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Clinical Pathology > Diseases of the renal system 2 > Flashcards

Diseases of the renal system 2 Flashcards

1
Q

What is obstructive uropathy?

A
  • Obstruction of the urinary tract
  • Can occur anywhere from the renal pelvis to the urethral meatus
  • Onset may be chronic or acute
  • Unilateral or bilateral
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2
Q

What are the pelvic causes of urinary tract obstruction?

A
  • calculi
  • tumours
  • ureteropelvic stricture
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3
Q

What are the ureter-intrinsic causes of urinary tract obstruction?

A
  • calculi
  • tumours
  • clots
  • sloughed papillae
  • inflammation
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4
Q

What are the ureter-extrinsic causes of urinary tract obstruction?

A
  • pregnancy
  • tumours (i.e. cervix)
  • retroperitoneal fibrosis
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5
Q

What are the bladder causes of urinary tract obstruction?

A
  • calculi
  • tumours
  • functional (e.g. neurogenic)
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6
Q

What are the prostatic causes of urinary tract obstruction?

A
  • Hyperplasia
  • carcinoma
  • prostatitis
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7
Q

What are the urethral causes of urinary tract obstruction?

A
  • Posterior valve stricture

- tumours (rare)

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8
Q

What are the possible sequelae of urinary tract obstruction?

A
  • Infection- cystitis, ascending pyelonephritis
  • Stone/calculi formation
  • Kidney damage - Acute or chronic
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9
Q

What do the consequences of a urinary tract obstruction depend on?

A
  • Site of obstruction
  • Degree of obstruction
  • Duration of obstruction
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10
Q

What is the result of obstructive uropathy - acute complete obstruction?

A
  • Reduction in glomerular filtration rate
  • Mild dilatation and mild cortical atrophy
  • Can cause acute renal failure
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11
Q

What is the result of obstructive uropathy - chronic and intermittent?

A
  • Continued glomerular filtration -> Dilatation of pelvis+calyces
  • Filtrate passes back into interstitium -> Compression of medulla -> Impaired concentrating ability
  • Eventual cortical atrophy, fall in renal filtration and renal failure
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12
Q

What are the clinical features of obstruction?

A

Acute bilateral obstruction

  • Pain,
  • Acute renal failure and anuria

Chronic unilateral obstruction

  • Asymptomatic initially
  • If unresolved cortical atrophy and reduced renal function

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

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13
Q

What is the epidemiology of renal calculi?

A
  • Affect 7-10% of the population - increasing
  • Male predominance
  • Peak onset 20 – 30
  • Can form anywhere in the urinary tract but most commonly in the kidney
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14
Q

What is the pathogenesis of renal calculi?

A
  • 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 levels
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15
Q

How are renal calculi composed?

A

By composition

  • Calcium stones (70%) - calcium oxalate +/- calcium phosphate
  • Struvite stones (15%) – magnesium ammonium phosphate
  • Urate stones (5%) – uric acid
  • Cystine stones (1%)
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16
Q

What is the most common cause of calcium stones?

A

Most commonly identified cause is hypercalciuria, due to:

  • Hypercalcaemia
  • Bone disease, PTH excess, sarcoidosis
  • Excessive absorption of intestinal Ca+
  • Inability to reabsorb tubular Ca+
  • Idiopathic
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17
Q

What are the other risk factors for calcium stones?

A
  • Gout: forms a core for Ca+ crystal formation
  • Hyperoxaluria:
    • Hereditary
    • Excess dietary intake
18
Q

What is the pathogenesis of struvite stones?

A
  1. Urease producing bacterial infection (proteus)
  2. Urease converts urea to ammonia
  3. Causes a rise in urine pH
  4. Precipitation of magnesium ammonium phosphate salts
  5. Large “staghorn” calculi
19
Q

What are the causes of urate stones?

A

Hyperuricaemia

  • Gout
  • Patients with high cell turn over e.g. leukaemia

Idiopathic

20
Q

What are the causes of cystine stones?

A
  • Rare

- Occur in the presence of an inability of kidneys to reabsorb amino acids

21
Q

What investigations do you performs for renal calculi?

A
  • Non-contrast CT scanning is gold standard-
    sensitivity of >95%
  • Ultrasound in pregnancy or where CT not possible 30-67% sensitive
  • Intravenous urography 70% sensitive for stones
22
Q

What are the sequelae of renal calculi?

A
  • Obstruction
  • Haematuria
  • Infection
  • Squamous metaplasia +/- Squamous cell carcinoma
23
Q

What percentage of cancers are renal cell?

A

3%

24
Q

What is the most common kind of renal cell carcinoma?

A

clear cell

25
Q

What is the epidemiology of renal cell carcinoma?

A
  • Peak (65-80)

- Male > female (3:2)

26
Q

What are the risk factors for renal cell carcinoma?

A
  • Tobacco
  • Obesity
  • Hypertension
  • Oestrogens
  • Acquired cystic kidney disease (due to chronic renal failure
  • Asbestos exposure
27
Q

What is Von Hippel-Lindau Syndrome?

A
  • The most common of several cancer syndromes observed in RCC
  • VHL gene required for breakdown of Hypoxia Inducible Factor-1 (HIF-1) oncogene
  • Therefore loss of gene function causes cell growth and increased cell survival
  • Tumours develop in kidneys, blood vessels, pancreas
  • VHL mutations also commonly identified in clear cell RCC
28
Q

What is the presentation of Von Hippel-Lindau Syndrome?

A

Local symptoms:
- Hematuria, palpable abdominal mass, costovertebral pain

Incidental

Late presentation:
- systemic symptoms or metastases (25%)

Paraneoplastic syndromes

29
Q

What are paraneoplastic syndromes?

A
  • 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
30
Q

What are the paraneoplastic syndromes associated with renal cell carcinoma?

A
  • Cushing’s syndrome - ACTH
  • Hypercalcaemia - parathyroid hormone related peptide
  • Polycythaemia - EPO
31
Q

What is the morphology of clear cell RCC?

A
  • Well defined yellow tumours
  • Often with haemorrhagic areas
  • May extend into perinephric fat or into renal vein
32
Q

What is the morphology of papillary RCC?

A
  • More cystic

- More likely to be multiple

33
Q

What is the microscopic appearance of clear cell RCC?

A
  • Clear cell has clear cells
  • Delicate vasculature
  • Usually small bland nuclei
34
Q

What is the microscopic appearance of papillary RCC?

A
  • Papillary tumours
  • Cuboidal, foamy cells
  • Surrounding fibrovascular cores often containing foamy macrophages or calcium
35
Q

What is the prognosis of renal cell carcinoma?

A
  • Overall 5 year survival ~45%
  • Organ confined > 70%
  • Tumours extending into perinephric fat or renal vein ~ 50%
  • Distant metastases = very poor prognosis (
36
Q

What percentage of bladder tumours are urothelial cell carcinomas?

A

95%

37
Q

What do urothelial cell carcinomas arise from?

A

Arising from the specialised multilayered epithelium

38
Q

Where else might urothelial cell carcinomas arise from?

A

Anywhere from the renal pelvis to the urethra

39
Q

What are the risk factors for urothelial call carcinoma?

A

Risk factors:

  • Age
  • Gender (male>female)

Carcinogens

  • Smoking
  • Arylamines
  • Cyclophosphamide
  • Radiotherapy
40
Q

What is the presentation of urothelial call carcinoma?

A
  • HAEMATURIA – most common
  • Urinary frequency
  • Pain on urination
  • Urinary tract obstruction
41
Q

What is the prognosis of urothelial cell carcinoma?

A
  • Recurrences are common
  • Outcome depends on grade and stage
  • Grade: low grade TCC 98% alive at 5 years
  • Stage: Muscle invasion = 60% 5 year survival
  • Poor prognosis for metastatic disease

Clinical Pathology (65 decks)

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