Pathology Flashcards
Glomerulonephritis
Non-infective
Glomerular tuft injury with secondary tubulointerstitial changes
Immunological mechanism
Diffuse
Pyelonephritis
Infective
Patchy
E.coli, Pseudomonas, Strep faecalis
How many organisms for bacteriuria?
> 104 organisms/ml
Risks for UTI
Female Pregnancy (hormonal/obstruction) Iatrogenic Obstruction (calculus/stricture) VUR Diabetes
VUR
Vesico-Ureteric Reflux
Competence of uretero-vesical valves
Ureters enter more perpendicular = don’t close properly
Chronic pyelonephritis
Often no previous UTI history Vague symptoms Large volume of urine Scarred cortex, distorted calyces = glomerular loss Patchy nature
Tuberculous pyelonephritis
Haematogenous spread from lungs Vague symptoms Sterile pyuria (pus/WBCs in urine) Caseous foci (necrosis, slow growth) Necrotising, granulomatous inflammation
Cystitis
Acute inflammation but can become necrotising if obstruction, e.g. BPH
E.coli, Klebsiella, Pseudomonas, Proteus
Long term reactive changes due to cystitis
Ureteritis cystica/Cystitis cystica - small fluid filled cysts into lumen
Schistosomiasis
Bladder infection due to S. haematobium
Tropical countries
Chronic UTI
Predisposes to SCC
Hydronephrosis
Dilatation of pelvis/calyces, parenchymal atrophy
Due to UTI/VUR
Cortical thinning
Pyonephrosis
Infection of collecting system, often after hydronephrosis
Effect of obstruction on detrusor
Criss cross hypertrophy
Simple cysts
No functional disturbance/symptoms
Can be secondary to dialysis
Infantile type PCKD
Terminal renal failure
No gross distortion of kidney
Congenital hepatic fibrosis and cirrhosis
Autosomal recessive PCKD
Bilateral renal enlargement
Elongated cysts (dilation of CDs)
1 in 4
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
Renal fibromas
Benign medullary tumour
White nodules
Renal adenoma
Benign epithelial tumour (papillary adenoma) - cortex
Yellow nodules
Renal angiomyolipoma
Benign mixture of fat, smooth muscle and BVs
Associated with tuberous sclerosis
JGCT
Juxtaglomerular Cell Tumour - benign
Increased renin = secondary hypertension
Nephroblastoma
Malignant - Wilm’s tumour
Commonest abdo tumour in kids = mass
Residual primitive renal tissue
Urothelial carcinoma
Malignant
Anywhere in renal tract - usually pelvis and calyces
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
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
