diseases of the urinary system 2

Question 1

Pelvic causes of urinary tract obstructions

Answer 1

renal stones
renal strictures
renal tumours
stag-horn calculi

Question 2

Intrinsic causes of urinary tract obstructions

Answer 2

calculi
tumour
clots
sloughed papillae
inflammation

Question 3

Extrinsic causes of urinary tract obstructions

Answer 3

pregnancy- obstruction of distal ureter due to utreus and prostaglandins.
tumour- e.g. cervical

Question 4

bladder causes of urinary tract obstructions

Answer 4

calculi
tumours
viscioureteral reflux- valve doesn’t work so when the bladder is full urine passes back up the ureter.

Question 5

urethral causes of urinary tract obstructions

Answer 5

valave stricture

Question 6

prostatic causes of urinary tract obstructions

Answer 6

hyperplasia, carcinoma, prostatins.

Question 7

what are the 4 categories of obstructions in any environment

Answer 7

obstruction within lumen
abnormalities of the wall
external compression
functional obstruction

Question 8

define sequeale

Answer 8

a condition which is the consequence of previous disease or injury.

Question 9

what are the consequences of a complete obstruction.

Answer 9

Reduced glomerular filtration rate and mild dilation and cortical atrophy
Acute renal failure.

Question 10

what are the consequences of intermittent obstruction

Answer 10

Filtrate will pass back into the interstitum
Compress the medulla, impairing concentrating ability
Cortical atrophy, fall in renal filtration and renal failure.

OR

Continued glomerular filtration
Dilation of the pelvis and calyces
Cortical atrophy, fall in renal filtration and renal failure.

Question 11

clinical features of acute bilateral obstruction.

Answer 11

pain, acute renal failure and anuria.

Question 12

clinical features of chronic unilateral obstruction.

Answer 12

asymptomatic initially, if unresolved cortical atrophy and reduced renal function.

Question 13

are males or females more likely to get renal calculi

Answer 13

males

Question 14

pathogenesis of renal calculi

Answer 14

Either due to excess of substances which precipitate out e.g. Ca +.
OR
A change in the urine constituents causing precipitation of substances e.g. change in pH.

Question 15

what is the most common type of renal stone

Answer 15

calcium

Question 16

what causes excess calcium to be present.

Answer 16

hypercalcemia- bone disease, excess PTH and sacrodosis,
excessive absorption of intestinal calcium
inability to resorb tubular calcium
idiopathic

Question 17

pathogenesis of striate stones formation

Answer 17

Urease producing bacterial infection (proteus)
Urease converts urea to ammonia
Cause a rise in urine pH.
Precipitation of magnesium ammonium phosphate salts
Large “staghorn” calculi.

Question 18

pathogenesis of urate stones

Answer 18

Hyperuricaemia- gout, high cell turnover (leukaemia), idiopathic

Question 19

pathogenesis of cystine stones

Answer 19

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

Question 20

what investigations are carried out for renal caliculi

Answer 20

Non-contrast CT scanning
ultrasound (if CT not possible)
Intraveous urography.

Question 21

sequalae to renal stones

Answer 21

obstruction, haematuria, infections, squamous metaplasia precursor.

Question 22

what cell type are the majority of renal carcinomas

Answer 22

clear cell.

Question 23

what are the risk factors of renal cell carcinoma

Answer 23

tobacco, obesity, hypertension, oestrogen’s, acquired cystic kidney disease
asbestos exposure.

Question 24

define von hippel-Lindau syndrome.

Answer 24

most common renal cell carcinoma

Question 25

pathogenesis of von hippel linadau syndromes

Answer 25

VHL gene required for breakdown of Hypoxia Inducible Factor-1 (HIF-1) oncogene
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

Question 26

clinical presentation of the von hippel liandau syndrome

Answer 26

local symptoms- haematuria, palpable abdominal mass, costovertebral pain/
paraneoplastic syndromes

Question 27

paraneoplastic syndromes associated with renal cell carcinoma

Answer 27

Cushings- ACTH
Hypercalcaemia- parathyroid hormone related peptide.
Polycythemia- erthropoietin.

Question 28

morphology of renal cell carcinoma

Answer 28

clear cell- well-defined yellow tumours, often with haemorrhagic areas, may extend to peripnephric fat or renal vein.
Papillary- more cystic, more likely to be multiple.

Question 29

microscopy of a clear cell

Answer 29

Clear cells, Delicate vasculature, small bland nuclei

Question 30

microscopy of papillary tumours

Answer 30

Cuboidal, foamy cells, surrounding fibro vascular cores often containing foamy macrophages or calcium.

Question 31

urothelial cell carcinoma can affect what aspects of the urinary tract

Answer 31

Urothelial lining is over, ureter, bladder and the pelvis.

Question 32

most common site for urothelial cell carcinoma

Answer 32

bladder

Question 33

risk factors for urothelial cancer

Answer 33

age

gender- more common in males

Question 34

carcinogens which cause urothelial cancer

Answer 34

smoking, aryl amines, cyclophosphamide, radiotherapy.

Question 35

diagnosis of urothelial cancer

Answer 35

cytoscopy

Question 36

clinical presentation of urothelial cancer

Answer 36

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

Question 37

prognosis of urothelial cancer

Answer 37

recurrence common

out come depends on grade and stage

Question 38

prognosis of renal clear cell carcinoma

Answer 38

5 years, but depends or whether the carcinoma is organ confined, tumour extends into perinephric fat and renal vein and whether it metastasises distally.