Lecture 17 - Pathology of the Urinary Tract

Question 1

Acute pyelonephritis

Answer 1

• disease of the tubules
• inflammation of the kidney and renal pelvis
• most often caused by bacteria = infectious
• often caused by extension of urinary tract infection (E. Coli most common)

Question 2

Chronic pyelonephritis

Answer 2

• disease of the tubules
• inflammation persists for longer period of time causing interstitial scarring between tubules of kidney
• results in deformity of renal pelvis -> renal failure

Question 3

Adult vs. Childhood Polycystic Kidney Disease

Answer 3

Adult:

• autosomal dominant
• more common
• larger cysts
• slower progressive (renal failure at age 50)
• hypertension and brain aneurysms also develop
• involves expanding cysts in both kidneys = enlarge

Childhood

• autosomal recessive
• less common
• smaller cysts w. spongey appearance
• proceed to renal failure quickly
• congenital cirrhosis may also develop
• multiple different subcategories based on presentation time

Question 4

Urolithiasis

Answer 4

• renal calculi / kidney stones
• calculus formation at any level of system
• most common stones: calcium oxilate and calcium phosphate, can be due to hypercalcinuria
• most common obstruction outflow of urine

Question 5

Hydronephrosis

Answer 5

• obstruction causes dilation of renal pelvis followed by renal atrophy
• due to a block at output of urine, anywhere in system
• can be caused by urolithiasis
• kidney swells fro build-up of urine

Question 6

Renal Cell Carcinoma

Answer 6

• most common malignancy in adults
• derived from renal tubular epithelium located predominantly in cortex
  3 forms:
  1. Clear cell (most common)
  2. Papillary Renal Cell
  3. Chromophobe (least common)

Question 7

Wilms Tumor

Answer 7

• also called nephroblastoma
• almost exclusively in children, present at 2-5 years
• comes from primitive cells of kidney that are destined to become glomeruli
• can be felt by doctor

Question 8

Transitional Cell Carcinoma

Answer 8

• arise from transitional epithelium (lines urethra, ureter, urinary bladder)
• most common in urinary bladder
• can be papillary or flat
• invasive or non-invasive
• occurs in older patients (50-70) and can experience blood in urine without pain
• risk factors = smoking, chronic cystitis

Question 9

Horseshore Kidney

Answer 9

• congenital defect
• fusion of kidneys at upper or lower poles (more common)
• can survive but can have predispositions to other diseases (stones, repeated UTIs)

Question 10

Potter Syndrome

Answer 10

• congenital defect
• renal agenesis - failure of kidney development
• infants typically die from pulmonary hypoplasia

Question 11

Prune belly syndrome

Answer 11

• congenital defect
• renal outlet obstruction
• severe outlet obstruction of the urinary bladder
• Example causes: urethral atresia (urethra ends bluntly), “tight” valves of urethral, and other congenital anomalies causing outlet obstruction.