06-03-23 - Pathology of the kidney, ureters and bladder 2 Flashcards
Learning outcomes
- cause and effects of renal calculi
- common tumours of urinary tract
- cause and effects of renal failure
- principles of renal replacement therapy
What are urinary calculi?
What are 2 types of urinary calculi?
What is renal colic?
What are 5 conditions associated with urinary calculi?
- Urinary calculi are kidney stones, which are hard deposits made of minerals and salts that form inside your kidneys.
- Urinary calculi can be acute or chronic
- Renal colic is pain that may occur when a stone gets stuck in part of your urinary tract
- 5 conditions associated with urinary calculi:
1) Haematuria
2) Pyelonephritis (kidney infection)
3) Obstructive uropathy
4) Hydronephrosis
* Condition where one or both kidneys become stretched and swollen as the result of a build-up of urine inside them
5) Post-renal renal failure
What 4 substances can calculi be made from?
What are 5 risk factors for calculi?
- 4 substances calculi can be made from:
1) Calcium – 75%
* Can be calcium oxalate/phosphate
2) Uric acid – 20+%
3) Infection
* Proteus species
4) Cystine – 1%
* Can be due to metabolic disorders, such as cystinuria
- 5 risk factors for calculi:
1) Hypercalcaemia
* E.g from sarcoidosis, Renal tubular acidosis, hyperparathyroidism
2) Gout
* Excess uric acid
3) Obstruction
* E.g vesico-ureteric reflux
4) Genetic
5) Dehydration
What are 5 potential features of bladder disease?
How can inflammation present in bladder disease histology?
- 5 potential features of bladder disease:
1) Inflammation
* Acute cystitis that could be caused by infection
* Cystitis is a urinary tract infection (UTI) that affects the bladder
2) Infection
3) Calculi
4) Neoplasia
* An abnormal mass of tissue that forms when cells grow and divide more than they should or do not die when they should.
* Neoplasms may be benign (not cancer) or malignant (cancer).
* Benign neoplasms may grow large but do not spread into, or invade, nearby tissues or other parts of the body.
5) Muscular hypertrophy
* Inflammation in bladder disease histology can present with capillaries stuffed with neutrophils and some cells falling apart, which is known as spongiosis with oedema
What is the most common type of bladder neoplasm?
What is the most common type of renal neoplasm?
What are 4 types of Less common or rare urinary tract tumours?
- The most common type of bladder neoplasm is urothelial (transitional cell) carcinoma
- The most common type of renal neoplasm are clear cell carcinoma (ccRCC) (4/5 cases)
- 4 types of Less common or rare urinary tract tumours:
1) Renal carcinomas other than clear cell including transitional cell
2) Renal nephroblastoma (Wilms’ Tumour)
3) Ureter transitional cell carcinoma
4) Renal/bladder sarcoma
What groups does Renal nephroblastoma (Wilms’ Tumour) affect?
Which gene is affected?
What does the histology resemble?
Which patients have a better prognosis?
How is it treated?
Who often diagnosis Wilm’s tumour?
- Renal nephroblastoma (Wilms’ Tumour) affects children (usually <3y)
- In Wilm’s tumour, the WT1 tumour suppressor gene is affected
- Histology resembles immature or embryonal blastema
- Younger patients have better prognosis
- Surgery, radio and chemo leads to 90% survival
- Wilm’s tumour is often diagnosed by the parents, as we may not examine younger children
Where do renal cell carcinomas originate?
What is the most common type of renal cell carcinoma?
What is another form?
How often does renal cell carcinoma occur?
What is it normally caused by?
What can it also be caused by?
What are the 3 types of genetic renal cell carcinoma?
What are renal cell carcinomas trying to form?
- Renal cells carcinomas originate in the ducts, especially the proximal convoluted tubule
- The most common type is clear cell renal carcinoma, with the name coming from the renal cells being filled with fat and having a white appearance
- Another from is also papillary chromophobe renal cell carcinoma
- Renal cell carcinoma is mostly sporadic (occurs infrequently)
- It is mostly linked to smoking and obesity and is more common in men than women
- There can also be a genetic cause
- 3 types of genetic renal cell carcinoma:
1) Von Hippel-Lindau Syndrome
* VHL gene mutated which determines how cells respond to hypoxia
* Causes the storage of glycogen and fat characteristically seen in renal cell carcinoma
2) Autosomal dominant RCC
3) Hereditary papillary
- Although renal cell carcinomas are solid tumours, they are trying to form tubules
How is the incidence of RRC (renal cell carcinoma changing?
What 2 conditions is RRC associated with?
Where do RRCs grow along?
Where can RRC spread to?
What is the 5 year survival rate of RRC?
What are 4 common signs/symptoms of RRC?
- The incidence of RRC (renal cell carcinoma is increasing
- 2 conditions RRC is associated with:
1) Chronic cystic disease]
2) Paraneoplastic syndromes
* A group of rare disorders that occur when the immune system has a reaction to a cancerous tumor known as a “neoplasm.”
* We can see pyrexia and altered hormones (eg EPO)
- RRCs grow along renal vein to IVC
- RRC can spread as metastases to the lungs, leading to “cannonball lesions”
- There is a 50% five-year survival – but very stage dependant
- 4 common signs/symptoms of RRC:
1) Haematuria most common presentation
2) Mass
3) Pain in the loins
4) Metastases
Where is urothelial cancer typically seen?
What 3 places of the bladder can cancer be found?
What are the 3 ways bladder cancer can present?
Describe the histology of bladder cancer (in picture)
- Urothelial cancer is typically seen in the bladder
- 3 places of the bladder can cancer be found:
1) Dome – 10% of cases
2) Posterior and lateral wall – 70%
3) Trigone and bladder neck – 20% - 2 ways bladder cancer can present:
1) Papillary (80%) - Papillary carcinoma
- Papillary carcinoma and invasive
2) Flat invasive
3) Carcinoma in situ (3%)– Flat non-invasive
- Histology of bladder cancer (in picture)
What are the chances of bladder cancer recurring?
What I the field-effect?
What must we do with patients that have had bladder cancer?
What are the 2 main causes of bowel-cancer?
What are 3 symptoms/signs of bowel cancer?
- There is a 5% chance each year that bladder cancer will return due toa field change
- The field effect in cancer is a phenomenon that describes histologically normal-appearing tissue surrounding or adjacent to a neoplasm that can give rise to additional neoplastic lesions.
- Bladder cancer has a high rate of recurrence and the development of multifocal lesions is common due to this
- For patients that have had bladder cancer, there needs to be careful monitoring and follow up
- 2 main causes of bladder-cancer:
1) Smoking
2) Industrial exposure e.g aniline dyes - 3 symptoms/signs of bladder cancer:
1) Haematuria – even once is significant
2) Dysuria
3) Obstruction
What are 2 pre-renal causes of renal failure?
What are 5 renal causes of acute renal failure?
What is a post-renal cause of acute renal failure?
What are 5 potential signs/symptoms of acute renal failure?
Which are the key features?
What feature can be very dangerous?
What is the most common pathogenesis of acute renal failure?
- 2 pre-renal causes of renal failure
1) Shock
2) Major trauma - 5 renal causes of acute renal failure
1) Some glomerulonephritides
2) Toxic e.g drugs
3) Malignant hypertension
4) Vasculitis
5) Analgesics - Obstruction is a post-renal cause of acute renal failure
- 5 potential signs/symptoms of acute renal failure:
1) Potassium high
2) Creatinine high
3) May be oliguria (can be more or less urine)
4) Hypertension (due to renin produced)
5) (Lipids in nephrotic syndrome) - High potassium and creatinine are often the key features seen
- Acute high potassium can be very dangerous as it can cause asystole
- The pathogenesis of acute renal failure is often acute tubular necrosis
What is a pre-renal cause of chronic renal failure?
What are 4 renal causes of chronic renal failure?
What is a post-renal cause of chronic renal failure?
What are 6 potential signs/symptoms of chronic renal failure?
- Atherosclerosis is a pre-renal cause of chronic renal failure
- 4 renal causes of chronic renal failure:
1) Glomerulonephritis
2) Diabetes
3) Hypertension
4) Polycystic - Obstruction is a post-renal cause of chronic renal failure
- 6 potential signs/symptoms of chronic renal failure:
1) Potassium high
2) Creatinine high
3) May be oliguria
4) Hypertension
5) Anaemia
6) Small kidneys - Patients have adapted to chronically high potassium, so this may not be as urgent
What are 7 intrinsic causes of obstructive neuropathy (in picture)?
What are 3 extrinsic causes of obstructive neuropathy?
What does obstructive neuropathy lead to?
- Intrinsic and extrinsic causes of obstructive neuropathy (in picture)
- Obstructive neuropathy can be acute or chronic, and can lead to post-renal renal failure
What is hydronephrosis?
What kind of kidney failure can it cause?
What are 2 types of intrinsic causes of Hydronephroses / hydroureter?
What is an extrinsic cause of Hydronephroses / hydroureter?
- Hydronephroses / hydroureter is a condition where one or both kidneys / ureters become stretched and swollen as the result of a build-up of urine inside them
- It can cause post-renal failure if bilateral (or unilateral if patietn only has one kidney)
- 2 types of intrinsic causes of Hydronephroses / hydroureter:
1) Within the wall - intrinsic tumour e.g. transitional cell carcinoma
2) In the lumen - calculi, blood clot etc - Tumours e.g. cervical cancer are extrinsic causes of Hydronephroses / hydroureter
What are 6 causes of bladder outflow obstruction?
What kind of kidney failure can Bladder outflow obstruction lead to?
- 6 causes of bladder outflow obstruction:
1) Prostate enlargement in men
2) Uterine prolapse in women
3) Calculi
4) Tumours
5) Urethral strictures
6) Neurological damage - Bladder outflow obstruction can lead to post-renal renal failure
What are 5 clinical features of renal failure?
- 5 clinical features of renal failure:
1) Anaemia
2) Immunosuppression
3) Bone disease
4) Neuropathy
5) Neoplasia - We can work this out from first principles
What is Renal osteodystrophy?
What is it caused by?
What are the main signs?
How can it be treated?
What is osteopenia?
Describe the flowchart for chronic renal failure and osteopenia (in picture)
- Renal osteodystrophy is a complication of chronic kidney disease that weakens your bones
- It’s caused by changes in the levels of minerals and hormones in your blood.
- The main signs are bone pain and fractures.
- There’s no cure except for a kidney transplant
- Osteopenia is a medical condition in which the protein and mineral content of bone tissue is reduced, but less severely than in osteoporosis.
- Flowchart for chronic renal failure and osteopenia (in picture)
What are 3 procedures that can be used in renal replacement therapy?
How do they each work?
- 3 procedures that can be used in renal replacement therapy:
1) Haemodialysis
* Haemodialysis is a process of purifying the blood of a person whose kidneys are not working normally
* A dialysis machine and a special filter called an artificial kidney, or a dialyzer, are used to clean the blood.
* To get the blood into the dialyzer, the doctor needs to make an access, or entrance, into a blood vessel
2) Peritoneal Dialysis
* Peritoneal dialysis is a treatment for kidney failure that uses the lining of your abdomen, or belly, to filter your blood inside your body
* Requires a permanent catheter
* Principle is the same as haemodialysis
* Can lead to low grade inflammation/fibrosis, meaning it can fail over time
3) Transplantation
