Automatic bladder vs Autonomous bladder
Automatic bladder | Autonomous bladder |
Level of injury above S2 | Injury below / at S2 |
UMN type lesion | LMN type lesion |
Controlled by reflex center of bladder | Controlled by intrinsic plexus of bladder |
Emptying is involuntary | Emptying is voluntary |
Residual urine volume is minimal | Residual urine volume is large (200–300 cc) |
Malakoplakia:
- Gross: Yellow plaques in bladder mucosa (cystoscopy).
- Cause: Defect in phagocytosis.
- Macrophages unable to digest E. coli → Calcium deposits.
- Calcium deposits form:
- Michaelis Gutmann bodies (bluish concretions).
- Macrophages containing bodies:
- von Hansmann cell.
- Mnemonic:
- Malakoplakia → malak (pretham) → who doesnt fear malak → Hans (Hansmann) vacha gutt (Guttman) ulla man
- Hansman → Macrophage hans vakkunna pole calcium eduthu vakkum
- Guttman → he has gut bcz h has good bone → calcium
Urine Casts
Cast Type | Composition / Appearance | Clinical Association / Notes |
Hyaline Cast | Made of Tamm-Horsfall protein | Dehydration/fever |
RBC Cast | Hyaline cast + red cells | Glomerulonephritis IgA Nephropathy |
WBC Cast | Hyaline cast + white blood cells | Pyelonephritis Allergic Interstitial nephritis (↑ eosinophils) PSGN |
Granular Cast | Degenerated cast | Non-specific |
Muddy Brown Cast | Brown color | Acute Tubular Necrosis (ATN) (e.g., mercury, ethylene glycol poisoning). |
Broad Waxy Cast (Broad Cast) | Very broad | Chronic Renal Failure (CRF) |
Maltase Cross Cast | ㅤ | Fabrys disease, Nephrotic syndrome |
Lipid of Fatty cast | ㅤ | Nephrotic Syndrome |
Pigmented fine granular cast | ㅤ | Hemolysis Rhabdomyolysis |
Fractured cast | Not a urine cast | Appearance of biopsy tissue after fixation in Multiple myeloma |
Gout vs. Pseudogout
Feature | Gout | Pseudogout |
Crystal Deposition | Uric acid crystals | Calcium pyrophosphate dihydrate (CPPD) crystals |
Crystal Shape | Needle-like | Rhomboid-shaped → psudogout (P for Pseudogout → R for Rhomboid) |
Birefringence with Polarizing microscope | Negatively birefringent | Weakly positive birefringent (P for positive) |
Kidney Biopsy
DO NOT CONFUSE LAMIN AND LAMININ
Lamin
- Aka nuclear lamin → intermediate filament
- Disorder of premature ageing (Hutchinson Gilford)
- Functions
- Disassembly and reformation of the nuclear envelope during mitosis
- positioning of nuclear pores and apoptosis.
Laminin
- Extracellular glycoprotein
- Mnemonic: if 2 in present → big protein - glycoprotein
- highest concentration in basement membranes
- Functions
- cell adhesion, migration, and signalling
Gross Appearance Malignant : Flea Bitten Kidney
RPGN Type | IF Patterns | Conditions | Deposits |
1 | Linear | Goodpasture Syndrome | Linear IgA + C3 deposits in capillary wall |
2 | Granular | Adult PSGN, SLE, HSP | Starry Sky, Lumpy Bumpy |
3 | Pauci-immune | Wegener’s Granulomatosis (pANCA) Microscopic Polyangiitis (cANCA) | No deposits |
Other Causes of Flea Bitten Kidney
- Wegener's granulomatosis
- HUS/TTP/HSP
- SLE/SABE
- Malignant HTN
- PAN
- PSGN, RPGN
- Mnemonic:
- Hus () Sleepan (SLE) poyapo Vegetable (wegner) Panil (PAN) vachu → flea vann (flea btten) irunn → kandapo BP (HTN) kuudi
Onion Skin Appearance:
- Mnemonic:
- Onion → PSC exam
- PSC (Primary Sclerosing) kk padikan Sleep (SLE, Spleen) kalanj Tea (Tay) kudich BP (HTN) kuutti → Kidappilayi (CIDP)
- but Wings (ewing) vannu
- Lysosomes with onion-skin appearance - Tay sach’s
- Paccinian corpuscles
- Seen in:
- Chronic inflammatory demyelinating polyneuropathy (Biopsy)
- Primary sclerosing cholangitis (Biopsy)
- SLE, spleen (Gross)
- Ewing's sarcoma (X-ray)
- Tay sach's disease (Electron microscopy)
- Malignant hypertension (Biopsy).
Benign Hypertension
Associated Condition | Benign Hypertension | Malignant Hypertension |
Feature | Benign Nephrosclerosis | Malignant Nephrosclerosis |
Histological Finding | Pink, homogenous hyaline thickening of vessel wall | Concentric laminated thickening of vessel wall |
Appearance/Result | Luminal narrowing | Onion skin appearance |
Made with Bullet