Pathology

Question 1

GN

Answer 1

non infectious

often diffuse, may be focal

Question 2

Pyelonephritis

Answer 2

• Bacterial infection (most common E.Coli) of renal pelvis, calyces, tubules and interstitium
• Acute or chronic. Patchy distribution.
• Commoner in females
• Blood borne (rare), Ascending infection (cystitis often present)
• Risk factors: Females, Pregnancy, Urinary tract obstruction (calculus, malignancy, stricture, protstate), Vesico-Ureteric Reflux (competence of valves, young school girls), diabetes.

Question 3

Chronic Pyelonephritis

Answer 3

• Vague symptoms. No history of UTI.
• Hypertension and/or uraemia.
• Large volume of urine
• Renal imaging (coarse cortical scarring, distortion of calyces)

Question 4

Tuberculous Pyelonephritis

Answer 4

• Haematogenous spread (from lung)
• Vague symptoms (wgt loss, fevrr, loin pain, dysuria)
• Sterile Pyuria (pus in urine)
• Caseous foci (necrosis) - spread to ureters, bladder etc. Ziehl Neilsen Stain.

Question 5

Cystitis

Answer 5

• E.Coli, Klebsiella, Proteus, Pseudomonas
• Acute inflammation, may become necrotising if outlet obstruction.
• Ureteritis, Cystitis Cystica = fluid filled cysts projecting into lumen. (reactive process, may resemble tumours)

Question 6

Schistosomiasis

Answer 6

• S.Haematobium (released from freshwater snails)
• Tropical countries
• Predisposing cause of urothelial malignancy (particularly squamous carcinoma)

Question 7

Hydronephrosis

Answer 7

• Dilatation of pelvicalyceal system with parenchymal atrophy
• Caused by Urinary Tract Obstruction and reflux
• Bilateral = urethral obstruction, neurogenic disturbance, VUR, bilateral ureteric obstruction
• Unilateral = calculi, neoplasms, pelvi-ureteric obstruction, strictures.
• If sudden = urine production ceases; if gradual = dilatation of kidney.
• Severe = cortical thinning, atrophy and fibrosis.

Question 8

Agenesis =

Answer 8

absence of both or one kidneys

Question 9

Hypoplasia =

Answer 9

small kidneys but normal development

Question 10

Horseshoe kidneys =

Answer 10

fusion at either pole, usually lower

Question 11

simple cysts =

Answer 11

very common, usually no functional disturbance. May be multiple and large. Secondary to other clinical conditions e.g. native kidneys in long term dialysis.

Question 12

Fibroma =

Answer 12

most common, medullary origin, white nodules

Question 13

Adenoma =

Answer 13

Yellowish nodules <2cm. cortical

Question 14

Angiomyolipoma =

Answer 14

mixture of fat, muscle and blood vessels. Can be multiple and bilateral. Associated with tuberous sclerosis.

Question 15

JGCT =

Answer 15

Juvenile Granulosa Cell Tumour

Produce renin > secondary HT

Question 16

Most common malignant tumour in children

Answer 16

Nephroblastoma (wilm’s tumour)

Question 17

Most common malignant tumour in adults (2:1 males)

Answer 17

Renal Cell carcinomas (renal tubular epithelium)

• Polycythaemia (high red cell count - erythropoetic)
• Commonly extends up renal vein into vena cava.
• Blood borne met > lung, bone. Lymph spread later.
• Clear cell type is most common (rich in glycogen and lipid)
• Fuhrman staging

Question 18

90% of bladder tumours

Answer 18

• Transitional Cell Carcinoma (urothelial) - from pelvicalyceal system to urethra.
• 80% are papillary
• Causes = Rubber industry, aniline dyes, cyclophosphamide, schistosomiasis, smoking.
• Haematuria most common symptom
• 75% occur in trigone (ureteric obstruction), papillae have thicker lining than normal urothelium.

Question 19

Most common malignant bladder tumour in children

Answer 19

Embryonal Rhabdomyosarcoma