Block 9 - Renal Flashcards
Renal pathologies?
What is bottle1842?
**1842 Kidney: normal
**
Here is a normal adult kidney. The capsule has been removed and a pattern of fetal lobulations still persists, as it sometimes does. The hilum at the mid left contains some adipose tissue. At the lower right is a smooth-surfaced, small, clear fluid-filled simple renal cyst. Such cysts occur either singly or scattered around the renal parenchyma and are not uncommon in adults.
What is bottle 1378?
1378 Horseshoe kidney
What is bottle 1320?
1320 Kidney & bladder: duplex collecting system (notes blank)
Double ureters are seen exiting from each kidney and extending to the bladder that has been opened. A small segment of aorta is seen between the normal, smooth-surfaced kidneys. A partial or complete duplication of one or both ureters occurs in about 1 in 150 persons. There is a potential for obstructive problems due to the abnormal flow of urine and the entrance of two ureters into the bladder in close proximity, but most of the time this is an incidental finding (except to a urologist).
What is bottle1328?
**1328 Kidney: Polycystic disease
**
Note the bilaterally enlarged kidneys that nearly fill the abdomen below the liver. The histologic appearance in this case, coupled with the gross appearance, was consistent with autosomal recessive polycystic kidney disease (ARPKD). This infant died soon after premature birth at 23 weeks gestation from pulmonary hypoplasia as a result of oligohydramnios. The oligohydramnios resulted from markedly diminished fetal urine output as a consequence of polycystic kidney disease.
What is bottle 1394 Kidney?
**1394 Kidney: Polycystic disease
**
The contents of the chest and peritoneal cavity have been removed at autopsy here to reveal markedly bilaterally enlarged kidneys in the retroperitoneum in an adult who died from complications of chronic renal failure. This patient had autosomal dominant polycystic kidney disease (ADPKD).
What is bottle 1394 Kidney?
This kidney in a patient with ADPKD weighed 3 kilograms! This disease is inherited with an autosomal dominant pattern, so the recurrence risk in the family is 50%. The cysts are not usually present at birth, but develop slowly over time, so the onset of renal failure occurs in middle age to later adult life.
Characteristic urinalysis findings for end stage renal disease are seen below. In ADPKD, there are often many oxalate crystals, and the cysts are often filled with them, too.
What is bottle 5?
**5 Kidney: Renal artery stenosis
**In this case, severe atherosclerosis in a patient with diabetes mellitus led to severe aortic atherosclerosis with renal arterial stenosis as well as nephrosclerosis and nodular glomerulosclerosis of the kidneys. Thus, the native kidneys seen here are both small. The end stage renal disease was treated with renal transplantation. The transplant kidney is placed in the pelvis because this is technically easier and there is usually no point in trying to remove the native kidneys. In this case, the patient developed chronic rejection and that is why focal hemorrhages are seen in the transplanted kidney that is slightly swollen. A radiographic study would show decreased renal blood flow in the transplant kidney.
1725 Kidney: Renal allograft - Renal vein thrombosis, chronic
1725 Kidney: Renal allograft - Renal vein thrombosis, chronic
The white arrow marks a renal vein thrombus. There are a host of etiologies for renal vein thrombosis, including trauma, compression by neoplasms, renal vein invasion by renal cell carcinoma, and nephrotic syndrome with membranous nephropathy and hypercoagulable state. Acutely, there can be flank pain and microscopic hematuria, but most cases are chronic and difficult to diagnose.
What is bottle 1735?
**1735 Kidney: Acute suppurative pyelonephritis
**
In the lower pole of this kidney is a 1 cm pale yellow abscess. Infections can reach the kidney either by ascending up the urinary tract (from a bladder infection, for example) or by hematogenous spread with sepsis. This lone abscess was probably hematogenous in origin.
What is bottle 1330?
**1330 Kidney: Analgesic nephropathy
**The pale white areas involving some or all of many renal papillae are areas of papillary necrosis. This is an uncommon but severe complication of acute pyelonephritis, particularly in persons with diabetes mellitus. Papillary necrosis may also accompany analgesic nephropathy.
What is bottle 43?
**43 Kidney: renal calculi -hydronephrosis
**
There was a large renal calculus (stone) that obstructed the calyces of the lower pole of this kidney, leading to a focal hydronephrosis (dilation of the collecting system). The stasis from the obstruction and dilation led to infection. The infection with inflammation is characterized by the pale yellowish-tan areas next to the dilated calyces with hyperemic mucosal surfaces. The upper pole is normal and shows good corticomedullary demarcations.
What is bottle 1357?
1357 Kidney: amyloidosis
What is bottle 56?
56 Kidney: endstage disease
The end result of many renal diseases – whether they are renal vascular diseases, glomerulonephritis, or chronic pyelonephritis–is end stage renal disease (ESRD). In ESRD, the kidneys are small bilaterally, as shown here. This condition is associated with chronic renal failure, and the patient’s blood urea nitrogen (BUN) and serum creatinine continue to increase. Chronic renal failure can be treated by dialysis or by kidney transplantation, as shown here. Note the normal size of the pre-owned kidney in comparison with native diseased kidneys.
What is bottle 1404?
1404 Kidney: Renal rejection
In this case, severe atherosclerosis in a patient with diabetes mellitus led to severe aortic atherosclerosis with renal arterial stenosis as well as nephrosclerosis and nodular glomerulosclerosis of the kidneys. Thus, the native kidneys seen here are both small. The end stage renal disease was treated with renal transplantation. The transplant kidney is placed in the pelvis because this is technically easier and there is usually no point in trying to remove the native kidneys. In this case, the patient developed chronic rejection and that is why focal hemorrhages are seen in the transplanted kidney that is slightly swollen. A radiographic study would show decreased renal blood flow in the transplant kidney.
What is bottle 1294?
**1294 Kidney: Angiomyolipoma
**
This rare neoplasm of the kidney is called angiomyolipoma. Note that it is solid and has a tan to yellowish-tan cut surface. It is also multifocal (a smaller nodule appears in the upper pole. Most of these tumors are incidental findings, but persons with a rare condition known as tuberous sclerosis often have these tumors. This neoplasm is one form of perivascular epithelioid cell tumor (PEComa) derived from the perivascular epithelioid cell (PEC), as elusive as the yeti, and not present in normal tissue.
What is bottle 1839 Kidney?
1839 Kidney: Nephroblastoma (Wilm’s tumour).
What is bottle 1710?
1710 Kidney: Renal cell carcinoma (Grawitz tumour), renal cyst
This is a renal cell carcinoma arising in the lower pole of the kidney. It is fairly circumscribed. The cut surface demonstrates a variegated appearance with yellowish areas, white areas, brown areas, and hemorrhagic red areas. Though these neoplasms are usually slow-growing, they can often reach a considerable size before detection because there is a lot of room to enlarge in the retroperitoneum, and there is another kidney to provide renal function.
What is bottle 1408?
1408 Kidney: Grawitz tumour.
What is bottle 30?
30 Kidney - transitional cell carcinoma pelvis
Transitional cell carcinoma is more commonly associated with the bladder, but can effect any part of the genitourinary tract.
Gross photo of a radical nephrectomy specimen showing a large mass lesion originally from renal pelvis, invading through the renal capsule to perirenal adipose tissue. Shown to be a transitional cell carcinoma.
Large tumour occupying the renal pelvis extending into the upper and mid pole calyces.
Hydroureters
A long-standing obstruction (probably congenital) at the ureteral orifice through which the metal probe passes led to the marked hydroureter along with hydronephrosis seen here. In the intravenous urogram below, note the dilation of the right ureter, compared to the normal left ureter. This patient had vesicoureteral reflux. Such obstructive processes increase the risk for urinary tract infection.
What pathology is this?
Staghorn calculi
Sometimes a very large calculus nearly fills the calyceal system, with extensions into calyces that give the appearance of a stag’s (deer) horns. Hence, the name “staghorn calculus”. Seen here is a horn-like stone extending into a dilated calyx, with nearly unrecognizable overlying renal cortex from severe hydronephrosis and pyelonephritis. Nephrectomy may be performed because the kidney is non-functional and serves only as a source for infection.
Shown below are typical urinalysis findings for this condition, with evidence for “infection stones” of magnesium ammonium phosphate.
