Pathology Flashcards by Ailsa Campbell

Glomerulonephritis

Non-infective
Glomerular tuft injury with secondary tubulointerstitial changes
Immunological mechanism
Diffuse

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Pyelonephritis

Infective
Patchy
E.coli, Pseudomonas, Strep faecalis

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How many organisms for bacteriuria?

> 104 organisms/ml

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Risks for UTI

Female
Pregnancy (hormonal/obstruction)
Iatrogenic
Obstruction (calculus/stricture)
VUR
Diabetes

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VUR

Vesico-Ureteric Reflux
Competence of uretero-vesical valves
Ureters enter more perpendicular = don’t close properly

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Chronic pyelonephritis

Often no previous UTI history
Vague symptoms
Large volume of urine
Scarred cortex, distorted calyces = glomerular loss
Patchy nature

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Tuberculous pyelonephritis

Haematogenous spread from lungs
Vague symptoms
Sterile pyuria (pus/WBCs in urine)
Caseous foci (necrosis, slow growth)
Necrotising, granulomatous inflammation

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Cystitis

Acute inflammation but can become necrotising if obstruction, e.g. BPH
E.coli, Klebsiella, Pseudomonas, Proteus

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Long term reactive changes due to cystitis

Ureteritis cystica/Cystitis cystica - small fluid filled cysts into lumen

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Schistosomiasis

Bladder infection due to S. haematobium
Tropical countries
Chronic UTI
Predisposes to SCC

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Hydronephrosis

Dilatation of pelvis/calyces, parenchymal atrophy
Due to UTI/VUR
Cortical thinning

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Pyonephrosis

Infection of collecting system, often after hydronephrosis

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Effect of obstruction on detrusor

Criss cross hypertrophy

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Simple cysts

No functional disturbance/symptoms

Can be secondary to dialysis

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Infantile type PCKD

Terminal renal failure
No gross distortion of kidney
Congenital hepatic fibrosis and cirrhosis

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Autosomal recessive PCKD

Bilateral renal enlargement
Elongated cysts (dilation of CDs)
1 in 4

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Adult PCKD

Autosomal dominant = 1 in 2. Chromosome 16
Middle adult life - mass, haematuria, HT, CRF
Bilateral renal enlargement
Multiple cysts = distortion of kidney
Non-functional cysts in liver, pancreas and lung
Berry aneurysms in COW = subarachnoid haemorrhage

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Renal fibromas

Benign medullary tumour

White nodules

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Renal adenoma

Benign epithelial tumour (papillary adenoma) - cortex

Yellow nodules

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Renal angiomyolipoma

Benign mixture of fat, smooth muscle and BVs

Associated with tuberous sclerosis

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JGCT

Juxtaglomerular Cell Tumour - benign

Increased renin = secondary hypertension

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Nephroblastoma

Malignant - Wilm’s tumour
Commonest abdo tumour in kids = mass
Residual primitive renal tissue

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Urothelial carcinoma

Malignant

Anywhere in renal tract - usually pelvis and calyces

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Renal Cell carcinoma

Malignant - clear cells from tubular epithelium
Presents late
Males 55-60
Abdo mass, haematuria, flank pain, paraneoplastic manifestations, hypercalcaemia, polycythaemia
Well circumscribed, yellow, extends up renal vein

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How does renal cell carcinoma spread?

Haematogenous to lung, bone

Commonest type of RCC

Clear cell type - rich in glycogen and lipid

Transitional cell carcinoma

Malignant - transitional epithelium (from pelvicalyceal system to urethra), mainly bladder trigone >50 years Haematuria, thick lining

Risk factors for transitional cell carcinoma

Aniline dyes, rubber, analgesics, schistosomiasis, smoking

How is transitional cell carcinoma spread?

Lymph to lungs and liver

Renal adenocarcinoma

Malignant Extroversion - bladder exposed Urachal remnants Long standing cystitis cystica

Renal squamous carcinoma

Schistosomiasis | Calculi = irritation

Commonest malignant bladder tumour in kids

Embryonal rhabdomyosarcoma

Nephrotic syndrome

Hypoalbuminaemia, proteinuria, peripheral/periorbital oedema | Non-proliferative (podocyte/epithelial side)

Nephritic syndrome

``` Oligouria AKI Pulmonary oedema HT Active urinary sediment (RBCs, granular casts) Proteinuria Haematuria ```

Epithelial crescent formation

Severe glomerular damage | Proliferation of epithelial cells in Bowman's capsule = compression and distortion of glomerulus

End stage in glomerular diseases

Glomerulosclerosis | Irreversible

Round eosinophilic lesions characteristic of diabetic nephropathy

Kimmelstiel-Wilson lesions (nodular glomerulosclerosis)

What ways can diabetes change the kidneys?

Atherosclerosis Pyelonephritis Renal papillary necrosis Nodular and diffuse glomerulosclerosis

Stain used to diagnose MM

Congo red stain = apple green birefringence | Amyloid

How does MM affect the kidney?

``` Amyloid deposition in GBM Myeloma kidney (Bence Jones proteins produced by malignant plasma cells) Renal calculi (hypercalcaemia from bone destruction) UTI/pyelonephritis due to immune deficiency ```

Appearance of seminoma (testicular tumour)

Solid white potato tumour Clear cells (favourable prognosis) Clusters of tumour cells with lymphocyte infiltrate

How does seminoma spread?

Lympahtics to para-aortic nodes | Haematogenous to lungs and liver

Prognosis of seminoma?

Good even if mets | Radiotherapy

What markers do teratomas with yolk sac elements produce?

a-fetoprotein

What markers do malignant teratomas with trophoblastic tissue produce?

HCG

What markers do seminomas produce?

Placental ALP | LDH

Which marker is important in diagnosing prostate cancer?

PSA

Latent carcinoma of prostate

Present but not clinically relevant

What is different about skeletal mets in prostate cancer?

Osteosclerotic (mets elsewhere are usually lytic)

Complications of renal calculi

Renal colic, urinary tract obstruction, infection, haematuria, SCC

What effects does HT have on the kidney?

``` Glomerulosclerosis Shrinks Narrowing of vessels = ischaemia Atherosclerosis Renal failure ```

Risks for RCC

Obesity HT Smoking

Seminoma

Commonest testicular tumour Painless lump 30-50 years Radiosensitive

Teratoma

Teens/early 20s Tumour of all 3 germ layers Chemosensitive HCG and a-fetoprotein

SCC of the penis

Skin of penis on glans/prepuce Usually in uncircumcised men Ulcerating cauliflower mass

Causes of penis SCC

Poor hygiene | HPV

Bowen's disease/erythroplasia of Queyrat

Pre-malignant SCC of penis Dry, crusty Raised velvet area on glans Full thickness dysplasia of epidermis

Cause of BPH

Hormonal imbalance, oestrogen

Prostatism

Difficulty starting stream Poor uneven stream Overflow incontinence

Complications of BPH

``` Bladder hypertrophy Diverticula in bladder wall Hydroureter (distension of ureter) Hydronephrosis Infection ```

Management of BPH

a blocker 5a reductase inhibitor surgery

BPH arises in what zone?

Central zone

Where does prostate carcinoma arise?

Peripheral zone

Spread of prostate cancer

Local Lymph (para-aortic nodes) Otosclerotic mets

Diagnosis of prostate cancer

``` PR exam US, x-ray (mets) PSA Trans-urethral resection Hormonal therapy Radiotherapy Surgery ```

Germ cell tumours of testicles

Seminoma (seminiferous tubules) | Teratoma