Pathology

Question 1

What is glomerulonephritis

Answer 1

Non-infective
glomerular tufts with secondary tubulo-interstitial changes
Usually diffuse, may be focal

Question 2

What usually causes glomerulonephritis

Answer 2

Immunological mechanisms often after an upper respiratory tract infection

Question 3

What is pyelonephritis

Answer 3

A bacterial infection of the renal pelvis, calyces, tubules and interstitial

Question 4

What are the common presenting symptoms of pyelonephritis

Answer 4

Pyrexia, sweating an other GU symptoms

Question 5

What is the commonest organism seen in pyelonephritis

Answer 5

E Coli

Also pseudomonas, strep or fungi

Question 6

Pyelonephritis is more common in who? men or women

Answer 6

women

Question 7

What is the pathogenesis of pyelonephritis

Answer 7

Blood-borne (rare) in septicaemia, post surgery

due to ascending infection from the more distal end of the urinary tract (cystitis)

Question 8

What are some of the risk factors for pyelonephritis

Answer 8

Age and sex:
Females (shorter, wider urethra)
Pregnancy (ureteric dilatation
Instrumentation or surgery carries a risk of UTI
UT Obstruction e.g. calculus, stricture, neoplasm congenitla anomaly, prostatic and urethral pathology (elderly males)
Diabetics
Vesico-ureteric reflex - if ureters are more perpendicular, then infection can travel back up to the kidney

Question 9

What is the main inflammatory cell seen in pyelonephritis

Answer 9

Neutrophil

Question 10

What are the signs and symptoms of chronic pyelonephritis

Answer 10

Often no previous history of UTI
Vague symptoms
Hypertension and / or uraemia (uric acid level)
Large volume of urine
Coarse cortical scarring and distortion of calyces on renal imaging

Question 11

Why is there large volumes of urine passed in a patient with chronic pyelonephritis

Answer 11

The kidney is scarred and so the patient can’t concentrate the urine

Question 12

What is lost and in pyelonephritis and what replaces it

Answer 12

Glomerular loss and replaced by a hyaline ball of connective tissue

Question 13

How is tuberculous pyelonephritis spread

Answer 13

Haematologically spread usually from the lung

Question 14

What are the symptoms and signs of tuberculous pyelonephritis

Answer 14

Vague symptoms: weight loss, fever, long pain, dysuria

Sterile pyuria

Question 15

How is TB pyelonephritis diagnosed

Answer 15

PCR

Question 16

What organisms cause cystitis

Answer 16

E Coli
Klebsiella
Proteus
Pseudomonas

Question 17

What can resemble tumours in cystitis

Answer 17

Ureteritis and cystitis Cystica

Question 18

Why does urinary tract obstruction result in hypertrophy of the muscle lining

Answer 18

Prolonged outlet obstruction causes more urine to be held in the bladder for longer which causes an increase in pressure

Question 19

What is hydronephrosis

Answer 19

Dilatation of pelvicalyceal system with parenchymal atrophy

Question 20

What are the 2 main causes of hydronephrosis

Answer 20

Urinary tract obstruction and reflux

Question 21

What structure usually results in bilateral hydronephrosis

Answer 21

The urethra
neurogenic disturbance
VUR
bilateral ureteric obstruction e.g. advanced carcinoma of cervix

Question 22

What usually causes unilateral hydronephrosis

Answer 22

Presence of stones but can also be neoplasms

Question 23

What type of obstruction is more likely to cause hydronephrosis

Answer 23

Gradual, partial or intermittent obstruction compared to a sudden and complete

Question 24

Why does pyonephrosis sometimes occur in hydronephrosis

Answer 24

Secondary infection often follows stasis

Question 25

Describe the typical appearance of detrusor muscle hyperplasia

Answer 25

Typical criss cross pattern