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renal > pathology > Flashcards

pathology Flashcards

1
Q

what happens when there is a glomerular blockage?

A

glomerular sieve stops working
membrane charge is disrupted
can get nephrotic or nephritic syndrome

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2
Q

what 3 modalities are used to assess a renal biopsy?

A

Light microscopy
Electron microscopy
Immunoflouresence

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3
Q

what antibodies can be seen in IMF?

A

IgM
IgA
IgG

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4
Q

what cell deposits are seen in electron microscopy

A

subepithelial (below podocyte)
membranous (on GBM)
subendothelial (below endothelium)
mesangial (around the mesangial cells)

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5
Q

what can be caused by anti-GBM disease?

A

goodpasture’s
nephritic syndrome
rapidly progressive glomerulonephritis

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6
Q

where does IgG bind to?

A

IgG binds to alpha-3 unit of type IV collagen found in basement membrane of glomerulus and lung

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7
Q

what causes membranous GN?

A

infection - hepatitis, malaria, syphilis
Drugs – penicillamine, NSAID, captopril, gold
Malignancy – lung, colon and melanoma
Lupus – 15% of all GMN in lupus
Autoimmune Disease - thyroiditis

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8
Q

what is the histological appearance of membranous GN?

A

thick membranes, sub-epithelial immune deposits

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9
Q

what is the most common cause of nephropathy worldwide?

A

IgA nephropathy

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10
Q

who gets IgA nephropathy?

A

genetic, acquired defect – coeliac

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11
Q

what causes membranoproliferative GN?

A

idiopathic (type 2- infection, lupus, malignancy)
seen in adults and children

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12
Q

what is the appearance of MPGN?

A

big lobulated hypercellular glomeruli with thick membranes – tram tracks

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13
Q

does MPGN cause nephrotic or nephritic syndrome?

A

both

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14
Q

does IgA nephropathy cause nephrotic or nephritic syndrome?

A

nephritic

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15
Q

what is the treatment of minimal change disease?

A

steroids - excellent prognosis

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16
Q

what is the most common cause of nephrotic syndrome in children?

A

minimal change disease

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17
Q

what causes focal segmental glomerulosclerosis (FSGS)?

A

obesity, HIV, sickle cell, IV drug use

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18
Q

does FSGS cause nephrotic or nephritic syndrome?

A

nephritic

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19
Q

does FSGS respond to steroids?

A

sometimes yes, sometimes progresses to renal failure

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20
Q

what do you see on the kidneys in diabetic nephropathy?

A

Diffuse and Nodular Glomerulosclerosis
Nodules – Kimmel Stiel Wilson Lesion

Also microvascular disease – arterial sclerosis

Infection – pyelonephritis, papillary necrosis

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21
Q

what is the bosniak score?

A

score to assess the likelihood of a kidney cyst being cancer

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22
Q

what is the main difference in kidneys in ADPKD and ARPKD?

A

ADPKD - big kidneys, uneven surface with large cysts
ARPKD- normal sized smooth kidneys

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23
Q

what is xanthogranulomatous pyelonephritis?

A

mass in kidney caused by chronic pyelonephritis so associated with infection and not malignancy

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24
Q

decsribe oncocytoma

A

Small, oval and well circumscribed tumour
brown with a central stellate (star shaped) scar

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25
Q

describe chromophobe renal cell carcinoma?

A

rare malignant tumours
look similar to oncocytomas but have shriveled nuclei and perinuclear halos

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26
Q

describe papillary renal cell carcinoma

A

2nd most common renal cancer
generally low grade
finger like projections

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27
Q

describe collecting duct carcinoma

A

rare tumour, high grade appearance with very desmoplastic stroma, poor survival

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28
Q

describe clear cell carcinoma

A

most common renal cancer, when people say renal cancer they usually mean this
common, risk factors- obesity, genetics
presents with haematuria, mass, rarely hypertension
bright yellow tumour surface

29
Q

where does clear cell carcinoma normally spread to?

A

renal vein - can then go –> vena cava –> heart

30
Q

what tumours does VHL cause?

A

Renal Cell Carcinoma
Cerebellar haemangioblastoma
Pancreatic serous cystadenoma
Tumours of the endolymphatic sac
Epididymal serous cystadenomas

31
Q

what type of epithelium lines the bladder?

A

urothelium

32
Q

what is cystitis?

A

inflammation of the bladder- usually caused by bacterial infection

33
Q

what is schistosomiasis?

A

water borne disease caused by larvae penetrating skin
presents with haematuria
untreated infection can cause hydronephrosis, renal failure and bladder scc

34
Q

how does schistosomiasis cause bladder scc?

A

persistent infection –> bladder metaplasia –> malignancy

even though there is no squamous epithelium!

35
Q

what is the presentation of interstitial cystitis?

A

middle aged women, persistent symptoms of dysuria but negative cultures

36
Q

what are risk factors for urothelial cancer?

A

smoking - almost as high risk as lung cancer
beta-naphthyline - dye industry

37
Q

describe papillary urothelial carcinoma?

A

malignant but not invasive, finger like projections

38
Q

what is the appearance of urothelial carcinoma in situ?

A

flat lesions

39
Q

what are rare types of urothelial bladder tumours?

A

adenocarcinoma - difficult to distinguish from metastasised colon adenocarcinoma

urachal adenocarcinoma

40
Q

describe the urachus

A

Remnant of the alantois + urogential sinus

From dome of bladder to the umbilicus
Usually involutes, in some various parts remain patent

Rarely – adenocarcinoma arises within it. Isolated to bladder dome

41
Q

what is the function of the prostate?

A

provides passage for urine, some contractile function during ejaculation

42
Q

describe benign prostatic hyperplasia

A

prostate gets bigger - hyperplasia in increase in cell number
affects central and transitional zones - obstructing flow of urine

43
Q

how common is prostate cancer?

A

At 50 – 30% of all men have it
At 70 – 70% of all men have it
At 90 - 90%

44
Q

what are the types of prostate cancer?

A

prostatic acinar carcinoma - most common
small cell carcinoma- most serious

45
Q

what is PSA?

A

prostate specific antigen - glycoprotein enzyme - kallikrein 3

46
Q

what is the problem with PSA?

A

If normal prostate epithelium makes PSA then very malignant cells won’t - a lot of cancers will though

but can be good in follow ups post tumour removal

47
Q

what is gleason staging of prostatic cancer?

A

based on histological appearance
Combination of 2 numbers
Each out of 5
Worst grade and predominant grade
Lowest is usually 3+3 (Score 6)
Highest is 5+5 (Score 10)
1 & 2 not used

48
Q

what is lichen sclerosus?

A

same as BXO
chronic inflammatory condition
affects glans, coronal sulcus and/or foreskin
can cause phimosis and paraphimosis
association with non-HPV related scc

49
Q

what is the clinical presentation of lichen sclerosus?

A

white patches with petechia, erosion, ulceration, pearly areas

50
Q

what is a condyloma?

A

genital wart
papillomatous proliferation of squamous epithelium
can occur in glans, coronal sulcus, foreskin, meatus
caused by HPV - usually 6 & 11 - low risk types

51
Q

what is PeIN?

A

penile intraepithelial neoplasia
can be differentiated - non HPV
or dedifferentiated - HPV related

52
Q

what has an association with penile cancer?

A

lichen sclerosus
phimosis
smoking

53
Q

what do male germ cells mature into?

A

spermatozoa

54
Q

what stimulates sertoli cells and what is their function?

A

FSH
function is to control environment within seminiferous tubules to let the sperm mature

55
Q

what are some common causes of testicular lumps?

A

Hernia
Cystocoele
Hydrocoele
Spermatocoele

56
Q

how do hydroceles form?

A

Accumulation of fluid around the testes

Between the two layers of the tunica vaginalis – mesothelial lining

Unicystic, smooth and fluid filled

57
Q

when do lesions transilluminate?

A

when they are fluid filled
solid filled lesions will not

58
Q

what is a spermatocele?

A

Cystic change within the vas of the epididymis

Unknown cause and usually asymptomatic
May feel a fullness etc.
Often present after self examination

59
Q

what is a varicocele?

A

Varicosities of venous plexus that drains the testis
Usually asymptomatic
May again present having felt a lump
“Bag of worms”

60
Q

what can cause testicular torsion?

A

bell clapper deformity
The insertion of the tunica vaginalis is high – the testis can rotate and even sit laterally

61
Q

what is the most common type of testicular tumour?

A

germ cell tumour - malignant
several types- seminoma is most common

62
Q

what are the most common testicular tumours in old people?

A

lymphoma
spermatic tumour
metastasis

63
Q

what is a risk factor for seminoma?

A

undescended testes - contralateral testes share risk

64
Q

what type of tumour are non-seminomatous tumours?

A

usually mixed- seminoma still most common subtype on the mix though

65
Q

what is the prognosis for most testicular cancer?

A

good - seminoma can be cured even at advanced stage
non-seminomatous still good but need to treat early

66
Q

what are the features of a mature teratoma?

A

can be derived from multiple germs layers
all classified as malignant even though might not be

67
Q

what do yolk sac tumours prdocuce?

A

alpha feto protein

68
Q

what is an embyonal tumour non-seminomatous tumour?

A

aggressive form. Looks high grade and is associated with freq mets

69
Q

describe trophoblast non-seminomatous tumour

A

strange looking cells on histology
Positive for beta HCG (human chorionic gonadotrophin)
Positive pregnancy test!

renal (23 decks)

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