8. Neoplasms of the Kidney

Question 1

What is chronic renal failure?

Answer 1

Reduced nephron numbers causes increased glomerular pressure in remaining
Results in progressive glomerulosclerosis

Question 2

What are the clinical signs of chronic renal failure?

Answer 2

Uraemia
Small, scarred kidneys
Hypertension and hypertrophy due to RAAS
Acute fibrinous pericarditis

Question 3

What are the benign tumours of the kidney?

Answer 3

Angiomyolipoma

Oncocytoma

Question 4

What cells do angiomyolipomas originate in?

Answer 4

Perivascular epitheloid cells

Question 5

What cells do oncocytomas originate in?

Answer 5

Collecting ducts

Question 6

What are the malignant tumours of the kidney?

Answer 6

Nephroblastoma (children)
Urothelial cell carcinoma
Renal cell carcinoma

Question 7

What cells do urothelial cell carcinomas originate in?

Answer 7

Pelvic calices

Question 8

What cells do renal cell carcinomas originate in?

Answer 8

Tubular epithelial cells

Question 9

What investigations can be done into a suspected kidney tumour?

Answer 9

Ultrasound
CT
Biopsy not done usually

Question 10

What reasons might a biopsy be done in a kidney tumour?

Answer 10

Single kidney
Possibility of not being RCC
If the patient is suitable for a partial nephrectomy

Question 11

What are the risk factors for renal cell carcinoma?

Answer 11

70s , male
Smoking, obesity, cystic lesions
Genes on chromosome 3

Question 12

What is the gross appearance of a renal cell carcinoma?

Answer 12

Yellow with haemorrhage and necrosis

Cystic

Question 13

What is the most common microscopic appearance of a renal cell carcinoma?

Answer 13

Clear cell
Adenocarcinoma but doesn’t produce mucin
Often invades renal vein which gives a poor prognosis

Question 14

Name 2 other types of renal cell carcinoma

Answer 14

Papillary

Chromophobe

Question 15

What are the genetic predispositions to papillary renal cell carcinomas?

Answer 15

Chromosome 7 or 17 trisomy

Loss of Y chromosome

Question 16

What is the cell of origin of a chromophobe renal cell carcinoma?

Answer 16

Intercalated cells

Question 17

Why do urothelial carcinomas require follow up?

Answer 17

Associated with tumours elsewhere in the urinary tract

Question 18

What is the most common type of cancer in the bladder?

Answer 18

Urothelial carcinoma

Question 19

What are the risk factors for urothelial carcinomas in the bladder?

Answer 19

Anniline dyes
Organic chemicals
Smoking

Question 20

What factors are associated with squamous cell carcinoma of the bladder?

Answer 20

Schistosomiasis

Long standing catheters

Question 21

What factor is associated with adenocarcinomas in the bladder?

Answer 21

Fistulas with the bowel

Question 22

What paraneoplastic syndromes are associated with RCC?

Answer 22

Polycythaemia
Hypercalcaemia
Hypertension
PUO

Question 23

Classify kidney disease in SLE

Answer 23

1. Positive on fluorescent microscopy
2. mesangial proliferation
3. Segmental lesions <50% of glomerulus
4. > 50% glomerulus
5. Membranous pattern

Question 24

What can be seen microscopically in SLE kidney disease?

Answer 24

All immunoglobulins positive
Deposits in all components of glomerulus
Segmental glomerular acute inflammation
Large subendothelial deposits