GUT: Renal Disease Flashcards
Congenital structural, non-neoplastic kidney diseases?
PKD
Agenesis
Horseshoe kidney
Abnormal ureteric systems
3 causes of obstructive hydronephrosis?
Extrinsic (eg lymph node)
Tumour in ureter wall
Stones
What can cause a staghorn calculus?
Proteus, or sometimes e coli, infection.
Staghorn calculus is molded by the luminal cavity of the pelvis and calyces over time.
Organisms causing acute pyelonephritis
May be bloode borne
E COLI MOST COMMON
Histology of pyelonephritis: Collections of _____ polymorphs. Grossly you can see small, studded ___ right through the renal parenchyma
Neutrophil
Abcesses
What needs to be present to define pyelonephritis as chronic?
POLAR SCARS involving the CALYX
Due to repeated infections
Histology of chronic pyelonephritis: Inflammation fibrosis, glom. sclerosis. And _____ of the tubules which contain a pink cast like material.
Thyroidisation (the pink casts resemble thyroid follicles)
Gross pathology of chronic pyelonephritis: Cystic appearing structures that are actually dilated _____. Renal parenchyma between these show a reduction in tissue.
Calyces
What percent of the population are born with one kidney?
1%, agenesis
Symptoms of PKD
Presents in 3rd decade
HTN
Renal masses
Chronic renal impairment
Complications of PKD
Cyst rupture or bleeding
10% develop cystic clear cell carcinoma
Liver and pancreas cysts
BERRY ANEURYSMS
Inheritance pattern of PKD
Autosomal dominant
Inheritance pattern of infantile PKD
Autosomal recessive
Prognosis of infantile PKD?
Very poor, severely impaired kidney function requiring dialysis from birth
Is a renal adenoma benign or malignant?
Benign
Is an oncocytoma benign or malignant?
Benign, but larger and very difficult to differentiate from a renal cancer so are often removed.
Is a metanephritic adenoma benign or malignant?
Benign, rare and often found incidentally
Examples of malignant tumours from the Heidelberg classification (6)
- Clear cell carcinoma
- Papillary carcinoma
- Chromophobe carcinoma
- Collecting duct carcinoma
Renal carcinoma unspecified Urothelial tumours (TCC)
Name the four most common types of renal cancer
Clear cell carcinoma
Papillary carcinoma
Chromophobe carcinoma
Collecting duct carcinoma
What percentage of renal cancers are Clear cell?
75%
Are renal tumours more common in M or F?
M>F (2:1)
Associated with smoking
When do renal tumours present?
5th decade
Risk factors for renal tumours?
Tuberous sclerosis
Von Hippel-Lindau disease
Renal transplants
DIALYSIS due to scarring
Molecular pathology: Which cancer is linked to 3p del?
Clear cell
Molecular pathology: Which cancer is linked to trisomy 7 and 17?
Papillary carcinoma
Triad of renal cancer symptoms
Mostly discovered incidentally, the clinical triad is rare
- Renal mass
- Haematuria
- Flank
First line investigation for renal cancer?
CT scan
Clear cell carcinoma histology: Sheets of ___cells. Vacuolated cytoplasm. Pyknotic ___. Cystic in ___.
Clear
Nuclei
15
Gross appearance of clear cell carcinoma: pale ____ (colour), tumour with areas of haemorrhage and cystic change in ___%
Yellow
15
In what % of cases is a papillary CA bilateral?
10% therefore always check other kidney
Histology of chromophobe CA: Very ___cell membrane. Also perinuclear ____
Thick
Halos
What is prognosis of collecting duct CA?
Very poor
Very aggressive tumour, even when small, found in renal medulla
Which grading system is used for renal CAs?
Fuhrman grading, based on exclusively on NUCLEAR SIZE
From I to IV
Stage pt1 of renal cancer
Confined to kidney, <7cm diameter
Stage pt2 of renal CA
Confined to kidney, >7cm
Stage pT3 of renal CA
Renal vein or vena cava involved
Stage pT4 of renal CA
Spread to adjacent organs or Gerota’s fascia
Treatment options for renal RA
Radical nephrectomy
Partial nephrectomy
Radiofrequency ablation for small tumours
Chemotherapy for metastasis (no benefit for renal tumour)
Interferon
What is a radical nephrectomy?
Removing whole kidney, portion of ureter, adrenal gland, and any higher lymph nodes
Prognosis of pT1 renal CA?
70% 5 year survival
Prognosis of pT4 renal CA?
5%
How does Transitional cell carcinoma present in the kidney?
Cauliflower tumour involving the renal pelvis. More common in bladder/ ureters.
Need to remove ureter in TCCs due to high risk of spread.
Another name for Wilms tumour?
Nephroblastoma
Can be bilateral
Who presents with WIlms tumour? How does it present?
2-4 yr olds
Usually abdominal mass rather than other symptoms.
Then it has got a stromal component that sometimes can form muscle and cartilage
prognosis has improved considerably, with improved surgical technique and chemotherapy in these
cases, you would expect a cure, providing there is not a sort of anaplasia within
the tumour.
How is glomerulonephritis classified? Clinically or pathologically
Mostly classified based on clinical features
What is Goodpasture’s?
An anti-glomerular basement membrane disease (glomerulonephritis)
5 categories of presentation of glomerulonephritis?
Nephrotic syndrome (protein loss in urine)
Nephritic syndrome
Acute renal failure
Chronic renal failure
Incidental finding eg on dipstick
What level of proteinuria indicates nephrotic syndrome?
> 3.5g in 24 hours
Classical features of nephrotic syndrome (4)
Proteinuria >3.5g in 24 hours
Oedema
Hypercholesterolaemia
Hypoalbuminaeia
Main cause of nephrotic syndrome in adults?
Membranous glomerulonephritis
Clinical features of nephritic syndrome? (4)
Haematuria
Renal impairment
Hypertension
ACTIVE URINE SEDIMENT
Histological signs of nephritis?
Proliferation of cells within glomeruli
Most common cause of pimary glomerulonephritis?
IgA nephropathy
Presents as chronic renal failure in young men with nephrotic syndrome
Very poor renal prognosis
Which primary glomerulonephritis causes nephrotic syndrome in children?
Minimal change disease
Is post-streptococcal GN a primary or secondary GN?
Primary
Rarely biopsied but has good outcome
Most common time of year to see Goodpasture’s disease?
Spring
Which primary glomerulonephritis is caused by lupus nephritis, hep C, cryoglobulinaemia etc?
Membranoproliferative GN
Gold standard test for diagnosing glomerulonephritis?
Renal biopsy under USS guidance
Why are 2-3 cores taken during a renal biopsy?
One for light microscopy
One for immunofluorescence
One for electron microscopy
What tissue is seen with Masson’s trichrome stain in histology?
Connective
What is silver stain used for in renal histology?
To look at basement membrane
What is periodic acid-Schiff (PAS) stain used for?
TO detect glycogen deposits eg in hyperglycaemia
Which antibodies are applied to frozen tissue in immunofluorescence? (kidney)
IgG, A and M
Complement (C3, C4, C1q)
Fibrin
What is electron microscopy used for in renal histology?
Can identify deposits along the BM.
Can also detect structural problems
True/false: In minimal change disease glomerulonephritis fusion of podocyte foot processes is seen at electron microscopy
True
