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Pathoma Renal > Chronic Renal Failure & Renal/LUT Carcinoma > Flashcards

Chronic Renal Failure & Renal/LUT Carcinoma Flashcards

1
Q

3 most common causes of chronic renal failure

A

diabetes mellitus,
hypertension,
glomerular disease

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2
Q
  1. Uremia
  2. Salt and water retention –> HTN
  3. Hyperkalemia w/ metabolic acidosis (anion gap)
  4. Anemia
  5. Hypocalcemia
  6. Renal osteodystrophy
A

chronic renal failure

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3
Q 
Nausea, 
anorexia, 
pericarditis, 
platelet dysfunction, 
encepalopathy with asterixis, 
deposition of urea crystals in skin
A

Chronic renal failure –> increased nitrogenous waste products in blood (azotemia) –>

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4
Q

why do you get anemia in chronic renal failure?

A

Decreased epo production by renal peritubular interstitial cells

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5
Q

why do you get hypocalcemia in chronic renal failure?

A
  1. decreased I-alpha-hydroxylation of vitamin D by proximal renal tubule cells
  2. hyperphosphatemia
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6
Q

Why do patients with CRF get platelet dysfunction?

A

uremia –> impairs platelet aggregation and adhesion

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7
Q

Why do patients with CRF get renal osteodystrophy?

A
  1. secondary hyperparathyroidism –> osteitis fibrosa cystica
  2. osteomalacia (can’t mineralize osteoid made by osteoblasts)
  3. osteoporosis (leach calcium from bone due to metabolic acidosis)
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8
Q

treatment of CRF

A

dialysis or renal transplant

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9
Q

what develops in the shrunken end-stage kidneys during dialysis?

A

cysts

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10
Q

patients on dialysis for chronic renal failure have increased frisk for

A

renal cell carcinoma

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11
Q

hamartoma comprised of blood vessels, smooth muscle, and adipose tissue; associated with tuberous sclerosis

A

angiomyolipoma

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12
Q

triad of renal cell carcinoma

A

hematuria, palpable mass, flank pain

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13
Q

malignant epithelial tumor arising from kidney tubules

A

renal cell carcinoma

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14
Q

paraneoplastic syndromes associated with RCC

A

EPO, renin, PTHrP, ACTH

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15
Q

involvement of the left renal vein by carcinoma blocks drainage of the left spermatic vein

A

RCC –> left variocele

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16
Q

why do you not get right-side varicocele in RCC?

A

right spermatic vein drains directly into the IVC

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17
Q

Increased IGF-1 –>

A

promotes growth

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18
Q

Increased HIF transcription factor –>

A

increased VEGF and PDGF

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19
Q

pathogenesis of RCC

A

loss of VHL (3p) tumor suppressor gene –> increased IG-F and HIF transcription facot

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20
Q

on what chromosome is VHL

A

3p

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21
Q

major risk factor for sporadic RCC

A

cigarette smoke

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22
Q

sporadic tumors classically arise in adult males (average age is 60) as a single tumor where?

A

upper pole of kidney

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23
Q

what disease –> hereditary RCC (wh/ arises in younger adults and is often bilateral)?

A

Von Hippel Lindau disease

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24
Q

Besides RCC, VHL dz increases risk for?

A

Hemangioblastoma of the cerebellum

25
Q

based on size and involvement of renal vein (occurs commonly and increases risk of hematogenous spread to lungs and bone)

A

T staging of RCC

26
Q

spread to retroperitoneal lymph nodes

A

N staging of RCC

27
Q

Malignant kidney tumor comprised of blastema (immature kidney mesenchyme), primitive glomeruli and tubules, and stromal ce;;s

A

Wilms tumor

28
Q

average age of onset of Wilms tumor

A

3

29
Q

Large, unilateral flank mass with hematuria and HTN (due to renin secretion) in a 3 yo

A

Wilms tumor

30
Q

WAGR syndome

A

Wilms tuomr
Aniridia
Genetial abnormalities
mental and motor Retardation

31
Q

WAGR syndrome is associated with DELETION of what tumor suppressor gene?

A

WT1

32
Q

Where is WT1 located?

A

11p13

33
Q 
Wilms tumor, 
progressive renal (glomerular) dz.
male pseudohermaphroditism
A

Denys-Drash syndrome

34
Q

What causes Denys-Drash syndrome?

A

MUTATION of WT1

35
Q

deletion of WT1 –>

A

WAGR syndrome

36
Q

mutation of WT1 –>

A

Denys-Drash

37
Q

Wilms tumor,
neonatal hypoglycemia,
muscular hemihypertrophy,
organomegaly (including tongue)

A

Beckwith-Wiedmann

38
Q

Beckwith-Wiedman is associated with mutations in what gene cluster?

A

WT2, particularly IGF-2

39
Q

WT2 gene cluster = imprinted genes at ?

A

11p15.5

40
Q

Types of lower urinary tract carcinoma

A
  1. urothelial (transitional cell) carcinoma
  2. squamous cell carcinoma
  3. adenocarcinoma
41
Q

malignant tumor arising from the urothelial lining of the renal pelvis, ureter, bladder, or urethra

A

urothelial carcinoma

42
Q

most common type of lower urinary tract cancer

A

urothelial carcinoma of bladder

43
Q

major risk factors for urothelial carcinoma

A

cigarrettes (polycyclic aromatic hydrocarbons),
napthylamine (also in cigarrettes),
azo dyes (used for coloring - hairdressers) ,
long term cyclophosphamide or phenacetin use

44
Q

two pathways by which urothelial carcinoma arises

A

flat

papillary

45
Q

Painless hematuria

A

urothelial carcinoma

46
Q

urothelial carcinoma that develops as a low-grade papillary tumor that progresses to high-grade papillary tumor and then invades

A

Papillary pathway

47
Q

urothelial carcinoma that develops as a high grade flat tumor and then invades

A

flat pathway

48
Q

flat pathway of urothelial carcinoma is associated with

A

p53 mutation

49
Q

why are urothelial carcinomas often multifocal and recurrent

A

field defect - all urothelial cells are mutated

50
Q

malignant proliferation of squamous cells, usually involving bladder, that arise in a background of metaplasia

A

squamous cell carcinoma

51
Q

Risk factors of squamous cell carcinoma of LUT

A 
chronic cystitis
schistosoma hematobium (young middle eastern male)
long-standing nephrolithiasis
52
Q

malignant proliferation of glands usually involving bladder

A

adenocarcinoma

53
Q

Do you normally have glandular epithelium lining the bladder?

A

No

54
Q

LUT adenocarcinoma arises from

A

urachal remnant
cystitis glandularis
exstrophy

55
Q

congenital failure to form the caudal portion of the anterior abdominal and bladder walls

A

exstrophy

56
Q

when adenocarcinoma arises from urachal remnant, the tumor develops where?

A

at the dome of the bladder

57
Q

What connects the fetal bladder to the yolk sac?

A

urachus (duct)

58
Q

chronic inflammation of bladder –> columnar metaplasia

A

Cystitis glandularis

Pathoma Renal (4 decks)

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