p> Signup and view all the answers

What is the primary difference between primary and secondary glomerulonephritis according to the text?

<p>The presence or absence of systemic disease (B)</p> Signup and view all the answers

What is the main histological characteristic of extracapillary productive glomerulonephritis?

<p>Formation of crescents compressing the glomerulus (B)</p> Signup and view all the answers

Which cell type contributes to the appearance of half moon formations ('crescents') in subacute glomerulonephritis?

<p>Podocytes (C)</p> Signup and view all the answers

What plays a significant role in the transformation of epithelial 'crescents' into fibrous adhesions or hyaline fields?

<p>Accumulation of fibrin in the glomerular capsule (D)</p> Signup and view all the answers

What is a common feature in the pathological anatomy of subacute glomerulonephritis?

<p>Fibrin thrombi within capillary loops (A)</p> Signup and view all the answers

What characterizes the appearance of the kidneys in subacute glomerulonephritis?

<p>'Large mottled' or 'large red' kidney appearance (B)</p> Signup and view all the answers

Which term best describes the appearance of capillary loops in subacute glomerulonephritis?

<p>'Necrotic' (B)</p> Signup and view all the answers

What contributes to the progression from extracapillary productive changes to fibrous adhesions in subacute glomerulonephritis?

<p>Proliferation of fibroblasts in the capsule (A)</p> Signup and view all the answers

What contributes significantly to the development of fibrous adhesions or hyaline fields in subacute glomerulonephritis?

<p>'Atrophy' of tubules and fibrosis of stroma (B)</p> Signup and view all the answers

What is a key characteristic that distinguishes subacute glomerulonephritis from other renal conditions?

<p>'Crescentic' formations compressing the glomerulus (C)</p> Signup and view all the answers

What is the main characteristic that distinguishes mesangioproliferative glomerulonephritis from mesangiocapillary glomerulonephritis according to the text?

<p>Proliferation of mesangiocytes and expansion of the mesangium without significant changes in the glomerular capillary walls (D)</p> Signup and view all the answers

What is the main feature that distinguishes lobular glomerulonephritis from other forms of mesangiocapillary glomerulonephritis according to the text?

<p>Displacement and compression of capillary loops to the periphery (D)</p> Signup and view all the answers

What is the primary characteristic that distinguishes fibroplastic (sclerosing) glomerulonephritis from other forms according to the text?

<p>Sclerosis and hyalinosis of capillary loops and formation of adhesions in the capsule cavity (B)</p> Signup and view all the answers

What is the primary morphological difference between diffuse and focal fibroplastic (sclerosing) glomerulonephritis according to the text?

<p>Proportion of glomeruli undergoing fibroplastic transformation (C)</p> Signup and view all the answers

What is the primary reason for the reduced size and appearance of kidneys with diffuse fibroplastic glomerulonephritis according to the text?

<p>Pronounced dystrophic and atrophic changes in the tubules, stromal sclerosis, and vascular sclerosis (C)</p> Signup and view all the answers

What is the primary difference between mesangial glomerulonephritis and other forms of glomerulonephritis according to the text?

<p>Changes not only in the glomeruli, but also in the tubules and stroma (B)</p> Signup and view all the answers

What is the primary pathological process that underlies the development of chronic renal failure in mesangiocapillary glomerulonephritis according to the text?

<p>Pronounced proliferation of mesangiocytes and diffuse damage to the glomerular capillary membranes (B)</p> Signup and view all the answers

What is the primary reason for the appearance of yellow spots in the cortical layer of kidneys with mesangial glomerulonephritis according to the text?

<p>Pronounced dystrophic and atrophic changes in the tubules and stroma (D)</p> Signup and view all the answers

What is the primary mechanism underlying the development of chronic glomerulonephritis in 80-90% of cases?

<p>Deposition of immune complexes in the mesangium and/or subendothelial space (A)</p> Signup and view all the answers

What is the primary morphological feature that distinguishes the mesangioproliferative variant of mesangial glomerulonephritis?

<p>Interposition of mesangial processes between the endothelium and basement membrane (C)</p> Signup and view all the answers

What is the characteristic morphological feature of the mesangiocapillary variant of mesangial glomerulonephritis?

<p>Thickening and splitting of the glomerular basement membrane (A)</p> Signup and view all the answers

Which of the following is NOT a characteristic feature of chronic glomerulonephritis according to the text?

<p>It is typically accompanied by nephrotic syndrome (C)</p> Signup and view all the answers

Based on the information provided, which of the following statements is TRUE regarding the pathogenesis of chronic glomerulonephritis?

<p>The deposition of immune complexes triggers an inflammatory response (B)</p> Signup and view all the answers

Which of the following statements best describes the role of mesangiocytes in the pathogenesis of mesangial glomerulonephritis?

<p>They proliferate and produce excessive extracellular matrix, leading to expansion of the mesangium (B)</p> Signup and view all the answers

According to the information provided, which of the following is a potential consequence of the interposition of mesangial processes in mesangioproliferative glomerulonephritis?

<p>Thickening and splitting of the glomerular basement membrane (A)</p> Signup and view all the answers

Which of the following statements is TRUE regarding the fibroplastic (sclerosing) type of chronic glomerulonephritis mentioned in the text?

<p>It involves the formation of fibrous adhesions or hyaline fields in the glomeruli (D)</p> Signup and view all the answers

Based on the information provided, which of the following statements is NOT true regarding the pathogenesis of chronic glomerulonephritis?

<p>It is primarily caused by autoantibodies against renal antigens (C)</p> Signup and view all the answers

What is the primary reason for the granular nature of the surface of the kidneys in chronic glomerulonephritis?

<p>Presence of hypertrophied nephrons (C)</p> Signup and view all the answers

What is the microscopic appearance of glomeruli in the sunken areas affected by chronic glomerulonephritis?

<p>Scars (B)</p> Signup and view all the answers

What is the main morphological feature that distinguishes the protruding areas of glomeruli in chronic glomerulonephritis?

<p>Hypertrophied capsular epithelium (D)</p> Signup and view all the answers

Which histological characteristic is observed in arterioles in chronic glomerulonephritis?

<p>Hyalinization (B)</p> Signup and view all the answers

What is the main feature of the capillary loops in the protruding areas of glomeruli in chronic glomerulonephritis?

<p>Sclerosis (B)</p> Signup and view all the answers

Which of the following best describes the cortical substance of the kidneys affected by chronic glomerulonephritis?

<p>Thinned (B)</p> Signup and view all the answers

What is the primary color of kidney tissue observed in chronic glomerulonephritis?

<p>Anemic (C)</p> Signup and view all the answers

What characteristic is typical of the lumen of tubules in protruding areas affected by chronic glomerulonephritis?

<p>Expansion (A)</p> Signup and view all the answers

Which of the following is a common complication of chronic glomerulonephritis?

<p>All of the above (D)</p> Signup and view all the answers

What is the primary reason for the development of arterial hypertension in chronic glomerulonephritis?

<p>All of the above contribute to arterial hypertension (D)</p> Signup and view all the answers

Which of the following statements regarding the differential diagnosis of chronic glomerulonephritis and renal hypertension is true?

<p>The differential diagnosis presents great difficulties in cases with secondary wrinkling of the kidneys, arterial hypertension, cardiac hypertrophy, and vascular sclerosis (D)</p> Signup and view all the answers

What is the primary treatment option for prolonging the life of patients with chronic renal failure due to chronic glomerulonephritis?

<p>Dialysis and kidney transplantation (B)</p> Signup and view all the answers

Which of the following statements regarding the outcome of glomerulonephritis is true?

<p>The outcome of acute glomerulonephritis is usually favorable, while subacute and chronic forms have an unfavorable outcome (B)</p> Signup and view all the answers

Which of the following pathological changes is NOT associated with chronic glomerulonephritis?

<p>Tubulointerstitial nephritis (D)</p> Signup and view all the answers

What is the primary pathological process underlying the development of chronic renal failure in mesangiocapillary glomerulonephritis?

<p>Glomerulosclerosis (A)</p> Signup and view all the answers

Which of the following statements regarding the pathogenesis of glomerulonephritis is true?

<p>The pathogenesis of glomerulonephritis can involve both immediate and delayed-type hypersensitivity reactions, depending on the specific form (B)</p> Signup and view all the answers

What is the main etiology of acute renal failure according to the text?

<p>Poisoning with salts of heavy metals and acids (A)</p> Signup and view all the answers

Which condition is closely related to the development of acute renal failure?

<p>Any etiology of shock (B)</p> Signup and view all the answers

What is the primary mechanism underlying the development of necronephrosis as a type of acute renal failure?

<p>Dehydration and dechlorination (D)</p> Signup and view all the answers

Which severe infection is specifically mentioned as a potential cause of acute renal failure?

<p>Cholera (D)</p> Signup and view all the answers

What is a common complication that can lead to acute renal failure according to the text?

<p>Nephrolithiasis (A)</p> Signup and view all the answers

Which substance poisoning is NOT associated with the development of acute renal failure according to the text?

<p>Arsenic (B)</p> Signup and view all the answers

What is the main feature characterizing the kidneys in cases of 'sublimate kidney' due to mercuric chloride poisoning?

<p>Massive calcium deposits (A)</p> Signup and view all the answers

Which type of accumulations are characteristic of 'hemolytic kidneys'?

<p>Hemoglobin amorphous masses (C)</p> Signup and view all the answers

What is the primary characteristic of kidney morphology in cases of antifreeze poisoning?

<p>Calcium oxalate crystals (D)</p> Signup and view all the answers

What is the key complication associated with acute renal failure according to the text?

<p>Segmental or total necrosis of renal cortex (B)</p> Signup and view all the answers

What is the typical outcome in cases where acute renal failure leads to necrosis of the cortical substance of the kidneys?

<p>Death (A)</p> Signup and view all the answers

What may develop many years after acute renal failure and contribute to patients dying from chronic renal failure?

<p>Cicatricial wrinkling of the kidneys (B)</p> Signup and view all the answers

Which of the following is a common outcome in acute renal failure, as mentioned in the text?

<p>Partial structural damage with focal nephrosclerosis (A)</p> Signup and view all the answers

What is the primary role of nephrotoxic substances in the pathogenesis of acute renal failure?

<p>Direct effect on the basement membrane of tubules (A)</p> Signup and view all the answers

What contributes to the increase in edema and intrarenal pressure in acute renal failure?

<p>Tubulovenous reflux and tubule blockage (A)</p> Signup and view all the answers

What is a characteristic feature in the pathological anatomy of kidneys during the oligoanuric stage of acute renal failure?

<p>Distal tubular necrotic changes with hypoxic tissue damage (B)</p> Signup and view all the answers

Which statement best summarizes the histological changes observed in kidneys during the shock stage of acute renal failure?

<p>Collapsed glomerular capillaries and focal cortical ischemia (A)</p> Signup and view all the answers

What contributes to the predominantly venous plethora observed in kidneys during the shock stage of acute renal failure?

<p>Focal ischemia in cortical layer (C)</p> Signup and view all the answers

Which condition is NOT commonly observed in kidneys during the stage of recovery of diuresis in acute renal failure?

<p>Increased leukocyte infiltration and venous congestion (D)</p> Signup and view all the answers

What is a hallmark feature that distinguishes progressive edema from venous congestion in acute renal failure?

<p>Stagnation of glomerular ultrafiltrate in cavities (C)</p> Signup and view all the answers

Which feature contributes significantly to tissue hypoxia and anoxia as a result of elevated intrarenal pressure?

<p>Destruction of tubular basement membranes (D)</p> Signup and view all the answers

What is a key characteristic that differentiates the pathological anatomy of kidneys between the oligoanuric stage and diuresis recovery stage in acute renal failure?

<p>Necrotic changes predominantly in distal tubules (B)</p> Signup and view all the answers

What is the primary cause of acute renal failure according to the text?

<p>Intoxication and infection (C)</p> Signup and view all the answers

Which of the following substances is NOT mentioned as a potential cause of acute renal failure?

<p>Acetaminophen (D)</p> Signup and view all the answers

Acute renal failure is closely associated with which of the following conditions?

<p>Shock of any etiology (D)</p> Signup and view all the answers

Which of the following infections is NOT listed as a potential cause of acute renal failure?

<p>Influenza (D)</p> Signup and view all the answers

What is the term used in the text to describe the morphological characteristic of acute renal failure?

<p>Necrotizing nephrosis (B)</p> Signup and view all the answers

Which of the following conditions can lead to acute renal failure according to the text?

<p>All of the above (D)</p> Signup and view all the answers

What is the term used in the text to describe acute renal failure caused by massive hemolysis?

<p>Hemolytic kidney (A)</p> Signup and view all the answers

Which of the following conditions is NOT mentioned as a potential cause of acute renal failure in the text?

<p>Massive transfusion (D)</p> Signup and view all the answers

What is the term used in the text to describe acute renal failure caused by dehydration and dechlorination?

<p>Chlorohydropenic kidney (B)</p> Signup and view all the answers

Which of the following statements about acute renal failure is NOT true according to the text?

<p>It is always accompanied by glomerular damage (D)</p> Signup and view all the answers

What is the primary pathophysiological mechanism underlying the development of acute renal failure according to the text?

<p>Increased lymph flow with interstitial edema (A)</p> Signup and view all the answers

What is the main reason for the appearance of hemorrhages in the intermediary zone of the kidney in acute renal failure?

<p>Venous congestion (D)</p> Signup and view all the answers

Which of the following is NOT a common outcome associated with tubular obstruction in acute renal failure?

<p>Normal tubular reabsorption (D)</p> Signup and view all the answers

What is the primary pathological process that determines the possibility of inadequate tubular reabsorption in acute renal failure?

<p>Tubulovenous reflux (B)</p> Signup and view all the answers

What role does the direct effect of nephrotoxic substances circulating in the blood play in the pathogenesis of acute renal failure?

<p>Development of deep dystrophic changes (A)</p> Signup and view all the answers

What is the main reason for the increase in intrarenal pressure in acute renal failure?

<p>Interstitial edema (B)</p> Signup and view all the answers

Which characteristic pathology is indicative of significant tissue hypoxia and anoxia in acute renal failure?

<p>Progressive ischemia of cortical layer (C)</p> Signup and view all the answers

What is the main cause of inadequate tubular reabsorption leading to an increase in intrarenal pressure in acute renal failure?

<p>Tubulovenous reflux (A)</p> Signup and view all the answers

What is the primary complication resulting from progressive edema of the renal tissue in acute renal failure?

<p>Deep dystrophic changes (B)</p> Signup and view all the answers

What pathological anatomy feature distinguishes the stage of recovery of diuresis from other stages in acute renal failure?

<p>Full-blooded glomeruli (D)</p> Signup and view all the answers

What is the primary role of connective tissue in areas where tubular necrosis is accompanied by destruction of the basement membrane?

<p>Forming foci of sclerosis (C)</p> Signup and view all the answers

In acute renal failure due to mercuric chloride poisoning, what type of deposits appear in areas of necrosis?

<p>Calcium salt deposits (D)</p> Signup and view all the answers

What is the common pathological feature seen in 'hemolytic kidneys'?

<p>Hemoglobin cylinders (A)</p> Signup and view all the answers

Which substance is found as crystals in the lumen of tubules in cases of antifreeze poisoning?

<p>Calcium oxalate (D)</p> Signup and view all the answers

What is the severe complication of acute renal failure that involves segmental or total necrosis of the renal cortex?

<p>Necrosis of the renal cortex (D)</p> Signup and view all the answers

What is the main cause of death in patients who experience necrosis of the cortical substance of the kidneys?

<p>'Chronic renal failure' (B)</p> Signup and view all the answers

What condition can lead to death from uremia in patients experiencing acute renal failure?

<p>'Shock or oligoanuric stage' (A)</p> Signup and view all the answers

'Recovery with hemodialysis treatment' is common in acute renal failure. What is another possible outcome mentioned?

<p>'Death from uremia' (A)</p> Signup and view all the answers

'Hemodialysis treatment' is commonly used in acute renal failure. What can sometimes extend the life of patients despite this treatment?

<p>'Chronic renal failure' (D)</p> Signup and view all the answers

What is a possible long-term effect after 'acute renal failure' that could eventually lead to patient death?

<p>Cicatricial wrinkling (A)</p> Signup and view all the answers

What characteristic differentiates acute pyelonephritis from chronic pyelonephritis?

<p>Sclerosis and exudative-necrotic processes in chronic pyelonephritis (D)</p> Signup and view all the answers

What is a distinguishing feature of chronic pyelonephritis that indicates sclerosis and metaplasia?

<p>Flattened epithelium of tubules (D)</p> Signup and view all the answers

In chronic pyelonephritis, what contributes to the large-tuberous appearance of the kidneys?

<p>Scar tissue fields in the renal parenchyma (C)</p> Signup and view all the answers

Which feature distinguishes pyelonephritic nephrosclerosis from nephrosclerosis and nephrocyrrhosis?

<p>Formation of dense adhesions between kidney tissue and capsule (D)</p> Signup and view all the answers

What is a key morphological difference between acute and chronic pyelonephritis in terms of tubule lumens?

<p>Filled with colloid-like contents in chronic pyelonephritis (B)</p> Signup and view all the answers

What contributes to the variegated appearance of renal tissue in chronic pyelonephritis?

<p>Presence of yellow-gray areas surrounded by hemorrhage zones (C)</p> Signup and view all the answers

What causes the resemblance of the kidney to the thyroid gland in structure in chronic pyelonephritis?

<p>'Dystrophy and atrophy' of tubules (C)</p> Signup and view all the answers

Which histological feature characterizes a 'pyelonephritic wrinkled kidney' towards the end of chronic pyelonephritis?

<p>'Uneven cicatricial wrinkling' and adhesion formation (D)</p> Signup and view all the answers

'Metaplasia of transitional epithelium into stratified squamous' is a distinguishing feature of which type of kidney infection?

<p>'Lymphogenic pyelonephritis' (C)</p> Signup and view all the answers

'Fibrinous pyelitis' is typically observed in which phase or type of kidney infection?

<p>'Acute peak' of disease (B)</p> Signup and view all the answers

What is the primary distinguishing feature of tubulointerstitial nephritis?

<p>Predominant immuno-inflammatory lesion of the interstitium and tubules (A)</p> Signup and view all the answers

Which of the following is NOT listed as a potential etiological factor for tubulointerstitial nephritis?

<p>Hypercholesterolemia (A)</p> Signup and view all the answers

In acute tubulointerstitial nephritis, what type of cellular infiltrate is characteristic of the eosinophilic variant?

<p>Eosinophils (A)</p> Signup and view all the answers

What is the primary pathogenetic mechanism underlying tubulointerstitial nephritis, according to the text?

<p>Cellular immune cytolysis (A)</p> Signup and view all the answers

Which of the following best describes the outcome of chronic tubulointerstitial nephritis?

<p>Varying degrees of nephrosclerosis (B)</p> Signup and view all the answers

What is the primary route of infection in pyelonephritis, according to the text?

<p>Ascending from the lower urinary tract (B)</p> Signup and view all the answers

Which of the following conditions is NOT mentioned as a predisposing factor for ascending pyelonephritis?

<p>Hyperthyroidism (C)</p> Signup and view all the answers

Which of the following pathological changes is NOT mentioned as a characteristic feature of acute pyelonephritis?

<p>Formation of epithelioid cell granulomas (B)</p> Signup and view all the answers

What is the primary causative agent of pyelonephritis?

<p>Escherichia coli (C)</p> Signup and view all the answers

Which of the following mechanisms is NOT mentioned as contributing to the urogenic ascent of infection in pyelonephritis?

<p>Lymphatic spread (C)</p> Signup and view all the answers

Which of the following is a potential complication of acute pyelonephritis?

<p>Sepsis resulting from the purulent process (B)</p> Signup and view all the answers

What is the primary cause of papillonekrosis, a complication of pyelonephritis?

<p>Toxic effect of bacteria in conditions of urinary stasis (B)</p> Signup and view all the answers

In chronic pyelonephritis, what is a potential outcome associated with unilateral disease?

<p>Nephrogenic arterial hypertension and arteriolosclerosis in the intact kidney (D)</p> Signup and view all the answers

Which of the following is a potential outcome of acute pyelonephritis?

<p>Chronic kidney abscesses due to restriction of the purulent process (A)</p> Signup and view all the answers

What is a potential complication of chronic pyelonephritis with wrinkling of the kidneys?

<p>Chronic renal failure (D)</p> Signup and view all the answers

Which of the following statements is true regarding the outcome of acute pyelonephritis?

<p>The outcome is usually recovery, but severe complications can be life-threatening (B)</p> Signup and view all the answers

What is a potential cause of death in chronic pyelonephritis with nephrogenic arterial hypertension?

<p>Cerebral hemorrhage or myocardial infarction due to complications of hypertension (A)</p> Signup and view all the answers

Which of the following statements is true regarding the progression of the purulent process in acute pyelonephritis?

<p>It results in the fusion of large abscesses and the formation of a carbuncle of the kidney (B)</p> Signup and view all the answers

Which of the following is a potential complication of acute pyelonephritis mentioned in the text?

<p>Pyonephrosis (communication of purulent cavities with the renal pelvis) (C)</p> Signup and view all the answers

Which of the following statements is true regarding the pathogenesis of acute pyelonephritis?

<p>The purulent process leads to the transition of the process to the fibrous capsule (perinephritis) (C)</p> Signup and view all the answers

What is the primary mechanism underlying the development of chronic glomerulonephritis in 80-90% of cases?

<p>Formation of immune complexes leading to inflammation and tissue damage (C)</p> Signup and view all the answers

Which type of hereditary tubulopathy is characterized by a rickets-like disease or osteopathy?

<p>Tubulopathies manifested by a rickets-like disease or osteopathy (D)</p> Signup and view all the answers

What is the primary pathological process that underlies the development of chronic renal failure in mesangiocapillary glomerulonephritis?

<p>Proliferation of mesangial cells and thickening of capillary walls (C)</p> Signup and view all the answers

Which acquired tubulopathy is characterized by the presence of paraproteins obstructing the tubules?

<p>Myeloma kidney (D)</p> Signup and view all the answers

What is the primary mechanism underlying the development of acute renal failure according to the text?

<p>Inadequate tubular reabsorption leading to increased intrarenal pressure (C)</p> Signup and view all the answers

Which of the following is NOT a type of hereditary tubulopathy mentioned in the text?

<p>Tubulopathies associated with Fanconi syndrome (C)</p> Signup and view all the answers

Which type of hypersensitivity reaction occurs in renal glomeruli when the composition of immune complexes contains antigens from the body's own organs and tissues?

<p>Type III hypersensitivity reaction (D)</p> Signup and view all the answers

What is the primary role of nephrotoxic substances in the pathogenesis of acute renal failure?

<p>Causing direct damage to the tubular epithelium (D)</p> Signup and view all the answers

Which feature contributes significantly to tissue hypoxia and anoxia as a result of elevated intrarenal pressure?

<p>Compression of renal vasculature (A)</p> Signup and view all the answers

What is the primary morphological basis of chronic renal failure syndrome?

<p>Nephrosclerosis (wrinkled kidneys) (B)</p> Signup and view all the answers

What is the primary factor associated with uremia in chronic renal failure?

<p>Acidosis and electrolyte imbalance (B)</p> Signup and view all the answers

In which phase of nephrosclerosis are all structural elements of the kidney equally exposed to sclerosis?

<p>Second phase (A)</p> Signup and view all the answers

What is a common characteristic observed in the pathological anatomy of kidneys affected by uremia?

<p>Gray-earthy color and urochrome accumulation (C)</p> Signup and view all the answers

What is the primary cause of the development of hypoxic factors in nephrosclerosis?

<p>Blockage of renal blood flow at the arteriolar level (D)</p> Signup and view all the answers

Which feature is characteristic of kidneys affected by nephrosclerosis but not by chronic renal failure?

<p>Fine-grained wrinkling (B)</p> Signup and view all the answers

What contributes significantly to autointoxication and cellular metabolism disorders in uremia?

<p>Nitrogenous slags and electrolyte imbalance (D)</p> Signup and view all the answers

Which of the following is NOT a primary cause of nephrosclerosis mentioned in the text?

<p>Diabetes mellitus (A)</p> Signup and view all the answers

What is the primary distinguishing feature between the 'nosological' and 'syndromic' phases of the patho- and morphogenesis of nephrosclerosis?

<p>The 'nosological' phase involves a specific disease etiology, while the 'syndromic' phase involves a common pathological process. (D)</p> Signup and view all the answers

Which of the following is NOT mentioned in the text as a potential cause of secondary renal scarring leading to nephrosclerosis?

<p>Hypertension (A)</p> Signup and view all the answers

What is the primary morphological distinction between 'arteriolosclerotic nephrosclerosis' and 'atherosclerotic nephrosclerosis' mentioned in the text?

<p>Arteriolosclerotic nephrosclerosis affects the arterioles, while atherosclerotic nephrosclerosis affects the larger renal arteries (B)</p> Signup and view all the answers

What is the primary mechanism by which nephrosclerosis of any etiology leads to the development of chronic renal failure according to the text?

<p>Tubular atrophy and interstitial fibrosis (B)</p> Signup and view all the answers

What is the primary distinguishing feature between 'primary wrinkling of the kidneys' and 'secondary wrinkling of the kidneys' mentioned in the text?

<p>Primary wrinkling involves sclerosis of the renal vessels, while secondary wrinkling involves changes in the glomeruli, tubules, and stroma (B)</p> Signup and view all the answers

What is the primary characteristic of nodular hyperplasia and prostate adenoma?

<p>Bumpy surface (B)</p> Signup and view all the answers

What distinguishes glandular hyperplasia from musculo-fibrous and mixed forms of nodular hyperplasia?

<p>Increase in glandular elements (A)</p> Signup and view all the answers

In what age group are nodular hyperplasia and prostate adenoma most commonly observed?

<p>Men over 70 (C)</p> Signup and view all the answers

What is the main consequence of the middle part (lobe) of the gland protruding into the lumen of the bladder?

<p>Difficulty in urine outflow (B)</p> Signup and view all the answers

Which histological forms are distinguished in nodular hyperplasia?

<p>Glandular, stromal, and mixed forms (D)</p> Signup and view all the answers

What is a common feature of adenomatosis and polyps of the cervix?

<p>Benign nature (C)</p> Signup and view all the answers

What is a characteristic feature of benign breast dysplasia?

<p>Calcifications within tissue (D)</p> Signup and view all the answers

Which condition is NOT classified under dyshormonal diseases of the genital organs and mammary gland?

<p>Adenocarcinoma (A)</p> Signup and view all the answers

What is a notable feature observed in endocervicosis?

<p>Endometrial gland-like structures (D)</p> Signup and view all the answers

What is the primary characteristic of muscular-fibrous (stromal) hyperplasia of the prostate?

<p>The appearance of a significant number of smooth muscle fibers with atrophic glandular elements and disturbed lobulation (A)</p> Signup and view all the answers

What is a common complication of dyshormonal hyperplastic prostatopathy?

<p>Compression and deformation of the urethra and bladder neck, leading to obstructed urine flow (D)</p> Signup and view all the answers

What is the primary cause of glandular hyperplasia of the uterine mucosa?

<p>All of the above (D)</p> Signup and view all the answers

Which of the following best describes the microscopic appearance of glandular hyperplasia of the uterine mucosa?

<p>The glands are elongated, tortuous, saw- or corkscrew-shaped, with growth of the stroma and hyperplasia of its cells (B)</p> Signup and view all the answers

What is the significance of glandular hyperplasia of the uterine mucosa?

<p>It is a precancerous condition of the uterus (A)</p> Signup and view all the answers

What is the primary characteristic of endocervicosis?

<p>Accumulation of glands in the thickness of the vaginal portion of the cervix with a change in the epithelial layer covering them (B)</p> Signup and view all the answers

Which of the following is considered a precancerous condition of the cervix?

<p>All of the above (D)</p> Signup and view all the answers

What is the primary difference between cervical adenomatosis and endocervicosis?

<p>Cervical adenomatosis involves the accumulation of glandular formations under the integumentary epithelium of the vaginal part of the cervix, while endocervicosis involves the accumulation of glands in the thickness of the vaginal portion of the cervix (B)</p> Signup and view all the answers

What is the primary characteristic of cervical polyps?

<p>They are formed by prismatic mucus-forming epithelium and often occur in the cervical canal or vaginal part (A)</p> Signup and view all the answers

What is a common complication associated with dyshormonal hyperplastic prostatopathy?

<p>Secondary infection, cystitis, pyelitis, and ascending pyelonephritis (B)</p> Signup and view all the answers

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Study Notes

Classification of Kidney Diseases

  • Bright's disease was divided into three main groups: nephritis, nephrosis, and nephrosclerosis, but this classification is no longer used in modern nephrology
  • Kidney diseases can be classified into two main groups: glomerulopathies and tubulopathies, which can be both acquired and hereditary
  • Glomerulopathies involve primary and predominant lesions of the glomerular apparatus, characterized by disturbances in glomerular filtration
  • Tubulopathies involve primary and leading lesions of the tubules, characterized by disturbances in concentration, reabsorption, and secretory functions

Glomerulopathies

  • Glomerulonephritis is a disease of an infectious-allergic or unknown nature, characterized by bilateral diffuse or focal non-purulent inflammation of the glomerular apparatus
  • Renal symptoms of glomerulonephritis include oliguria, proteinuria, hematuria, cylindruria, and extrarenal symptoms include arterial hypertension, left heart hypertrophy, dysproteinemia, edema, hyperazotemia, and uremia
  • Classification of glomerulonephritis takes into account nosological affiliation, etiology, pathogenesis, course, and morphology
  • Primary glomerulonephritis can be classified into:
    • Immunologically determined glomerulonephritis (associated with immune complexes and/or antibodies)
    • Non-immunologically determined glomerulonephritis

Pathological Anatomy of Glomerulonephritis

  • Morphological changes in glomerulonephritis relate to the glomerular apparatus, tubules, stroma, and vessels
  • Glomerulonephritis can be classified into:
    • Intra- and extracapillary forms
    • Exudative, proliferative, and mixed forms
    • Diffuse and focal forms
  • Acute glomerulonephritis is characterized by hyperemia, infiltration of the mesangium and capillary loops by neutrophils, and proliferation of endothelial and mesangial cells
  • Subacute glomerulonephritis is characterized by extracapillary productive changes, proliferation of the epithelium of the capsule, and formation of "crescents"
  • Chronic glomerulonephritis is characterized by mesangial and fibroplastic changes, leading to sclerosis and hyalinosis of the glomeruli

Complications of Glomerulonephritis

  • Acute renal failure can be a complication of acute and subacute glomerulonephritis
  • Chronic renal failure is a complication of chronic glomerulonephritis
  • Cardiovascular insufficiency, cerebral hemorrhage, and death can also occur as a result of glomerulonephritis### Acute Renal Failure
  • Main link in pathogenesis is impaired renal hemodynamics, which is a reflection of general hemodynamic changes in shock
    • Leads to a spasm of cortical vessels and discharge of blood into the veins along the renal shunt
    • Reduced blood circulation in the kidneys causes progressive cortical ischemia and impaired renal lymph flow, leading to interstitium edema
  • Impaired renal hemodynamics leads to:
    • Deep dystrophic and necrotic changes in tubules of main sections
    • Rupture of tubular basement membrane (tubulorhexis)
    • Direct effect of nephrotoxic substances on epithelium, mainly affecting proximal tubules
  • Tubular necrosis and basement membrane rupture lead to:
    • Inadequate tubular reabsorption
    • Entry of glomerular plasma ultrafiltrate into renal interstitium
    • Increased edema and intrarenal pressure
  • Pathological anatomy:
    • Enlarged, swollen, edematous kidneys
    • Fibrous capsule is tense and easily removed
    • Wide pale gray cortical layer sharply demarcated from dark red pyramids
    • Hemorrhages often occur in the intermediary zone and pelvis
  • Histological examination:
    • Initial (shock) stage: sharp venous plethora of intermediary zone and pyramids, focal ischemia of cortical layer, and glomerular capillaries in a collapsed state
    • Oligoanuric stage: necrotic changes in tubules, destruction of basement membranes, and cylinders closing the nephron at different levels
    • Stage of recovery of diuresis: many glomeruli become full-blooded, edema and infiltration of the kidney are reduced

Etiology and Pathogenesis

  • Main causes of acute renal failure:
    • Intoxication
    • Infection
  • Acute renal failure is a syndrome morphologically characterized by:
    • Necrosis of the epithelium of the tubules
    • Profound disorders of the renal blood and lymph circulation
  • Pathogenesis is closely related to the mechanisms of shock of any etiology:
    • Traumatic, toxic, hemolytic, bacterial
  • Any shock stimulus capable of causing acute circulatory disorders, hypovolemia, and a drop in blood pressure can cause acute renal failure

Complications

  • Segmental or total necrosis of the renal cortex
  • Death from uremia, which often occurs in the shock or oligoanuric stage
  • Necrosis of the cortical substance of the kidneys usually ends in death, but life can be extended through hemodialysis
  • Many years after acute renal failure, cicatricial wrinkling of the kidneys may develop, leading to death from chronic renal failure

Interstitial Nephritis

  • Interstitial nephritis is a group of diseases characterized by:
    • Inflammation of the predominantly interstitial tissue of the kidneys
    • Involvement of the entire nephron in the process
  • Tubulointerstitial nephritis and pyelonephritis are of the greatest importance
  • Tubulointerstitial nephritis:
    • Predominant immuno-inflammatory lesion of the interstitium and tubules of the kidneys
    • Etiological factors:
      • Toxic (drugs, heavy metals)
      • Metabolic (hypercalcinosis, hypokalemia)
      • Radiation
      • Infectious (viruses, bacteria)
      • Immunological and sensitizing
      • Angiogenic (vasculitis)
      • Oncogenic (leukemia, malignant lymphomas)
      • Hereditary
  • Pathological anatomy:
    • Edema and infiltration of the interstitium of the kidneys by lymphocytes and macrophages
    • Formation of epithelioid cell granulomas
    • Necrotic changes in nephrocytes combined with dystrophic ones
    • Components of immune complexes (IgG, IgM, and C3) on the tubular basement membrane

Pyelonephritis

  • Pyelonephritis is an infectious disease involving:
    • Renal pelvis, its calyces, and the substance of the kidneys
    • Predominant lesion of the interstitial tissue
  • Etiology and pathogenesis:
    • Causative agents: various infections (E. coli, enterococcus, streptococcus, staphylococcus, proteus, etc.)
    • Microbes are brought into the kidneys by an ascending route from the ureters, bladder, urethra
    • Dyskinesia of the ureters and pelvis, increased intrapelvic pressure, and pyelovenous reflux contribute to the urogenic ascent of the infection
  • Pathological anatomy:
    • Enlarged, swollen, edematous kidneys
    • Fibrous capsule is tense and easily removed
    • Wide pale gray cortical layer sharply demarcated from dark red pyramids
    • Hemorrhages often occur in the intermediary zone and pelvis### Pyelonephritis
  • Pyelonephritis is an infection of the kidneys that can occur through the bloodstream (hematogenous descending pyelonephritis) or through the lymphatic system (lymphogenic pyelonephritis)
  • The development of pyelonephritis requires not only the penetration of the infection into the kidneys but also local causes that impair urine outflow and cause urinary stasis

Pathological Anatomy of Acute Pyelonephritis

  • Characterized by plethora and leukocyte infiltration of the pelvis and calyces
  • Foci of necrosis of the mucous membrane and a picture of fibrinous pyelitis
  • Edematous interstitial tissue with leukocyte infiltration and multiple small abscesses
  • The kidney is enlarged and swollen with a dull, hemorrhagic mucous membrane in the pelvis and calyces

Pathological Anatomy of Chronic Pyelonephritis

  • Characterized by a combination of sclerotic and exudative-necrotic changes
  • Sclerosis of the pelvis and calyces with lymphoplasmacytic infiltration and mucosal polyposis
  • Chronic interstitial inflammation with proliferation of connective tissue, encapsulation of abscesses, and macrophage resorption of purulent-necrotic masses
  • Dystrophy and atrophy of tubules with stretching and flattening of epithelium

Complications of Pyelonephritis

  • Acute pyelonephritis may lead to pyonephrosis, sepsis, and papillonekrosis
  • Chronic pyelonephritis may lead to nephrogenic arterial hypertension, arteriolosclerosis, and chronic renal failure

Chronic Tubulopathies

  • Include myeloma kidney and gouty kidney
  • Myeloma kidney: characterized by paraproteinemic nephrosis and blockage of the tubules by a low molecular weight protein
  • Gouty kidney: characterized by blockage of the interstitium and obstruction of the tubules by uric acid and its salts

Nephrosclerosis

  • Compaction and deformation of the kidneys due to the growth of connective tissue
  • Can be caused by hypertension, atherosclerosis, and chronic inflammatory and degenerative changes in the glomeruli, tubules, and stroma
  • Leads to chronic renal failure

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