Pathology Flashcards
What term is used to describe infective inflammation of the kidney
Pyelonephritis
What term is used to describe non-infective inflammation of the kidney
Glomerulonephritis
What is Goodpasture’s syndrome
Antibodies form against a subunit of collagen that is found in the glomerulus and alveoli
What can lead to circulating immune complexes
Infection = hepatitis, strep, HIV
Drugs - gold, peniciilin
Cancer
What is the difference between cANCA and pANCA
cANCA the antibodies are found in the cytoplasm
pANCA they are perinuclear
Granulomatosis with polyangiitis is pANCA positive - true or false
False
cANCA
Microscopic polyangiitis is pANCA positive - true or false
True
How do immune complexes affect the glomerulus
Disrupt the sieve mechanism
Things get through the membrane that shouldn’t – e.g. albumin and blood cells
How does nephritic syndromes present
haematuria and hypertension
How does nephrotic syndrome present
Heavy proteinuria
oedema
hyperlipidaemia
Protein loss leads to immunosuppression and thrombosis
How does nephrotic syndrome lead to immunosuppression
The proteins lost include antibodies so immune system is depleted
How do you classify a kidney disease
Light microscopy
Electron microscopy
Immunofluorescence
What do crescents on kidney microscopy indicate
Rapidly progressing glomerulonephritis
Bad sign - less likely to recover
In which conditions would granulomas be seen on microscopy
GPA
Sarcoidosis
What signs of GMN may be seen on light microscopy
Hypocellularity - increase inflammatory cells
Sclerosis
Crescents
How is electron microscopy used in GMN
Looks at the basement membrane itself and shows if there are deposits and where they are
How does Goodpasture’s present on immunofluorescence
Linear deposits of IgG
How does minimal change GMN present
Nephrotic syndrome
Not much to see on microscopy - need EM
How do treat minimal change GMN
Usually resolves with some steroids
What causes FSGS
Obesity
HIV
Sickle cell disease
IV drug use - particularly heroin
How does FSGS present
Nephritic syndrome
Focal inflammation
What causes membranous GMN
Infection - hep, malaria or syphilis
Drugs - penicillamine, NSAID etc
Malignancy - lung, colon and melanoma
Lupus
How does membranous GMN present
Nephrotic syndrome - slow progression
Thickened membranes
Sub-epithelial immune deposits - igG
What type of GMN present with ‘spiky membrane’ on microscopy
membranous
due to spaces of deposits
What causes IgA deposits to lead to GMN
Genetic causes
Coeliac disease
Occurs post-infection - URTI or GI
How does IgA GMN present
Nephritic syndrome
IgA deposits in mesangium
How does Membranoproliferative GMN present on microscopy
Big hypercellular glomeruli with thick membranes
Tram track membrane
What causes Membranoproliferative GMN
Idiopathic
Or infection, lupus or malignancy
What is the classic sign of diabetic damage to the kidney
Kimmel Stiel Wilson lesions/nodules
What is the bosniak score used for
Predict risk of cancer in people with polycystic kidney diseases
Long term dialysis leads to cyst formation - true or false
True
type of acquired cyst
Does ADPCKD present in childhood or adulthood
Adulthood
The cysts take a while to develop
What are the symptoms of ADPCKD
Symptoms often occur due to changes within the cyst - haemorrhage, infection or rupture
Eventually will get a mass effect - pain or mass
What systemic disease can occur as a result of ADPCKD
Liver cyst
Cerebral aneurysm
Associated with sub-arachnoid haemorrhage
Does ARPCKD present in adulthood or childhood
Childhood
The younger you present, the worse the prognosis
What is Xanthogranulomatous pyelonephritis
A specific kidney infection that creates a mass
Name a benign tumour of the kidney
oncocytoma
Name 4 malignant kidney tumours
Chromophobe
Clear cell
Papillary
Collecting duct
Describe the appearance of a oncocytoma
Small, oval and well circumscribed
Mahogany brown with a central stellate scar
Describe the appearance of a chromophobe tumour
Histologically similar to oncicytoma but with raisonoid nuclei and perinuclear haloes
Describe the presentation of papillary kidney tumours
Low grade = Low rate of mets and recurrence
Finger like projections
Describe collecting duct carcinoma
Least common kidney tumour but very nasty
High grade with desmopastic stroma
What is the most common type of renal cancer
clear cell carcinoma
How does clear cell carcinoma present
haematuria
kidney mass
rare hypertension
List risk factors for clear cell carcinoma
Obesity
Genetic influence
Describe the appearance of clear cell carcinoma
Partly cystic
Very heterogenous surface
Bright yellow tumour
Lots of clear cells on
Where does clear cell cancer often invade
Propensity for vascular invasion – enters the renal vein
Doesn’t necessarily touch the walls but can extend up for quite a distance
Which gene is commonly involved in the development of renal cancers
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
Mutations in stages of the TCA cycle are associated with renal cancers - true or false
True
What type of epithelium lines the bladder
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
Is cystitis common
Yes - very common
Mostly dealt with in primary care
What causes schistosomiasis infection
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
What are the results of a schistosomiasis infection
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
How does bladder inflammation lead to metaplasia
Squamous epithelium forms as an attempt to protect against the persistent inflammation
This is a risk for cancer
What is aseptic cystitis
Persistent symptoms of UTI that don’t clear up with antibiotics and have negative culture and urinalysis
Cannot find a causative organisms
How might aseptic cystitis appear on biopsy
Some inflammation, congestion and mast cells
In-dwelling catheters have a risk of cancer - true or false
True
Constantly having a catheter in leads to inflammation etc
This increases risk of metaplasia and then cancer
Which group is particularly at risk of developing squamous cancer in the bladder from catheterisation
Paraplegic patients
They cannot feel that there is inflammation/infection so have a higher risk of cancer development
What is cystitis cystica
Descriptive term that means infolding of the bladder mucosa into ‘cysts’
Non-specific sign of long-standing inflammation
What can diverticula of the urinary tract lead to
Stagnation of urine
This can lead on to infection, stones and cancer
What can cause obstruction to the urinary tract
Prostatic hyperplasia
Stones
Tumours
What happens when the urinary tract becomes obstructed
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
What is hydronephrosis
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
An obstruction where would affect both kidneys
urethra or bladder
An obstruction where would only affect one kidney
Ureter or kidney itself
What is the major risk factor for uroepithelial cancer
Smoking
What is a main symptom of urinary tract cancer
Haematuria
How can transitional cell carcinoma appear
Papillary - finger like projections
Or flat carcinoma
What is the main type of cancer to affect the bladder
Transitional cell carcinoma
If you find adenocarcinoma in the bladder, what must be ruled out
A colon cancer that has invaded through the wall
Why must you be careful of a urachus in a cancer case
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
Which zones does prostatic hyperplasia affect
transitional and central zones
What can cause BPH
Hormonal influence
How do you treat BPH
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
How do you manage prostate cancer
Most are low grade and only need monitoring
If treatment is needed you can give radiotherapy, androgen therapy, surgery (last line)
How do you diagnose prostate cancer
Can use PSA levels but not sensitive or specific
Use trans-rectal biopsy - take 6 samples from each lobe
Which system is used to grade prostate cancer
Gleason system
Which zone of the prostate does cancer usually affect
Peripheral zone
What are the different classes of haematuria
Visible - can be seen in urine
Invisible - found on urine tests
Symptomatic - associated with pain
Asymptomatic - no pain
What can cause haematuria
Trauma - catheters Cancer - bladder, urethra or kidney Infection Stones Polycystic kidneys Glomerular disease Occasionally with prostate issues Worse if on anticoagulants
If the haematuria occurs at the start of micturition where is the likely pathology
Prostate or urethra
If the haematuria occurs at the end of micturition where is the likely pathology
Bladder neck
If the haematuria occurs throughout micturition where is the likely pathology
Kidneys
Ureters
Bladder
Which drugs can contribute to haematuria
Anticoagulants
NSAIDs
How can radiotherapy cause haematuria
Local damage to tissue - lots of telangiectasia in the bladder
What tests would you do for haematuria
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
What is the gold standard for visible haematuria
CT urogram
What is renal colic
Pain associated with urinary tract stone - caused by contraction of tract trying to push stone out
Loin to groin pain
Very severe pain
What conditions other than stones can give renal colic
pyelonephritis
ruptured AAA
diverticulitis
How would you manage renal colic caused by calculi
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
What causes genital warts
HPV 6 and 11
What is hydrocele
Accumulation of fluid around the testes
Between the two layer of tunica vaginalis – mesothelial lining
Unicystic, smooth and fluid filled
What is spermatocele
Cystic change in the vas of the epididymis
May feel fullness or be asymptomatic
Will see sperm on biopsy
What is varicocele
Varicosities of the venous plexus that drains the testes
Feels like a bag of worms
Usually asymptomatic
Describe testicular torsion
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
What is peculiar about skeletal metastases of prostatic carcinoma
They are sclerotic (most mets are osteolytic)
What is pyelonephritis
Infection of the kidney
Commonly from lower GI tract - E.coli, klebseilla
Often affects women
How does pyelonephritis present
Fever
Loin pain
Dysuria
What are the risk factors for bladder cancer
Smoking
Beta-naphthalene dye
How does prostate cancer present
Often asymptomatic
Hard craggy mass on PR
May get systemic symptoms or bone pain from mets
How does BPH present
hesitancy, nocturia, increased frequency, smooth and rubbery on PR,
Which vitamins can cause renal stones if taken in excess
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
What is hypospadias
Congenital abnormality of the penis
Urethral opening is on the ventral surface
May also have a hooded foreskin and ventral curvature of penis
List complications of hypospadias
Infection is common
May have a partial structure which can lead to urethral obstruction
How do alpha blockers treat BPH
They reduce LUTS by relaxing the smooth muscle at the neck of the bladder
What factors can predispose you to recurrent UTI
Catheterisation
Post-coital
Urinary retention
What is considered a simple UTI
Simple and common infection caused by bacteria getting into urethra
What is considered a complicated UTI
UTI caused by some form of obstruction
What is the definition of recurrent UTI
Definition is twice in 6 months or 3 times in one year
How do you diagnose and treat a UTI
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
Why are post-menopausal women at high risk of UTI
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
How do you investigate recurrent UTI
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
How do you treat recurrent UTIs
Prolonged antibiotic course and treatment of underlying cause
List the common lower urinary tract symptoms
Poor flow Frequency Urgency Nocturia Hesitancy Intermittent flow Post void dribble Split stream/spraying Incontinence
Split into voiding and storage symptoms
What can cause urinary voiding symptoms
Weakness of bladder muscle
What can cause urinary storage symptoms
Overactive bladder muscles
What are some red flag urinary symptoms
Visible haematuria
Sudden onset LUTS
How do you investigate LUTS
Do rectal exam in men to check prostate - enlargement is a common cause
Scoring systems for LUTS - assesses severity
