Pathology of the Kidney 2

Question 1

What are kidney calculi?

Answer 1

Kidney stones. They are hard deposits of minerals and salts.

Question 2

what are some of the clinical effects of kidney calculi?

Answer 2

• Renal colic pain,
• Hhaematuria,
• Pyelonephritis,
• Obstructive uropathy (urine can’t flow),
• Hydronephrosis (swelling of the kidney due to build up of urine),
• Post-renal renal failure

Question 3

What are Calculi caused by?

Answer 3

• Hypercalcaemia (eg, sarcoid) as many calculi is made up of calcium.
• Gout,
• Obstruction (eg, vesico-ureteric reflux)
• Genetic,
• Dehydration.

Question 4

Describe features of Wilms’ tumours

Answer 4

• Occurs in children due to defects WT1 tumour suppressor gene.
• Histology resembles immature or embryonal blastema.

Question 5

Describe features of renal cell carcinoma

Answer 5

• They originate in ducts, especially PCT.
• Most common type is clear cell.
• Smoking and obesity are biggest causes,
• Some genetics

Question 6

Describe clinical presentation of renal cell carcinoma

Answer 6

• Occurs more often in men than women.
• Presents most commonly with haematuria. Can also present with masses, pain and metastasis.
• Can cause paraneoplastic syndromes

Question 7

What is paraneoplastic syndromes?

Answer 7

Tends to occur when the proteins on the surface of cancer cells are also present on cells in brain and nerve cells. Therefore immune reactions can target out bodies own cells

Question 8

What are clinical features of urotherlial cancer

Answer 8

• Spectrum of malignancy with field change which tend to recur so careful monitoring is vital.
• Caused by smoking (main) and some industrial.
• Presents with haematuria, dysuria and obstruction

Question 9

What are the causes of acute renal failure?

Answer 9

1) Pre-renal - Shock, major trauma.
2) Renal - Some glomerulonephritides, drugs, malignant, hypertension, vasculitis, analgesics.
3) Obstruction

Question 10

What are some of the effects of acute renal failure?

Answer 10

• High potassium,
• High creatinine,
• Oliguria (reduced volume of urine),
• Hypertension,
• Lipids in nephrotic syndrome

Question 11

What are some causes of chronic renal failure?

Answer 11

1) Pre-renal - atherosclerosis.
2) Renal - Glomerulonephritis diabetes, hypertension, polycystic,
3) Post-renal - Obstruction

Question 12

What are some of the effects of chronic renal failure?

Answer 12

• High potassium,
• High creatinine,
• May be Oliguria,
• Hypertension,
• Anaemia,
• Small kidneys

Question 13

Name some causes of obstructive uropathy?

Answer 13

• Carcinoma of renal pelvis,
• thrombus,
• Carcinoma of ureter,
• Retroperitoneal fibrosis,
• Pregnancy,
• Carcinoma of cervix,
• Endometriosis,
• Neurogenic bladder,
• Benign prostatic hyperplasia,
• Urethral structure

Question 14

What are some causes of bladder outflow obstruction?

Answer 14

• Prostate enlargement in men,
• Uterine prolapse in women,
• Calculi,
• Tumours,
• Urethral structures,
• Neurological damage

Question 15

What is renal osteodystrophy?

Answer 15

It occurs in chronic renal failure. Calcium and phosphate precipitate out of the kidney so blood calcium falls. Parathyroid gland produces PTH causing more precipitation and eventually parathyroid gland hyperplasia. So calcium is taken out of bone to make up blood levels. Can lead to weak bone

Question 16

What are the principles of renal replacement therapy?

Answer 16

To maintain;

• Electrolytes,
• Fluid,
• Excretion,
• Erythropoietin
• Nutrition,
• BP

Question 17

What are some difficulties with renal transplantation?

Answer 17

Cross matiching - high risk of rejection which could be acute cellular rejection, acute antibody mediated rejection, acute vascular rejection.
- Immunosuppression - risk of infection, skin cancer and lymphoma.