Pathology 5: Summary from Tutorial 2 Flashcards
What are the main causes of renal papillary necrosis?
- Pyelonephritis
- Obstruction
- Sickle cell disease
- Tuberculosis
- Cirrhosis
- Analgesic and alcohol abuse (phenacetin, long continual paracetamol)
- Renal vein thrombosis
- Diabetes
- Systemic vasculitis
Remember POSTCARDS
What happens to the necrosed papillae in renal papillary necrosis?
They can slough off and be passed in the urine
What is the most common type of necrosis in the kidney?
Cortical necrosis
What causes cortical necrosis?
Hypovolaemic states
This leads to hypoperfusion and necrosis of the renal cortex
How does pyelonephritis present?
Loin pain
Fever
Dysuria
What are the key causative organisms in pyelonephritis?
E. coli
Enterobacter
Proteus
Pseudomonas aeruginosa
In the glomeruli, what is the purpose of the mesangial cells?
Provide support to capillaries
Regulate blood flow by altering contractile status
Nephritic syndrome involves damage to which aspects of the glomeruli?
Endothelium
Mesangial cells
How does nephritic syndrome typically present?
Haematuria
Hypertension
Oedema
Nephrotic syndrome typically involves damage to which aspects of the glomeruli?
Capillaries
Podocytes
How does nephrotic syndrome typically present?
Proteinuria
Hypoalbuminaemia
Peripheral oedema
What is rapidly progressive glomerulonephritis?
Acute deterioration of kidney function associated with crescent formation around the glomerulus
What is Goodpasture’s syndrome?
Autoimmune condition where anti-GBM antibodies attack type IV collagen affecting the kidneys and lungs
How does Goodpasture’s syndrome present?
AKI
Haematuria
Haemoptysis
How does Goodpasture’s syndrome present on immunofluorescence?
Linear IgG deposition along basement membrane
Which conditions can be associated withe rapidly progressive glomerulonephritis?
Immune complex mediated type of glomerulonephritis e.g. minimal change, focal segmented
Vasculitis
Immunological (SLE, HSP, Goodpasture’s)
What is renal cell carcinoma?
Cancer of the kiney arising from the epithelium in the proximal tubule
What is the most common type of renal cell carcinoma?
Clear cell
(cytoplasm rich in lipids and glycogen)
What is the second most common type of renal cell carcinoma?
Papillary
(elongated papillae with foamy cells)
What is the most aggressive for of renal cell carcinoma?
Collecting duct
What is the classic feature of renal cell carcinoma on CXR?
Cannonball metastases
Involvement of what in renal cell carcinoma indicates a poor prognosis?
Renal vein
Who generally gets renal cell carcinoma?
Older men (>60)
Why is renal cell carcinoma potentially a particularly dangerous type of cancer?
It often goes unnoticed
It is known as a “silent cancer”
Which symptoms are associated with renal cell carcinoma?
Haematuria
Palpable mass
Loin pain
Fever/weight loss
Which genetic condition is associtaed with renal cell carcinoma?
von Hippel Lindau syndrome
(RCC can be caused by a mutation in the vHL tumour suppressor protein)
How are renal cell carcinomas usually treated?
Nephrectomy or surgical resection
(resistant to chemotherapy and radiotherpy)
New treatments such as anti-VEGF receptor therapies are effective
Which area in the prostate is typically affected by prostate cancer?
Peripheral zone
(posterior aspect (felt on PR) is most common)
Which type of cancer affects the prostate?
Adenocarcinoma
(since the prostate is a gland)
How can prostate cancer be treated best?
Chemotherapy and radiotherapy
Androgen deprivation therapy
How is the prostate biopsied in suspected prostate cancer?
Areas from the entire gland are biopsied
This allows the localisation of cancer and allows mnay zones to be examined
How is the staging of prostate cancer undertaken?
Gleason staging
(cancer is graded 1-5 depending on severity. The most common grade is added to the highest sampled grade. The overall number gives a risk score)
- Low risk < 6
- Intermediate risk = 7
- High risk = 8-10
Whta is the most malignant type of testicular cancer?
Trophoblastic tumours
In which age group do trophoblastic testicualr cancers occur?
20-40
How are trophoblastic tetsicular cancers treated?
Chemotherapy
What are the serum markers for
a) Testicular tumours derived from yolk-sac components
b) Testicular tumours derived from trophoblastic components
a) Yolk-sac components - Alpha-feta protein
b) Trophoblastic components - bHCG
Which serum marker is associated with seminoma?
PLAP
(placental alkaline phosphatase)
If any cancer is non-specific and undifferentiated what 3 things is it likely to be?
Metastatic carcinoma
Primary malignant lymphoma
Melanoma
