Diseases of the renal system 2 (Kidneya and urinary system pathology)

Question 1

What is obstructive uropathy?

Answer 1

Obstruction of the urinary tract .

it can occur anywhere from the renal pelvis to the urethral meatus.

Question 2

What are the causes and sites of urinary tract obstruction?

Answer 2

1) PELVIS:
- Stones (calculi)
- Tumour
- Ureteropelvic stricture

2) Ureter (intrinsic):
- clots
- inflammation
- stones (calculi)
- tumour

3) Ureter (Extrinsic)
- Pregnancy
- Retroperitoneal fibrosis
- tumour

4) Bladder
- stones
- tumour

5) Urethra
- valve stricture

6) Prostate
- hyperplasia
- tumour
- prostatitis

Question 3

What is sequelae?

Answer 3

Infection of kidneys

Question 4

What happens to the kidneys in Hydronephrosis?

Answer 4

• Dilated calyces
• Dilated pelvis
• cortical atrophy

*Hydronephrosis is when the kidney gets stretched and swollen due to a collection of urine inside.

Question 5

What are the consequences of complete obstructive uropathy?

Answer 5

1) reduction in glomerular filtration rate
2) dilation and cortical artophy

Leads to ACUTE RENAL FAILURE

Question 6

What are the clinical features of acute bilateral obstruction?

Answer 6

• pain
• actue renal failure
• Anuria (failure to produce urine)

Question 7

What are the clinical features of chronic unilateral obstruction?

Answer 7

• initially asymptomatic

- leads to cortical atrophy & reduced renal function.

Question 8

What are the clinical features of bilateral partial obstruction?

Answer 8

• Polyuric (excessive urination)
• renal scarring
• reduced renal function

Question 9

What are the 4 different types of stones found in the Renal system?

Answer 9

1) Calcium (70%)
2) Struvite (15%) = Mg and phosphate.
3) Urate (5%) = Uric acid
4) Cystine stones (1%)

Question 10

Why do calcium stones form and what are the risk factors?

Answer 10

1) Hypercalciuria caused by:
- hypercalcaemia (PTH excess, bone disease)
- increased absorption of calcium from intestines.

2) Gout

Question 11

Why do struvite stones form?

Answer 11

1) Bacterial infection produces urease.
2) Urease converts urea to ammonia
3) pH rises
4) causes precipitation of magnesium and phosphate&raquo_space;>struvite stone

Question 12

Why do urate stones form?

Answer 12

Hyperuricaemia due to gout

Question 13

What type of cells are most renal carcinomas?

Answer 13

Clear Cell

Question 14

What are the risk factors of renal carcinomas ?

Answer 14

1) Tobacco
2) Obesity
3) Hypertension
4) Oestrogens

Question 15

what is Von Hippel-Lindau Syndrome?

Answer 15

Characterised by the formation of cysts and Tumours of kidney, blood vessels and pancreas caused buy mutations in the VHL gene.

Question 16

What is the morphology of renal cell carcinoma?

Answer 16

Clear Cell:

• well defined yellow tumour.
• haemorrhagic areas

Papillary:
-cystic

Question 17

Which part of renal system is urothelial cell carcinoma most common?

Answer 17

Bladder

Question 18

How does urothelial cell carcinoma present clinically?

Answer 18

1) Haematuria
2) Urinary frequency
3) pain on urination
4) Urinary tract obstruction

Question 19

What is the prognosis of Renal Cell carcinoma?

Answer 19

Good prognosis. (5 year survival)

however if metastesised then bad as it can be resistant to chemo

Question 20

What is the prognosis of urothelial cell carcinoma?

Answer 20

Recurrences common

low grade then most alive at 5 yrs

Muscle invasion then 60% alive at 5 years

Poor prognosis for metastatic disease