5: Pathology 2 Flashcards
What is agenesis of the kidneys?
Complete failure of one or both kidneys to develop
Hypoplasia describes ___ organs with (normal / abnormal) development.
smaller
normal development
Which poles of the kidneys usually fuse to cause horseshoe kidney?
Inferior poles
Does horseshoe kidney affect renal function?
Usually not
but can obstruct ureters
Congenital abnormalities of the kidney predispose you to ___.
UTIs
What neurological presentation is associated with renal agenesis?
Oligohydramnios
Low volume of amniotic fluid in the placenta
What abnormal facial appearance is associated with oligohydramnios?
Which congenital renal disorder causes it?
Potter’s facies - low set ears, small jaw, flattened tip of the nose
Renal agenesis
What type of kidney disease, with a characteristic appearance, is very common?
Cystic kidney disease
What can cysts contain?
Serous fluid
Why may cystic kidney disease cause abdominal pain?
Ruptured cysts
What are the two types of polycystic kidney disease and how are they inherited?
a) Autosomal dominant PKD - adults, PKD1 on chromosome 16
b) Autosomal recessive PKD - kids, PKDH1, chromosome 6
Is polycystic kidney disease unilateral or bilateral?
Bilateral
What happens to the kidneys in
a) ADPKD
b) ARPKD?
a) Hyperplasia, damage to tubules
b) Hypoplasia, damage to collecting ducts, fibrosis
What is a characteristic feature of ARPKD?
Hypoplasia due to fibrosis
What are the symptoms of polycystic kidney disease?
Haematuria
Polyuria
Chronic loin pain
Hypertension
Because ADPKD causes hyperplasia, what may be seen on examination?
Abdominal mass
What neuro presentation is associated with ADPKD?
Subarachnoid haemorrhage
What diseases are associated with
a) ADPKD
b) ARPKD?
a) Loads - subarachnoid haemorrhage, valve disease, diverticulae and hernia
b) Fibrosis of kidneys
What are the most common benign kidney tumours?
Fibromas
What do fibromas look like?
White
Found in renal medulla
What do adenomas look like?
Where in the kidneys are they found?
Yellow
Adrenal cortex
What benign kidney tumours are found in tuberous sclerosis?
Angiomyolipoma
blood vessels, muscles and fat
Which benign kidney tumours produce renin?
What systemic disease can this cause?
Juxtaglomerular cell tumours
Secondary hypertension
What is the commonest malignant kidney tumour in children?
Nephroblastoma
arises from embryological tissue
What is the commonest malignant kidney tumour found in adults?
Renal cell carcinoma
(Men / women) are at greater risk of RCC.
Men
What are the symptoms of RCC?
Abdomnal mass
Haematuria
Loin pain
Weight loss, anorexia, fever, fatigue
What is polycythaemia?
Increased number of red cells
Why do patients with RCC develop
a) polycythaemia
b) hypercalcaemia?
a) Overproduction of EPO
b) Overproduction of calcitriol (activated Vitamin D)
Where do RCCs tend to be found?
Renal cortex
By which vessels can RCCs spread?
Renal vein
What specific type of RCC is the most common?
Clear cell RCC
RCCs tend to spread (haematogenously / lymphatically).
haematogenously
What is seen on histology in RCC?
Cysts
Haemorrhage
Necrosis
Which malignant tumour arises from the urothelium?
Transitional cell carcinoma
Where can transitional cell carcinomas be found?
Renal pelvis
to
Urethra
Which tumour is most commonly found in the bladder?
Transitional cell carcinoma
What are major risk factors for transitional cell carcinoma?
Industrial - work with dyes, rubber
Smoking
Drugs - cyclophosphamide, analgesia
Schistosomiasis infection
What is the biggest risk factor for transitional cell carcinoma?
Smoking
What is the main presenting complaint of transitional cell carcinoma?
Haematuria
As transitional cell carcinoma can be found in the bladder, what problem may it cause?
Obstruction
What do low-grade TCCs look like?
What do high-grade TCCs look like?
Papillary - like hairs
Solid
How is TCC investigated?
Cystoscopy
or urography/USS kidneys, depends on where it is
Which lymph nodes may TCCs spread to?
Obturator nodes
TCC is staged by its invasion of which structures?
Muscle
Blood vessels
Lymph nodes
Which malignant tumours are associated with
a) glandular metaplasia
b) squamous metaplasia?
a) Adenocarcinoma
b) Squamous cell carcinoma
What is the commonest malignant urinary tract tumour in children?
Rhabdomyosarcoma
malignant tumour of skeletal muscle
