Nephrology & Urology

Question 1

Symptoms of nephritic and nephrotic

Answer 1

NEPHRITIC
- Haematuria with RBC
- Oliguria
- Azotaemia
- Arterial Hypertension

NEPHROTIC
- HEAVY Proteinuria (MORE than 3.5 g/day)
- Hypoalbuminemia
- Hyperlipidaemia
- Oedema

Question 2

Pyelonephritis definition and acute chronic morph

Answer 2

DEFINITION = Term for BACTERIAL Infections of RENAL PARENCHYMA + RENAL Pelvis

• Hematogenous Spread can occur in Px w/ INFECTIVE Endocarditis OR Bacteraemia

ACUTE
- Abscess throughout Cortex + Medulla
- Wedge-Shaped Confluent Area of Suppuration

• Tubules are DISTENDED by Inflammatory Cells + GRANULAR Necrotic Material

CHRONIC
a) Obstructive Chronic
b) Non-Obstructive Chronic

MORPHOLOGY
0 Macro
- Kidney involvement either UNILATERAL or BILTAERAL if asymmetrical

• DEEP IRREGULAR Scares on Surface
• DISTINCTIVE Relationship BTW Scarred Area AND Underlying DEFORMED, DILATED CALCYES

0 Micro
- Chronic Inflammation of Kidney + Renal Pelvis
- PERICAPSULAR FIBROSIS of Glomeruli
- DILATED Tubules
- LINING of Epithelium shows ATROPHY
- PINK MATERIAL in Lumen, giving THYROID APPEARANCE

Question 3

Classification of nephrosclerosis

Answer 3

1) VASCULAR NEPHROSCLEROSIS
a. ArterioLOSCLEROTIC
b. ArterioNECROTIC
c. ArterioSCLEROTIC

2) INFLAMMATORY NEPHROSCLEROSIS
a. Glomerulonephritic
b. Pyelonephritic
c. Tuberculous

3) METABOLIC NEPHROSCLEROSIS
a. DUE to AMYLOIDOSIS
b. Diabetic
c. Gout-Related

4) URINARY NEPHROSCLEROSIS
a. DUE to HYDRONEPHROSIS
b. Due to URINARY CALCULI

5) COMBINED

Question 4

Urothelial carcinoma histo and morpho.
-gross & histological changes in renal carcinoma

Answer 4

ETIOLOGY = UROTHELIUM (Transitional Epithelium of BLADDER)

• MOSTLY Papillary + NON-Ulcerating

MORPHOLOGY
0 Gross
- 90% Papillary, 10% Flat
- Papillary are FREE-FLOATING
- Flat are BULKIER THAN Ulcerated Surface
- Found in Lateral Walls / Trigone / Ureteral Orifices

0 Micro
- Originated from MUCOSA of UB
- Made of - BRANCHED Papillae / Covered in MULTI-LAYERED Epithelium
- Anastomoses
- UMBRELLA CELLS on Surface
- INFILTRATES Bladder Wall
- SHORT Papillae, THICKENED + FUSED

Question 5

Describe the macroscopic type and microscopic structure of clear cell carcinoma of the
kidney

Answer 5

Clear Cell Carcinoma of Kidney IS ADENOCARCINOMA from the TUBULAR EPITHELIUM

GROSS:
- UPPER POLE of the Kidney is SOLITARY, UNILATERAL, LARGE, GOLDEN-YELLOW + CIRCUMSCRIBED

• On a CUT-SURFACE, there are LARGE AREAS of Ischaemic Necrosis, Cystic Change + Haemorrhages
• The TUMOUR THROMBUS in the RENAL VEIN, can EXTEND INTO –> VENA CAVA

HISTO:
- LARGE Tumour Cells
- CLEAR Cytoplasm that’s OPTICALLY EMPTY
- Arranged in PAPILLAE / TUBULES
- SMALL Amount of Stroma, BV’s + Lymphocytes
- Tumour Cells INVADE VENOUS Walls

• Has a THICK PSEUDOCAPSULE, showing PARTIAL TUMOUR Infiltration