[PATHO] RENAL FAILURE, RENAL TUMORS

Question 1

Acute RF cc by

Answer 1

oliguria
rapid onset azotemia

Question 2

causes of acute RF

Answer 2

1- severe GFR reduction
2-acute failure of tubular epithelium

Question 3

prerenal causes of GFR reduction

Answer 3

acute circulatory failure

Question 4

postrenal causes of GFR reduction

Answer 4

complete obstruction of urethra/both ureters

Question 5

renal causes of GFR reduction

Answer 5

acute rapidly progressive glomerulonephritis

Question 6

causes of acute failure of tubular epithelium

Answer 6

1-acute tubular injury
2-papillary necrosis
3-acute pyelonephritis

Question 7

pathologic changes in RF (12)

Answer 7

1-changes in kidney
2-fibrinous pericarditis + pleurisy
3-uraemic pneumonitis
4-ulcerative enterocolitis
5-immunodeficiency
6-cvs changes w/ HTN
7-Renal osteodystrophy
8-normocytic normochromic anemia
9-mental changes
10-peripheral neuritis
11-coma
12-acid base, fluid, electrolytes disturbances

Question 8

benign tumors of renal pelvis (3)

Answer 8

1-villous papilloma
2-hemangioma
3-fibroma

Question 9

1ry malignant tumors of renal pelvis (2)

Answer 9

1-transitional cell carcinoma
2-sarcoma

Question 10

adults
small
cortical foci of tubular/papillary epithelium

Answer 10

renal adenoma

Question 11

well circumscribed
yellow-grey
soft
formed of BV, smooth muscle,adipose tissues

Answer 11

angiomyolipoma

Question 12

well circumscribed
large
brown
central stellate star
formed of eosinophilic epithelial cells w uniform rounded nuclei

Answer 12

oncocytoma

Question 13

RCC arises from

Answer 13

epithelial cells of renal tubules

Question 14

adult male
smoker
possible exposure to cadmium
painless hematuria
flank pain
lung & bone manifestations
anemia, fever, weightloss
HTN
polycythemia
hypercalcemia
gynecomastia

Answer 14

RCC

Question 15

GROSS picture of RCC (5)

Answer 15

1-well delineated mass
centered in cortex
2-yellow-golden cut surface
3-Hg
4-necrosis
5-cystic changes

Question 16

MICRO: clear RCC (6)

Answer 16

1-arranged in solid masses/cords
tubules
2-dilated cysts w/ papillary formation
3-large cells w/ clear cytoplasm
4-scanty vascular stroma
5-Hg
6-necrosis

Question 17

cells in RCC have clear cytoplasm due to

Answer 17

accumulation of glycogen & fat

Question 18

polycythemia in RCC is due to

Answer 18

production of erythropoietic stimulating substance

Question 19

hypercalcemia in RCC is due to

Answer 19

production of PTH-like substance

Question 20

gynecomastia in RCC is due to

Answer 20

production of gonadotropin & placental lactogen production

Question 21

genetic mutation associated w/ clear RCC

Answer 21

VHL disease

Question 22

early extension in RCC

Answer 22

to renal pelvis

Question 23

late extension in RCC

Answer 23

to renal capsule

Question 24

most common sites of metastasis in RCC

Answer 24

lungs
bones (pelvis & femur)
CNS
suprarenals

Question 25

blood spread in RCC is due to

Answer 25

renal vein invasion

Question 26

left renal vein invasion in RCC can lead to

Answer 26

varicoceles on left side

Question 27

lymphatic spread in RCC to

Answer 27

lumbar LNs

Question 28

genetic mutations associated w/ papillary RCC

Answer 28

MET proto-oncogene mutation

Question 29

bilateral multifocal bad prognosis branching papillae cells w/ large nuclei & little cytoplasm psamomma bodies

Answer 29

papillary RCC

Question 30

large cells clear halo ↑mitochondria granular eosinophilic cytoplasm prominent cell membranes multiple losses of chromosomes

Answer 30

Chromophobe RCC

Question 31

children 2-5 years rapidly growing large abdominal mass hematuria abdominal pain intestinal obstruction HTN destructive, infiltrative homogenous grey cut surface Hg necrosis

Answer 31

Wilm's tumor

Question 32

embryona-nephroblastoma

Answer 32

Wilm's tumor

Question 33

Wilm's tumor arises from

Answer 33

embryonic precursor cells

Question 34

early extension in Wilm's tumor

Answer 34

renal capsule

Question 35

late extension in Wilm's tumor

Answer 35

renal pelvis & ureter

Question 36

MICRO: extremely cellular small oval primitive cells v scanty/oncocytoid cytoplasm

Answer 36

blastematous areas in Wilm's tumor

Question 37

spindle cell fibroblast like config differentiation towards smooth msc, skeletal msc, cartilage, myxomatous tissue

Answer 37

mesenchymal areas in Wilm's tumor

Question 38

glandular/tubular/glomerular formation of anaplastic masses of malignant epithelial cells

Answer 38

epithelial areas in Wilm's tumor

Question 39

sites of blood metastasis in Wilm's tumor

Answer 39

lungs liver brain

Question 40

local invasion in Wilm's tumor of

Answer 40

1-renal capsule 2-perirenal soft tissue 3-adrenals 4-liver 5-bowel 6-vertebrae

Question 41

Cl/P of Wilm's tumor (5)

Answer 41

1-hematuria 2-HTN 3-intestinal obstruction 4-large abdominal mass 5-abdominal pain

Question 42

Cl/P of RCC (9)

Answer 42

1-painless hematuria 2-HTN 3-Flank pain 4-anemia 5-fever 6-weight loss 7-polycythemia 8-hypercalcemia 9-gynecomastia

Question 43

MICRO: Papillary RCC

Answer 43

branching papillae covered by single layer of cells w/ large nuclei & little cytoplasm

Question 44

MICRO: Chromophobe RCC (3)

Answer 44

1-large cells w/ granular eosinophilic cyto 2-prominent cell membranes 3-compact pattern arrangement

Question 45

GROSS: Wilm's tumor (4)

Answer 45

1-cut surface: homogenous grey 2- infiltrates capsule & pelvis 3-Hg 4-Necrosis