Diseases of the Renal System 2 Flashcards
Causes of obstructive uropathy in the pelvis and kidney
Calculi
Tumours
Stictures
dilated calyces, dilated pelvis, corticol atrophy
Hydronephrosis
A type of obstruction with pain and acute renal failure and anuria
Acute bilateral obstruction
A type of obstruction which is asymptomatic initially with corticol atrophy and decreased renal function
Chronic unilateral obstruction
A type of obstruction which is initially polyuric with progressive renal scarring and impairment
Bilateral partial obstruction
Another name for renal calculi
Urolithiasias
Are renal calculi more common in males or females?
Males
4 causes of renal calculi
Excess of substances
Change in urine constituents
Supersaturation
Decreased citrate levels
Why does decreased citrate levels predispose you to renal calculi?
Citrate combines with Ca2+ and prevents calcification.
Not peeing for a long tiem
Supersaturation
What conditions can cause renal calculi though precipitation of excess substances?
Bone disease
Increased PTH
Sarcoidosis
Name 4 things that renal calculi can be made of
Calcium (70%)
Struvite-produced by bacteria
Urate stones-uric acid
cystine stone
Describe the pathogenesis of struvite stones
Urease producing bacterial infection-converts urea to ammonia.
Ammonia increases the urine pH
Precipitation of magnesium ammonium phosphate salts
What component are struvite stones made out of?
Magnesium ammonium phosphate salts
Describe the calculi that form from struvite
Large ‘staghorn’ calculi
Who is predisposed to developing urate stones?
People with hyperuricaemia (a consequence of gout or patients with a high cell turnover e.g. leukaemia)
What kidney stones do you get if you can’t reabsorb amino acids?
Cysteine stones
3 ways you can investigate for renal calculi
Non-contrast CT scanning
Ultrasound in pregnancy where CT is not possible
IV urography- inject dye
4 complications of renal calculi
Obstruction
Haematuria-destroys lining of endothelium
Infection
Squamous metaplasia-chronic irritation. Precursor for squamous cell carcinoma
What is the most common type of renal cell carcinoma
Clear cell
Apart from clear cell, name 2 other types of renal cell carcinoma
Papillary
chromophobe
Is renal cell carcinoma more common in males or females?
Males
What are the main risk factors for renal cell carcinoma
Smoking obesity hypertension oestrogens acquired cystic kidney disease asbestos exposure
A genetic disease associated with renal cell carcinoma, especially clear cell
Von Hippel Lindau Syndrome
Von Hippel Lindau syndrome is a malfunction of what gene?
VHL gene required for breakdown of hypoxia-inducible factor 1 (HIF-1) tumour suppressor gene. Loss of gene function causes cell growth and T cell survival (Von Hippel in Hifi)
Where do tumours commonly develop in Von Hippel lindae syndrome
Kidneys, blood vessels, pancreas
How does renal cell carcinoma present
Haematuria palpable abdominal mass costovertebral pain If late presentation-systemic symptoms or metaplasia paraneoplastic syndromes
what paraneoplastic symptoms are seen in renal cell carcinoma
Cushings-ACTH
Hypercalcaemia-PTH
Polycythaesia-erythropoietin
Describe the morphology of clear cell carcinoma
Clear cells- nucleus/cytoplasm are dissolved during processing
Well defined yellow, often with haemorrhagic areas
May extend into perinephric fat or into renal vein
Describe the morphology of papillary carcinomas
More cystic, multiple, bilateral
Cuboidal, foamy cells.
Surround fibrovascular cores often containing foamy macrophages or calcium
Prognosis with renal cell carcinoma
Chemo-resistant-v.poor prognosis with metastases
Where do 95% urothelial cell carcinomas develop
Bladder
Risk factors for urothelial cell carcinomas
Age
Male
Carcinogens (smoking, cylamines, radiotherapy)
Presentation of urothelial carcinomas
Haematuria
Urinary frequency
Pain on urination
Urinary tract obstruction
What are the 2 types of urothelial carcinomas
Papillary (more common)
Flat (usually high grade)
If the tumour invades the muscularis propria (T2) of the bladder, what is the treatment
Resect bladder
Prognosis for urothelial carcinomas
Recurrences are common
Cytoscopy-regular follow up
