Pathology Flashcards
Define pyelonephritis
Bacterial infection of renal pelvis, calyces, tubules and interstitium
What is the main cause of pyelonephritis?
E. Coli
but also pseudomonas and strep faecalis
what is the difference between glomerulonephritis and pyelonephritis?
glomerulonephritis in non infective- cause is often immune related
how does infection spread to the kidney to cause pyelonephritis
Usually ascending infection. Cystitis (bladder infection) often present.
Blood-born spread rare
what are the risk factors for pyelonephritis?
Female, pregnancy, obstruction (eg calculi or neoplasm), vesico-ureteric reflux, diabetes
how does chronic pyelonephritis present?
often no history of UTI. Uraemia, hypertension, polyuria
on imaging there is cortical scarring and distortion of calyces
how does tb spread to kidneys?
What are the symptoms of Tuberculous Pyelonephritis?
What are the buzzwords associated with TB pyel.
What is the standard diagnostic test for TB?
haematogenous spread
Vague- fever, weight loss, loin pain, dysuria
Sterile pyuria. (Pyuria= puss in urine) (Seems sterile because it takes a long time to culture TB)
Caseating, granulomatous inflammation
Mycobacteria may be seen on histological special stains (Zeehl-Neilsen)
what are the common causes of cystitis
E. Coli., Klebsiella, Proteus, Pseudomonas
what causes cystitis to become necrotising?
if the outlet is obstructed
What is cystitis cystica?
Cystitis Cystica; multiple small fluid filled cysts projecting into lumen. Reactive process, but can resemble tumours.
What is the main cause of outflow obstruction and what pathological changes can this lead to?
Prostatic hyperplasia,
detrusor muscle hyperplasia diverticulum
can cause hydronephrosis
what is hydronephrosis and what causes it
dilatation of pelvicalyceal system with parenchymal atrophy
caused by urinary tract obstruction
list causes of bilateral and unilateral hydronephrosis
Bilateral; Urethral obstruction, neurogenic disturbance, VUR, bilateral ureteric obstruction (e.g. advanced carcinoma of cervix).
Unilateral; Calculi, neoplasms, pelvi-ureteric obstruction, strictures.
what congenital abnormalities are there involving the kidneys?
Agenesis; absence of one or both kidneys.
Hypoplasia; small kidneys but normal development.
“Horseshoe” Kidney; fusion at either pole, usually lower.
Duplex systems.
how common is Cystic Disease and what are the symptoms
very common and usually harmless
what is the prognosis, inheritance, and pathology of infantile polycystic disease?
causes terminal renal failure, some live a few months
autosomal recessive
dilatation of medullary collecting ducts
what other condition is commonly associated with infantile polycystic disease?
congenital hepatic fibrosis
What is the presentation, inheritance and common association of adult polycystic kidney disease?
massive bilateral enlargement (up to 1kg) haematuria, hypertension, chronic kidney failure
autosomal dominant,
berry aneurysms in circle of willis
what is the commonest intra-abdominal tumour in children?
nephroblastoma
what is the commonest renal cancer in adults
renal cell carcinoma
where does renal cell carcinoma commonly spread and how?
lung and bone via blood
what is a common paraneoplastic manifestation of renal cell carcinoma?
polycythaemia (erythropoietic stimulating substance),
what constitutes 90% of bladder cancers? What is the commonest symptom?
where are the majority of these cancers located?
and name one risk factor?
transitional cell carcinoma
haematuria
75% found around trigone
smoking
