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Urinary System > Lecture 9.1: Glomerular Pathology and Malignancies of the Urinary Tract > Flashcards

Lecture 9.1: Glomerular Pathology and Malignancies of the Urinary Tract Flashcards

1
Q

What is Glomerulonephritis (GN)?

A

It is a renal disease characterised by inflammation and damage to the glomeruli

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2
Q

What is the effect of Glomerulonephritis?

A

This glomerular damage allows protein (with or without blood) to leak into the urine (proteinuria and haematuria respectively)

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3
Q

What can Glomerulonephritis present with? (5)

A
  • Isolated Haematuria or Proteinuria
  • Nephrotic Syndrome
  • Nephritic Syndrome
  • Acute Renal Failure
  • Chronic Renal Failure (CKD)
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4
Q

What 2 categories can Glomerulonephritis (GN) can be broadly put into?

A
  • Proliferative Disease
  • Non-Proliferative Disease
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5
Q

Pathophysiology of GN

A

Increased permeability of the glomerulus leading to loss of proteins into the tubules

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6
Q

What does characteristics does Nephrotic Syndrome include (in terms of protein and albumin)?

A
  • Loss of significant volumes of protein via
    the kidneys (proteinuria) which results in
    hypoalbuminaemia
  • The definition of nephrotic syndrome
    includes both massive proteinuria (≥3.5
    g/day) and hypoalbuminaemia (serum
    albumin ≤30 g/L)
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7
Q

What are the other associated symptoms as a result of hypoalbuminaemia?

A
  • Oedema (due to reduced oncotic pressure)
  • Hyperlipidaemia
  • Hypercoagulability
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8
Q

Clinical Symptoms of Nephrotic Syndrome (10)

A
  • Peripheral Oedema (more common in adults)
  • Facial Oedema (more common in children)
  • Frothiness of Urine
  • Fatigue
  • Poor Appetite
  • Recurrent Infections (due to immune dysfunction)
  • Venous or Arterial Thrombosis (e.g. myocardial
    infarction, deep vein thrombosis) due to
    hypercoagulability
  • Oliguria
  • Hypertension
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9
Q

Clinical Signs of Nephrotic Syndrome (4)

A
  • Oedema (e.g. peri-orbital, lower limb,
    ascites)
  • Xanthelasma and/or xanthoma
  • Leukonychia
  • Shortness of breath (with associated chest
    signs of pleural effusion)
  • Uraemia (toxins in urine)
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10
Q

What are typical findings on Urinalysis in the context of Nephrotic Syndrome? (2)

A
  • Proteinuria (protein ++++)
  • Frothy appearance of urine
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11
Q

Pathophysiology of Nephrotic Syndrome

A

Thin glomerular basement membrane with pores that allow protein and blood into the tubule

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12
Q

What are some Red Flags of Malignancy in the Urinary Tract? (10)

A
  • Abdominal Pain
  • Fatigue
  • Lower Back Pain
  • Appetite or Weight Loss
  • Iron Deficiency
  • Haematuria
  • Erectile Dysfunction
  • Change in Bladder Habit
  • Poor Stream
  • Bone Pain
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13
Q

Renal Parenchymal Tumours (2)

A
  • Renal Adenocarcinoma
  • Nephroblastoma Tumour of Childhood
    Known as Wilms’ tumour
  • Metastases
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14
Q

Renal Adenocarcinoma (RCC)

A

Most commonly clear cell cancer, incidental
findings

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15
Q

Risk Factors for RCC

A
  • Smoking
  • Obesity
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16
Q

Classic Triad of RCC

A
  • Haematuria (may produce iron deficient
    anaemia)
  • Loin Pain
  • Palpable Flank Mass
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17
Q

What are Paraneoplastic Syndromes?

A
  • Paraneoplastic syndromes are a group of
    rare disorders that are triggered by an
    abnormal immune system response to a
    cancerous tumour known as a “neoplasm”
  • They are thought to happen when cancer-
    fighting antibodies or WBCs (T-cells)
    mistakenly attack normal cells in the
    nervous system
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18
Q

What is Metastatic Disease/Metastasis?

A
  • It is when cancer cells break away from
    where they first formed (primary cancer)
  • Travel through the blood or lymph system
  • Form new tumours (metastatic tumours)
    in other parts of the body
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19
Q

How often does Paraneoplastic Syndromes occur in RCC?

A

<20%

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20
Q

How often does Metastasis occur in RCC?

A

15-20%

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21
Q

How common is RCC?

A
  • 8th most common cancer in UK
  • 95% of all upper urinary tract tumours
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22
Q

What is Von Hippel-Lindau Syndrome?

A

It is an inherited disorder characterised by the abnormal growth of both benign and cancerous tumours and cysts in many parts of the body

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23
Q

Risk Factors for developing RCC

A
  • Smoking (2x↑)
  • Obesity
  • Dialysis
  • Von Hippel-Lindau Syndrome
  • Familial Inheritance
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24
Q

Mortality of RCC

A
  • 8 in every 10 people live at least a year after
    diagnosis
  • 5 in 10 live at least 10 years
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25
Q

What is Nephritic Syndrome?

A
  • Nephritic syndrome is a condition
    involving haematuria, mild to moderate
    proteinuria (typically less than 3.5g/L/day),
    hypertension, oliguria and red cell casts in
    the urine
  • The patient usually has a more prominent
    creatinine elevation and hypertension as
    well which helps differentiate it from
    Nephrotic Syndrome
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26
Q

What is Iatrogenic Cushing’s Syndrome?

A

It is usually related to prolonged and/or high-dose oral or parenteral steroid use

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27
Q

Iatrogenic Cushing’s Syndrome Signs and Symptoms (4)

A
  • Moon-Face
  • Odema
  • Purple Stretch Marks
  • Hair Thinning
  • Hypokalaemia
  • Hypernatraemia in blood (as cortisol can
    mimic effects of aldosterone)
  • Initial weight-loss
  • Then central weight gain
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28
Q

What is Intravesical BCG?

A

Chemotherapy injected directly into bladder

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29
Q

Why are people with Nephrotic Syndrome given corticosteroid?

A

In most children with nephrotic syndrome, this protein leak resolves with corticosteroid drugs (prednisone, prednisolone) reducing the risk of serious infection

30
Q

What corticosteroids are prescribed for Nephrotic Syndrome?

A
  • Prednisone
  • Prednisolone
31
Q

What is the difference between Prednisone and Prednisolone?

A

Prednisone must be converted by liver enzymes to Prednisolone before it can work

32
Q

Paraneoplastic Syndromes (5)

A

1) Polycythaemia: due to secretion of erythropoietin
2) Hypercalcaemia: due to secretion of PTH-related
peptide
3) Hypertension: due to secretion of renin
4) Neuromyopathy
5) Feminising or masculinising syndromes

33
Q

How is Diagnosis of RCC done? (5)

A
  • Ultrasound
  • CT scan
  • MRI
  • Cystoscopy
  • Biopsy
34
Q

Treatment of RCC

A
  • Radiation Therapy
  • Radical Nephrectomy
  • Partial Nephrectomy
  • Radio Frequency Ablation or Cryotherapy
  • Embolisation
35
Q

What is Embolisation?

A

Embolisation is a procedure to block the blood supply to the tumour, causing it to shrink

36
Q

What is a Nephroblastoma/Wilms’ Tumour? What is it caused by?

A
  • A rare kidney cancer that primarily affects
    children
  • Caused by a Chromosome 11 abnormality
  • 80% Present before 5 years of age
  • Rarely seen after 10 years of age
37
Q

What Symptoms does Nephroblastoma/ Wilms’ Tumour present with? (7)

A
  • Large Abdominal Mass
  • Abdominal Pain
  • Anaemia
  • Incidental Finding
  • Hypertension
  • Haematuria
  • Weight Loss
38
Q

Investigations for Nephroblastoma/Wilms’ Tumour (4)

A
  • CT Scan
  • Ultrasound
  • MRI
  • Kidney Biopsy
39
Q

What is the Treatment for Nephroblastoma/ Wilms’ Tumour?

A
  • Nephrectomy
  • Chemotherapy
40
Q

What is the Prognosis of Nephroblastoma/ Wilms’ Tumour?

A
  • 80% Cured
41
Q

What is another name for Ureteric (Urothelial) Cancer?

A

Transitional Cell Carcinoma (TCC)

42
Q

Where does Urothelial Carcinoma arise from?

A
  • Arise from the renal pelvis and resemble
    bladder cancer cells
  • Urothelium
43
Q

What is the Prevalence of Ureteric (Urothelial) Carcinoma?

A
  • Only <5% of all malignancies of upper
    urinary tract
44
Q

What are Risk Factors for Ureteric (Urothelial) Carcinoma? (5)

A
  • Smoking
  • Phenacetin Abuse
  • Being exposed to certain Dyes
  • Chemicals used in making leather goods,
    textiles, plastics, and rubber
  • Hereditary non-polyposis colorectal cancer
45
Q

What Investigations are done for the Diagnosis of Ureteric (Urothelial) Carcinoma? (6)

A
  • Ultrasound
  • CT Urogram
  • Retrograde pyelogram
  • Ureteroscopy
  • Biopsy
  • Washings for cytology lkan’s nephropathy
46
Q

What Key Factor about Haematuria makes it a Red Flag for Malignancy?

A

Painless haematuria must be treated as urinary tract malignancy until proven otherwise

47
Q

What is the percentage of recurrence of bladder cancer?

A

50-75%

48
Q

Low Grade Bladder Cancer (T1): How often do they recur? How many progress to invasive tumours? Percentage mortality? Treatment?

A
  • Unlikely to spread further
  • 70% recur
  • 10-20% progress to more invasive
    tumours
  • Mortality 1-15%
  • Rx: TURBT + Intravesical cytotoxics (MMC –
    60% effective,for high Grade BCG)
49
Q

Moderately Invasive Bladder Cancer (T2-T3): Spread? Treatment?

A
  • Spread to muscle layers
  • Risk of cancer spreading further to rest of
    body
  • Rx= Radical cystectomy +/- radiotherapy,
    post op chemo or neo-adjuvant chemo
50
Q

High Grade Invasive Bladder Cancer (T4): Spread? Treatment?

A
  • Spread beyond bladder
  • Mets – pelvic structures, local LN, liver and
    lungs
  • Rx: Palliative chemo/radiotherapy
  • Aim is pain relief and controlling
    symptoms
51
Q

Prevalence of Prostate Cancer? What type of cancer is it?

A
  • It is the most common type of cancer in
    men
  • Prostate cancer is the second most
    common cause of cancer death in males in
    the UK (after lung cancer), accounting for
    13% of all cancer deaths
  • 95% are adenocarcinomas
52
Q

What is the PSA Test? Is it good?

A
  • Prostate Specific Antigen Test
  • PSA is a protein (serine protease)
    produced by normal and cancerous
    prostate cells
  • Not very good as may things can give a
    postive PSA Tests e.g. injured prostate,
    benign prostatic hyperplasia, prostate
    cancer, vigorous exercise, UTI ..etc
53
Q

What are some Risk Factors for Prostate Cancer? (6)

A
  • > 50
  • Black
  • Genetics
  • Obesity or being overweight
  • Migrants moving from low risk to high risk
    areas acquire the local incidence rate
  • Incidence rates higher in more affluent
    men
54
Q

Where do Prostate Cancers most commonly metastasise? (2)

A
  • Bone
  • Lungs
55
Q

What Signs and Symptoms can Prostate Cancer present with? (7)

A
  • LUTS: nocturia, hesitancy, poor stream,
    terminal dribbling
  • Asymptomatic
  • Bone Pain
  • Anaemia
  • Weight Loss
  • General Malaise
  • Cachexia
56
Q

What is Gleason Score/Grade?

A

It is the most common system doctors use to grade prostate cancer

57
Q

Gleason Grading: Score 6 (Grade Group 1)

A
  • The cells look similar to normal prostate
    cells
  • The cancer is likely to grow very slowly, if
    at all
58
Q

Gleason Grading: Score 7 (or 3 + 4 = 7) (Grade Group 2)

A
  • Most cells still look similar to normal
    prostate cells
  • The cancer is likely to grow slowly
59
Q

Gleason Grading: Score 7 (or 4 + 3 = 7) (Grade Group 3)

A
  • The cells look less like normal prostate
    cells
  • The cancer is likely to grow at a moderate
    rate
60
Q

Gleason Grading: Score 8 (Grade Group 4)

A
  • Some cells look abnormal
  • The cancer might grow quickly or at a
    moderate rate
61
Q

Gleason Grading: Score 9/10 (Grade Group 5)

A
  • The cells look very abnormal
  • The cancer is likely to grow quickly
62
Q

Investigations to diagnose Prostate Cancer (4)

A
  • PSA
  • Digital Rectal Examination (DRE)
  • MRI
  • Biopsy (Transrectal ultrasoundguided
    (TRUS)
    is being replaced by Trans Perineal (Tp)
    Prostate Biopsy)
63
Q

How are Prostate MRIs Standardised

A

PI-RADS Scoring (Prostate Imaging-Reporting and Data System)

64
Q

Complications of Transrectal Ultrasoundguided (TRUS) (4)

A
  • Sepsis
  • Acute Urinary Retention
  • Haematuria
  • Bleeding per rectum and blood on
    ejaculation
65
Q

Prevalence of Testicular Cancer

A

Commonest cancer in men between 15-35 yrs

66
Q

Where do 95% of Testicular Cancers arise from?

A

Germ Cell

67
Q

What does Testicular Cancer often present with? (8)

A
  • Irregular, firm, fixed, no transillumination
  • Dragging sensation
  • Testicular/abdominal pain
  • Lymphadenopathy
  • Gynaecomastia (beta-hCG production)
  • Back Pain (mets)
  • Hepatomegaly (spread to liver)
  • Neurological Disease
68
Q

Prevalence of Penile Cancer

A

Very Rare

69
Q

What does Penile Cancer present with? (2)

A
  • Presents with non tender swelling of the
    glans penis
  • Purulent and/or Bleeding from under the
    foreskin
70
Q

Risk Factors for Penile Cancer (4)

A
  • Phimosis (inability to retract the skin
    (foreskin or prepuce) covering the head
    (glans) of the penis)
  • HPV
  • Smoking
  • Low Immunity
71
Q

What type of cancers are Penile Cancers usually?

A

Squamous Cell Carcinomas

Urinary System (15 decks)

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