Renal Path 3

Question 1

blood flow in kidney

Answer 1

renal cortex recieves 90% of the blood supply

renal medulla is relative ischemic

Question 2

Renal artery stenosis- gender, what happens

Answer 2

Young women

-Fibromuscular dysplasia of the renal artery

Question 3

What is atheroembolic renal disease

Answer 3

pieces of atherosclerotic plaques from one loc may travel all the way down to the kidney causing a blockage in arteries of the kidney

Question 4

Pathogenic causes of atheroembolic renal disease

Answer 4

Build up of plaque in central renal artery can occur due to:

1. Atheroclerosis- Creation of atehrosclerotic plaque in arterial wall
2. Atheroembolic- a plaque that originated from a major artery elsewhere in the body and becomes dislodged and travels to kidney

• both mech reduce blood flow to kidney
• low blood flow to glomerular apparatus activates renin angiotensin system yielding an increase in aldosterone

Question 5

predisposing factors for atheroembolic renal disease

Answer 5

• systemic atherosclerosis and hypertension
• smoking
• hypercholesterimia
• diabetes
• > 55
• trauma to plaque

Question 6

What is benign nephroclerosis

Answer 6

an increase in wall thicknes of smaller caliber artery leads to constantly reduced lumen over time
-results in focal ischemia of perenchyma

Question 7

What is malignant hypertension

Answer 7

-A hypertensive emergency is a condition in which elevated BP results in target organ damage (180-200sBP)

Question 8

What does malignant hypertension lead to

Answer 8

Acute and severe elevation of BP, usually as a result of primary mech (initially related to vascular damage)

Question 9

What does malignant hypertension lead to

Answer 9

Results in an increase in permeability of the vessel to

• Fibrinogen and plasma proteins
• Platelet deposition

Together resulting in hyperplastic arteriosclerosis (luminal obliteration + reduction in Blood flow)

Question 10

What is a renal infarction (+ symptoms)

Answer 10

-Sudden, abrupt blockage of renal artery or smaller renal artery (EMERGENCY)

cause- thrombi, atherosclerotic embolus

Symptoms- flank pain/hematuria

Question 11

What is sickle cell nephropathy and what is it due to

Answer 11

• secondary to sickle cell disease
• increased blood viscosity (due to crisis) contributes to ischemia and eventual infarction that involves the renal microcirculation
• the ischemia and infarction cause papillary necrosis

Question 12

what is diffuse cortical necrosis due to

Answer 12

• acute condition involbing patchy necrotic changes to the cortex of the kidney
• caused by local or generalized compromised blood supply

Question 13

Complications of diffuse cortical necrosis

Answer 13

Acute renal failure

chronic renal failure

Question 14

Renal cell carcinoma- age, gender, risks, tissue targeted

Answer 14

6-7th decae
Male: Female 2:1
Smoking, cadmium,chronic dialysis
Targets proximal renal tubular epithelium

(hereditary caused by alteration of the short arm of chromosome 3)

Question 15

What is von hippie landau syndrome

Answer 15

autosomal dominant syndrome that confers predisposition to a variety of neoplasms including:
-renal cell carcinoma (40% of causes)

Question 16

microscopy of clear cell renal cell carcinoma

Answer 16

-consists of clear cytoplasm cells

Question 17

What is a papillary renal cell carcinoma

Answer 17

• very invasive tumor- often invades renal vein and sometimes inf vena cava
• has potential to produce erythropoietin (tumor marker)

Question 18

What is the primary site of metastasis in RCC (3)

Answer 18

lungs
bones
liver

Question 19

What is the mc primary renal tumor in children

Answer 19

Wilms tumor

Question 20

Clinical findings of Wims tumor

Answer 20

• Unilateral palpable mass in a child
• Hypertension due to renin secretion
• metastisis into the lungs (MC)

Question 21

What is WAGR syndrome

Answer 21

Wilms tumor
Aniridia (lack of iris)
Genetal Abnormalities
Retardation

Question 22

What is beck Weidmann syndrome and what causes it

Answer 22

congenital disorder (CH 11 distal region)

• Syndrome involves:
• Wilms tumor
• enlarged body organs
• Hemihypertrophy of extremities

Question 23

etiology of cystitis

Answer 23

• fecal flora
• radiation cystitis (inflammation of mucosa of urinary bladder due to radiation)
• chemotherapeutic cystitis

Female>male

Question 24

clinical manifistations of cystitis

Answer 24

Frequency, urgency, dysuria, suprapubic pain, systemic signs

Question 25

What is the mc malignancy of the urinary system

Answer 25

Urinary bladder tumor

Urothelial carcinoma (mc in west)
Non urethral carcinoma (mc in world)

Question 26

Urinary bladder cancer risk factors

Answer 26

• cigarette smoking
• occupational exposure to azo dye
• exposure to 2 napthylamine

Question 27

Urinary bladder cancer clinical manifestations

Answer 27

Painless Hematuria
Dysuria
Urgency
Frequency
Hydronephrosis
Pyelonephritis

Question 28

What is a patent urachus

Answer 28

Fitstula forms bw external umbilical ring and upper pole of urinary bladder

Question 29

What is an umbilical polyp

Answer 29

Discharge from umbilicus but no direct connection bw umbilical opening and urinary bladder

Question 30

What is bladder diverticulum

Answer 30

complete obliteration of urachus at umbilical level

Question 31

What is a urachal cyst

Answer 31

Complete obliteration of urachus at the bladder end

Question 32

What is acquired diverticula

Answer 32

External protrusion of the bladders wall

Question 33

What is a cystoele

Answer 33

Bladder prolapse into vagina