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Renal > Pathology > Flashcards

Pathology Flashcards

1
Q

What term is used to describe infective inflammation of the kidney

A

Pyelonephritis

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2
Q

What term is used to describe non-infective inflammation of the kidney

A

Glomerulonephritis

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3
Q

What is Goodpasture’s syndrome

A

Antibodies form against a subunit of collagen that is found in the glomerulus and alveoli

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4
Q

What can lead to circulating immune complexes

A

Infection = hepatitis, strep, HIV
Drugs - gold, peniciilin
Cancer

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5
Q

What is the difference between cANCA and pANCA

A

cANCA the antibodies are found in the cytoplasm

pANCA they are perinuclear

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6
Q

Granulomatosis with polyangiitis is pANCA positive - true or false

A

False

cANCA

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7
Q

Microscopic polyangiitis is pANCA positive - true or false

A

True

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8
Q

How do immune complexes affect the glomerulus

A

Disrupt the sieve mechanism

Things get through the membrane that shouldn’t – e.g. albumin and blood cells

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9
Q

How does nephritic syndromes present

A

haematuria and hypertension

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10
Q

How does nephrotic syndrome present

A

Heavy proteinuria
oedema
hyperlipidaemia

Protein loss leads to immunosuppression and thrombosis

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11
Q

How does nephrotic syndrome lead to immunosuppression

A

The proteins lost include antibodies so immune system is depleted

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12
Q

How do you classify a kidney disease

A

Light microscopy
Electron microscopy
Immunofluorescence

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13
Q

What do crescents on kidney microscopy indicate

A

Rapidly progressing glomerulonephritis

Bad sign - less likely to recover

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14
Q

In which conditions would granulomas be seen on microscopy

A

GPA

Sarcoidosis

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15
Q

What signs of GMN may be seen on light microscopy

A

Hypocellularity - increase inflammatory cells
Sclerosis
Crescents

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16
Q

How is electron microscopy used in GMN

A

Looks at the basement membrane itself and shows if there are deposits and where they are

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17
Q

How does Goodpasture’s present on immunofluorescence

A

Linear deposits of IgG

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18
Q

How does minimal change GMN present

A

Nephrotic syndrome

Not much to see on microscopy - need EM

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19
Q

How do treat minimal change GMN

A

Usually resolves with some steroids

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20
Q

What causes FSGS

A

Obesity
HIV
Sickle cell disease
IV drug use - particularly heroin

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21
Q

How does FSGS present

A

Nephritic syndrome

Focal inflammation

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22
Q

What causes membranous GMN

A

Infection - hep, malaria or syphilis
Drugs - penicillamine, NSAID etc
Malignancy - lung, colon and melanoma
Lupus

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23
Q

How does membranous GMN present

A

Nephrotic syndrome - slow progression
Thickened membranes
Sub-epithelial immune deposits - igG

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24
Q

What type of GMN present with ‘spiky membrane’ on microscopy

A

membranous

due to spaces of deposits

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25
Q

What causes IgA deposits to lead to GMN

A

Genetic causes
Coeliac disease
Occurs post-infection - URTI or GI

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26
Q

How does IgA GMN present

A

Nephritic syndrome

IgA deposits in mesangium

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27
Q

How does Membranoproliferative GMN present on microscopy

A

Big hypercellular glomeruli with thick membranes

Tram track membrane

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28
Q

What causes Membranoproliferative GMN

A

Idiopathic

Or infection, lupus or malignancy

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29
Q

What is the classic sign of diabetic damage to the kidney

A

Kimmel Stiel Wilson lesions/nodules

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30
Q

What is the bosniak score used for

A

Predict risk of cancer in people with polycystic kidney diseases

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31
Q

Long term dialysis leads to cyst formation - true or false

A

True

type of acquired cyst

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32
Q

Does ADPCKD present in childhood or adulthood

A

Adulthood

The cysts take a while to develop

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33
Q

What are the symptoms of ADPCKD

A

Symptoms often occur due to changes within the cyst - haemorrhage, infection or rupture
Eventually will get a mass effect - pain or mass

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34
Q

What systemic disease can occur as a result of ADPCKD

A

Liver cyst
Cerebral aneurysm
Associated with sub-arachnoid haemorrhage

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35
Q

Does ARPCKD present in adulthood or childhood

A

Childhood

The younger you present, the worse the prognosis

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36
Q

What is Xanthogranulomatous pyelonephritis

A

A specific kidney infection that creates a mass

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37
Q

Name a benign tumour of the kidney

A

oncocytoma

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38
Q

Name 4 malignant kidney tumours

A

Chromophobe
Clear cell
Papillary
Collecting duct

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39
Q

Describe the appearance of a oncocytoma

A

Small, oval and well circumscribed

Mahogany brown with a central stellate scar

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40
Q

Describe the appearance of a chromophobe tumour

A

Histologically similar to oncicytoma but with raisonoid nuclei and perinuclear haloes

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41
Q

Describe the presentation of papillary kidney tumours

A

Low grade = Low rate of mets and recurrence

Finger like projections

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42
Q

Describe collecting duct carcinoma

A

Least common kidney tumour but very nasty

High grade with desmopastic stroma

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43
Q

What is the most common type of renal cancer

A

clear cell carcinoma

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44
Q

How does clear cell carcinoma present

A

haematuria
kidney mass
rare hypertension

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45
Q

List risk factors for clear cell carcinoma

A

Obesity

Genetic influence

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46
Q

Describe the appearance of clear cell carcinoma

A

Partly cystic
Very heterogenous surface
Bright yellow tumour
Lots of clear cells on

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47
Q

Where does clear cell cancer often invade

A

Propensity for vascular invasion – enters the renal vein

Doesn’t necessarily touch the walls but can extend up for quite a distance

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48
Q

Which gene is commonly involved in the development of renal cancers

A

VHL - codes for HIF
In normal circumstance, they are attached but if damaged they dissociate and HIF acts as a transcription factor for VEGF etc

49
Q

Mutations in stages of the TCA cycle are associated with renal cancers - true or false

A

True

50
Q

What type of epithelium lines the bladder

A

Transitional epithelium with umbrella cells on the surface

This epithelium is present from the collecting system, down the ureter, bladder and into the first part of the urethra

51
Q

Is cystitis common

A

Yes - very common

Mostly dealt with in primary care

52
Q

What causes schistosomiasis infection

A

Caused by the schistosomiasis haematobium parasite which is found in large bodies of water - Lake Malawi
They swim up the urethra and cause inflammation in the bladder - mainly due to eggs

53
Q

What are the results of a schistosomiasis infection

A

The body reacts to the presence of a foreign parasite and starts an inflammatory response
It is hard to get rid of the eggs so you get persistent inflammation
This can lead to squamous metaplasia and squamous cell carcinoma

54
Q

How does bladder inflammation lead to metaplasia

A

Squamous epithelium forms as an attempt to protect against the persistent inflammation
This is a risk for cancer

55
Q

What is aseptic cystitis

A

Persistent symptoms of UTI that don’t clear up with antibiotics and have negative culture and urinalysis
Cannot find a causative organisms

56
Q

How might aseptic cystitis appear on biopsy

A

Some inflammation, congestion and mast cells

57
Q

In-dwelling catheters have a risk of cancer - true or false

A

True
Constantly having a catheter in leads to inflammation etc
This increases risk of metaplasia and then cancer

58
Q

Which group is particularly at risk of developing squamous cancer in the bladder from catheterisation

A

Paraplegic patients

They cannot feel that there is inflammation/infection so have a higher risk of cancer development

59
Q

What is cystitis cystica

A

Descriptive term that means infolding of the bladder mucosa into ‘cysts’
Non-specific sign of long-standing inflammation

60
Q

What can diverticula of the urinary tract lead to

A

Stagnation of urine

This can lead on to infection, stones and cancer

61
Q

What can cause obstruction to the urinary tract

A

Prostatic hyperplasia
Stones
Tumours

62
Q

What happens when the urinary tract becomes obstructed

A

Bladder muscles work harder and the walls thicken and become trabeculated
This leads to back pressure that will eventually affect the kidneys
There is dilatation of the collecting system and hydronephrosis can occur

63
Q

What is hydronephrosis

A

This occurs when there is back pressure in the kidney
Kidney and renal parenchyma become atrophied and there is significant dilatation
Parenchyma space is taken up by excess urine

64
Q

An obstruction where would affect both kidneys

A

urethra or bladder

65
Q

An obstruction where would only affect one kidney

A

Ureter or kidney itself

66
Q

What is the major risk factor for uroepithelial cancer

A

Smoking

67
Q

What is a main symptom of urinary tract cancer

A

Haematuria

68
Q

How can transitional cell carcinoma appear

A

Papillary - finger like projections

Or flat carcinoma

69
Q

What is the main type of cancer to affect the bladder

A

Transitional cell carcinoma

70
Q

If you find adenocarcinoma in the bladder, what must be ruled out

A

A colon cancer that has invaded through the wall

71
Q

Why must you be careful of a urachus in a cancer case

A

Its an embryological remnant that can remain patent in some

If adenocarcinoma develops in this structure, the whole structure from bladder to umbilicus must be excised

72
Q

Which zones does prostatic hyperplasia affect

A

transitional and central zones

73
Q

What can cause BPH

A

Hormonal influence

74
Q

How do you treat BPH

A

First start with medication - Alpha blockers like tamsulosin - relax the prostate and bladder neck muscles to reduce voiding symptoms
Fenestaride - alpha reductase inhibitor which reduces action of testosterone in the prostate (takes 3-6 months to work)

Failure to respond would mean surgery is an option:
Transurethral resection of prostate – widens the channel to reduce symptoms

75
Q

How do you manage prostate cancer

A

Most are low grade and only need monitoring

If treatment is needed you can give radiotherapy, androgen therapy, surgery (last line)

76
Q

How do you diagnose prostate cancer

A

Can use PSA levels but not sensitive or specific

Use trans-rectal biopsy - take 6 samples from each lobe

77
Q

Which system is used to grade prostate cancer

A

Gleason system

78
Q

Which zone of the prostate does cancer usually affect

A

Peripheral zone

79
Q

What are the different classes of haematuria

A

Visible - can be seen in urine
Invisible - found on urine tests
Symptomatic - associated with pain
Asymptomatic - no pain

80
Q

What can cause haematuria

A 
Trauma - catheters 
Cancer - bladder, urethra or kidney 
Infection 
Stones 
Polycystic kidneys 
Glomerular disease 
Occasionally with prostate issues
Worse if on anticoagulants
81
Q

If the haematuria occurs at the start of micturition where is the likely pathology

A

Prostate or urethra

82
Q

If the haematuria occurs at the end of micturition where is the likely pathology

A

Bladder neck

83
Q

If the haematuria occurs throughout micturition where is the likely pathology

A

Kidneys
Ureters
Bladder

84
Q

Which drugs can contribute to haematuria

A

Anticoagulants

NSAIDs

85
Q

How can radiotherapy cause haematuria

A

Local damage to tissue - lots of telangiectasia in the bladder

86
Q

What tests would you do for haematuria

A 
Clinical exams - PR, Abdo, vaginal 
Urine dipstick 
Urine cytology - looks for cancer cells 
Blood - Hb and renal function 
CT urogram 
USS - better for non-visible 
MRI - if allergic to contrast 
Cystoscopy
87
Q

What is the gold standard for visible haematuria

A

CT urogram

88
Q

What is renal colic

A

Pain associated with urinary tract stone - caused by contraction of tract trying to push stone out
Loin to groin pain
Very severe pain

89
Q

What conditions other than stones can give renal colic

A

pyelonephritis
ruptured AAA
diverticulitis

90
Q

How would you manage renal colic caused by calculi

A

NSAIDs - diclofenac (IM or PR)
Bloods - FBC, U&E, CRP, urate and calcium
CT KUB - gold standard for diagnosis

Wait for it to pass - if small and no sepsis
Break up with shock waves/laser - allows it to pass
Emergency stenting - if very unwell

91
Q

What causes genital warts

A

HPV 6 and 11

92
Q

What is hydrocele

A

Accumulation of fluid around the testes
Between the two layer of tunica vaginalis – mesothelial lining
Unicystic, smooth and fluid filled

93
Q

What is spermatocele

A

Cystic change in the vas of the epididymis
May feel fullness or be asymptomatic
Will see sperm on biopsy

94
Q

What is varicocele

A

Varicosities of the venous plexus that drains the testes
Feels like a bag of worms
Usually asymptomatic

95
Q

Describe testicular torsion

A

Urological emergency (if not treated fast the teste will die)
Testes and cord rotate around the arterial supply
Will present with extreme pain
Common in children and adolescents

96
Q

What is peculiar about skeletal metastases of prostatic carcinoma

A

They are sclerotic (most mets are osteolytic)

97
Q

What is pyelonephritis

A

Infection of the kidney
Commonly from lower GI tract - E.coli, klebseilla
Often affects women

98
Q

How does pyelonephritis present

A

Fever
Loin pain
Dysuria

99
Q

What are the risk factors for bladder cancer

A

Smoking

Beta-naphthalene dye

100
Q

How does prostate cancer present

A

Often asymptomatic
Hard craggy mass on PR
May get systemic symptoms or bone pain from mets

101
Q

How does BPH present

A

hesitancy, nocturia, increased frequency, smooth and rubbery on PR,

102
Q

Which vitamins can cause renal stones if taken in excess

A

Vitamin C - excess can be converted to oxalic acid which can form calcium oxalate stones

Vitamin D - increases calcium absorption which can lead to calcium stones

103
Q

What is hypospadias

A

Congenital abnormality of the penis
Urethral opening is on the ventral surface
May also have a hooded foreskin and ventral curvature of penis

104
Q

List complications of hypospadias

A

Infection is common

May have a partial structure which can lead to urethral obstruction

105
Q

How do alpha blockers treat BPH

A

They reduce LUTS by relaxing the smooth muscle at the neck of the bladder

106
Q

What factors can predispose you to recurrent UTI

A

Catheterisation
Post-coital
Urinary retention

107
Q

What is considered a simple UTI

A

Simple and common infection caused by bacteria getting into urethra

108
Q

What is considered a complicated UTI

A

UTI caused by some form of obstruction

109
Q

What is the definition of recurrent UTI

A

Definition is twice in 6 months or 3 times in one year

110
Q

How do you diagnose and treat a UTI

A

Initially do a urine dip to check for infection - look for leukocytes, nitrites and blood
Treat with nitrofurantoin or trimethoprim most commonly - based on sensitivity

111
Q

Why are post-menopausal women at high risk of UTI

A

The lack of oestrogen leads to vaginal atrophy so the production of lactic acid is reduced which allows more bacteria to colonise the area
The atropy also affects the mucosa in the urethral meatus which becomes stenosed

112
Q

How do you investigate recurrent UTI

A

Needs urology referral for UT ultrasound to look for any underlying abnormality which could be causing it (stones, tumour, stricture etc)
Can then do a CT for more detail if something is found
Also do flexible cystoscopy to look more closely at tract and bladder

113
Q

How do you treat recurrent UTIs

A

Prolonged antibiotic course and treatment of underlying cause

114
Q

List the common lower urinary tract symptoms

A 
Poor flow 
Frequency
Urgency
Nocturia
Hesitancy
Intermittent flow
Post void dribble
Split stream/spraying
Incontinence

Split into voiding and storage symptoms

115
Q

What can cause urinary voiding symptoms

A

Weakness of bladder muscle

116
Q

What can cause urinary storage symptoms

A

Overactive bladder muscles

117
Q

What are some red flag urinary symptoms

A

Visible haematuria

Sudden onset LUTS

118
Q

How do you investigate LUTS

A

Do rectal exam in men to check prostate - enlargement is a common cause
Scoring systems for LUTS - assesses severity

Renal (18 decks)

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