CP 32 - Renal System 2

Question 1

what can cause obstruction at the pelvis of the kidney level?

Answer 1

calculi, tumours, ureteropelvic stricture

Question 2

what can cause obstruction at the ureter-intrinsic level?

Answer 2

calculi, tumours, clots, sloughed papillae, inflammation

Question 3

what can cause obstruction at the ureter-extrinsic level?

Answer 3

pregnancy, tumours, retroperitoneal fibrosis

Question 4

what can cause obstruction at the urinary bladder level?

Answer 4

vesicoureteral refluex

Question 5

what can cause obstruction at the prostate level?

Answer 5

hyperplasia of the prostate

Question 6

what are some of the consequences of UT obstruction?

Answer 6

Detrusor hypertrophy and trabeculation
obstruction at urethral level

ureteric obstruction - hydroureter

hydronephrosis - dilated calyces, dilated pelvis, cortical atrophy

Question 7

what will happen if complete obstruction of the ureter occur in an acute setting?

Answer 7

reduction in glomerular filtration (can also cause mild dilation and mild cortical atrophy)- cause acute renal failure

Question 8

what will happen if complete obstruction of the ureter occur in a chronic and intermittent setting?

Answer 8

continued glomerular filtration - dilation of pelvis calyces - eventual cortical atrophy, fail in renal filtration and renal failure

filtrate passes back into interstitium - compression of medulla - impaired concentrating ability - eventually cortical atrophy, ail in renal filtration and renal failure

Question 9

what are some clinical presentation of obstructed ureter?

Answer 9

acute bilateral obstruction - pain, acute renal failure and anuria

Chronic unilateral obstruction- asymptomatic initially, if unresolved cortical atrophy and reduce renal function

Bilateral partial obstruction - initially polyuric with progressive renal scarring and impairment

Question 10

what are the other names for renal stones?

Answer 10

renal calculi, urolithiasis

Question 11

how does renal stone form?

Answer 11

Either due to an excess of substances which may precipitate out e.g. Ca+

A change in the urine constituents causing precipitation of substances e.g. change in pH

poor urine output - supersaturation

decreased citrate level

Question 12

what is supersaturation?

Answer 12

poor urine output

Question 13

what are the different types of renal stones

Answer 13

1) calcium stones - ca
2) struvite stones - Mg, NH3, PO4
3) urate stones - uric acid
4) cystine stones

Question 14

what are some investigation for renal calculi

Answer 14

non-contrast CT
USS in pregnancy
IV urography

Question 15

what are the consequences for renal stones ?

Answer 15

obstruction, haematuria, infection, squamous metaplasia - maybe carcinoma

Question 16

what are the risk factors for renal cell carcinoma?

Answer 16

Tobacco
Obesity
Hypertension
Oestrogens
Acquired cystic kidney disease (due to chronic renal failure
Asbestos exposure

Question 17

what is von Hippel-Lindau Syndrome

Answer 17

most common of several cancer syndromes observed in RCC

Question 18

what are some clinical presentation of renal cell carcinoma

Answer 18

haematuria, palpable abdominal mass, costovertebral pains

paraneoplastic syndromes

Question 19

what is paraneoplastic syndromes

Answer 19

clinical syndromes caused by tumours

Not related to the tissue that the tumour arose from

Not related to invasion by the tumour itself or its metastases

Question 20

what are some paraneoplastic syndrome caused by RCC?

Answer 20

cushing’s syndrome - ACTH

hypercalcaemia - parathyroid hormone related peptide

polycytheamia (an abnormally increased concentration of haemoglobin in the blood,) - erythropoietin

Question 21

what are some morphology of RCC

Answer 21

clear cell - well defined yellow tumours, often with haemorrhagic areas - clear cells w

papillary - more cystic or likely to be multiple - cuboidal, foamy cells

Question 22

what does distant metastasis of RCC have very poor prognosis?

Answer 22

RCC tends to be chemo-resistant

Question 23

what is the most common origin of urothelial cell carcinoma?

Answer 23

95% bladder tumours - Most common in the bladder but may arise anywhere from renal pelvis to urethra

Question 24

risk factors for urothelial cell carcinoma ?

Answer 24

age, gender (male > ), smoking, radiotherapy

Question 25

what are some clinical presentation of urothelial tumours

Answer 25

haematuria, urinary frequency, pain on urination, urinary tract obstruction

Question 26

what is another name for urothelial tumours ?

Answer 26

transitional cells tumours

Question 27

what are the histological patterns in TCC

Answer 27

2 types

1) papiloma - invasive papillary carcinoma
2) flat noninvasive carcinoma - flat invasive carcinoma