Pathology of the kidney, ureters and bladder 2 Flashcards
How does a renal stone present acutely?
Colickly pain, back, can cause haematuria
How can you treat kidney stones?
- Pain relief
- US (lithotripsy)
- Surgery
What can renal calculi contain?
- Calcium (75%)
- Uric acid (20+%)
- Cystine (1%)
What kind of kidney stone is radiolucent?
Uric acid
What can the underlying causes of a calcium stone be?
Hypercalcaemia
- Sarcoid, renal tubular acidosis, hyperparathyroidism
What can the underlying causes of a uric acid stone be?
Gout
What can cause a cystine stone?
- Genetic mutation in PCT cystine transporter
- Dehydration
What can cause bladder disease?
- Inflammation
- Trauma
- Infection
- Calculi (schistosomiasis)
- Neoplasia
What are the different types of urinary tract neoplasms?
- Bladder - urothelial (transitional cell) carcinoma (1/5)
- Renal - Clear cell carcinoma (ccRCC) (4/5)
Less common - Transitional cell renal carcinoma
- Renal nephroblastoma (Wilm’s tumour)
- Ureter transitional cell carcinoma
- Renal/bladder sarcoma
Why is bladder cancer a major health burden?
- Ocurs mainly in elderly
- High chance of another tumour (5% chance per anum) due to whole mucosa being exposed to carcinogens
Who is mainly affected by Wilm’s tumour?
Children (usually < 3 years)
What is wilm’s tumour due to?
Mutation in WT1 tumour suppressor gene
What does the histology of wilm’s tumour look like?
Resembles immature or embryonal blastema
What is the survival rate from Wilm’s tumour?
90% (after surgery, radio, chemo)
Younger = better prognosis
What does Wilm’s tumour usually present with?
Large palpable abdominal mass in achild
Where does Renal cell carcinoma usually originate?
In ducts esp PCT
What is the commonest type of renal cell carcinoma?
- Clear cell
- Papillary chromophobe
- Mostly sporadic
What greatly increases the risk of renal cell carcinoma?
Smoking and obesity
What diseases can increase the risk of renal cell carcinoma?
- Chronic cystic disease
- Von Hippel-Lindau syndrome
- Autosomal dominant RCC
- Hereditary papillary
What can renal cell carcinoma present with?
- Loin pain
- Mass
- Haematuria
- Metastases (cannonball lesions along lung)
How can renal cell carcinoma typically metastasis?
Along renal vein to IVC
What can renal cell carcinoma cause?
- Paraneoplastic syndromes eg pyrexia, hormones (EPO)
- Metastases (cannonball lesions along lung)
What is the prognosis of urothelial cancer which is muscle invasive?
50% death in 5 years
What are the major risk factors for bladder cancer?
- Smoking
- Industrial (eg aniline dyes)
What type of malignancy is most dangerous in bladder cancer?
Muscle invasive
What is acute renal failure associated with?
- High K+
- High creatinine
- May be oliguria
- Hypertension
- (lipids in nephrotic syndrome)
What is chronic renal failure associated with?
- High K+
- High creatinine
- May be oliguria
- Hypertension
- Anaemia
- Small kidneys
WHat can the causes of obstructive uropathy be?
Intrinsic and extrinsic Acute or chronic - Staghorn calculus - Ureteropelvic stricture - Transitional cell carcinoma of renal pelvis - Blood clot - Ureteral stone - Transitional cell carcinoma of ureter - Retroperitoneal fibrosis - Pregnancy (exrinsic) - Carcinoma of cervix (exrinsic) - Endometriosis (exrinsic) - Urothelial carcinoma - Neurogenic bladder - Benign prostatic hyperplasia - Urethral stricture
What is hydronephrosis?
Kidney swells due to urine failing to properly drain from the kidney to the bladder. Usually unilateral
What is involved in renal replacement therapy?
- Electrolyte balance
- Fluid balance
- Excretion
- EPO
How can dialysis be done at home?
- Through ambulatory peritoneal dialysis (requires permenant catheter)
- Peritoneal membrane acts as filter
What are the problems associated with kidney transplantation?
- Acute cellular rejection
- Acute antibody mediated rejection
- Acute vascular rejection
- Chronic allograft nephropathy (chronic rejection)
- BK virus infection
What type of stone does proteus mirabilis produce?
Ammonium phosphate (can cause staghorn calculi)
