7. Pathology of the kidney, ureters and bladder 2 Flashcards
Causes of urinary calculi
• Hypercalcaemia – eg sarcoid, Renal tubular acidosis, hyperPTHism • Gout • Obstruction – eg vesico-ureteric reflux • Genetic • Dehydration (common cause for acute)
Clinical features of urinary calculi
Acute: Renal colic ** Haematuria, either microscopic or macroscopic Pyelonephritis Obstructive uropathy Hydronephrosis, can be cause or effect
Chronic:
Post-renal renal failure
4 different forms of bladder disease?
Inflammation (cystitis due to UTI commonly)
Infection
Calculi
Neoplasia
Urinary tract neoplasms:
Common and less common tumours?
Common: Bladder and renal
Rare: Renal carcinomas (not clear cell), renal nephroblastoma (Wilm’s tumour), Ureter transitional cell carcinoma, renal/bladder sarcoma
Common bladder tumour?
Urothelial (transitional celll) carcinoma
Common renal tumour?
4/5 are clear cell carcinoma (ccRCC)
Wilm's tumour: Incidence? Genetics? Histology? Treatment/prognosis?
Incidence: Children less that 3yrs
Genetics: WT1 tumour suppressor gene
Histology: Resembles immature or embryonal blastema
Treatment/prognosis: Surgery, radio, chemo leads to 90% survival
Renal cell carcinoma: Location? Common type? Others? Predisposing factors? Genetics?
Location: Originates in ducts esp PCT Common type: Clear cell Other types: Papillary, chromophobe Predisposing factors: Smoking and obesity Genetics: – von Hippel-Lindau Syndrome – autosomal dominant RCC – hereditary papillary -(VHL mutation and HIF1a)
Renal cell carcinoma: Location? Common type? Others? Predisposing factors? Genetics?
Location: Originates in ducts esp PCT Common type: Clear cell Other types: Papillary, chromophobe Predisposing factors: Smoking and obesity Genetics: – von Hippel-Lindau Syndrome – autosomal dominant RCC – hereditary papillary
Renal cell carcinoma: Growth pattern? Matastasises to? Prognosis? Incidence? Common presentation? Paraneoplastic syndromes?
Growth pattern: Along renal vein to IVC in continuous cord
Metastasises to lung as cannonball lesions
Prognosis: 50% five year survival, but very stage dependent
Incidence: Men
Common presentation: Haematuria (may be microscopic) and loin pain
Paraneoplastic syndromes: Pyrexia of unknown origin i.e. no infection, hormones (e.g. EPO)
Renal colic characteristics?
More intense pain that then completely disappears
Components of calculi?
Calcium (75%)
Uric acid (20+, not radio opaque)
Cystine (1%)
Infection from proteus species
Grading of urothelial cancer
Invasion: Papillary invasion extend. Into muscle means problem
From flat lesion or papilla
Flat lesion looks bad but unless there’s invasion, the prognosis is okay
Pathology of urothelial carcinoma?
In situ carcinoma: Nucleus abnormal, big cells
Papillary carcinoma: Thicking transitional outline
Bladder/urothelial cancer: Spectrum of malignancy? Aetiology? Presentation? Why field change effect?
Spectrumof malignancy from superficial, carcinoma in situ to deeply invasive
Aetiology
• Smoking
• Industrial eg aniline dyes
Presentation
• Haematuria – even once is significant
• Dysuria
• Obstruction
Allow sequential new tumours to form as you have a thin layer of transitional cells bathed in an acidic solution full of carcinogens
Causes of acute renal failure
• Pre-renal – Shock, major trauma • Renal – Some glomerulo- nephritides, toxic eg drugs, malignant hypertension, vasculitis, analgesics • Post-renal – Obstruction
As renal cells have gone into shock ( and necrosis)
Effects of acute renal failure
- Potassiumhigh
- Creatininehigh
- May be oliguria
- Hypertension
- (Lipidsinnephrotic syndrome)
Causes of chronic renal failure
• Pre-renal – Atherosclerosis • Renal – Glomerulonephritis, diabetes, hypertension, polycystic • Post-renal – Obstruction
Effects of chronic renal failure
- Potassiumhigh
- Creatininehigh
- May be oliguria
- Hypertension
- Anaemia
- Small kidneys
Obstructive uropathy leading to post renal renal failure, main causes?
- Prostate enlargement in men
- Uterine prolapse in women
- Calculi
- Tumours
- Urethral strictures
- Neurological damage
** Must be bilateral to cause renal failure**
What is hydronpehrosis?
-Hydronephrosis—literally “water inside the kidney”
-Refers to distension and dilation of the renal pelvis and calyces, usually caused by obstruction of the free flow of urine from the kidney.
Untreated, it leads to progressive atrophy of the kidney.
One or both kidneys may be affected.
[In cases of hydroureteronephrosis, there is distention of both the ureter and the renal pelvis and calices.]
Clinical features of post renal renal failure?
Anaemia Immunosuppression Bone disease Neuropathy Neoplasia
What is renal osteodystrophy?
Renal osteodystrophy is a bone disease that occurs when your kidneys fail to maintain proper levels of CALCIUM and PHOSPHORUS in the blood.
This interacts with the parathyroid gland in Ca regulation, potentially leading to hyperplasia of parathyroid gland
Renal replacement therapy:
Role?
Risks?
Role: To rebalance electrolytes, fluid levels, excretion and EPO
Risks: • Diet & nutrition • Anaemia • Calcium/phosphate • Bloodpressure • Infection
