pathology of the urinary tract

Question 1

normal microscopy of the kidney

Answer 1

glomerulus
capillary
distal and proximal tubule
bowmans capsule

Question 2

renal function impairment/failure

Answer 2

decreased ability of the kidney to excrete nitrogenous waste and regulate water and electrolytes
actue renal function impairment
chronic kidney disease (CKD) - stages 1-4 based on GFR

Question 3

Parameters to assess renal function (Us and Es)

Answer 3

urea
creatinine
Na, K, Cl
eGFR

Question 4

which excretory compounds are raised in renal failure

Answer 4

urea and creatinine

Question 5

what test will be abnormal when assessing full blood count in chronic renal failure

Answer 5

GFR and ACR (albumin to creatinine ratio)

Question 6

causes of acute renal failure

Answer 6

hypovolaemic shock due to bleeding (haemorrhage, pregnancy, burns, vomiting/diarrhoea)
drugs eg gentamicin
congestive cardiac failure

Question 7

causes of chronic renal failure

Answer 7

glomerulonephritis 
chromic use of drugs eg aspirin 
chronic pyelonephritis
hypertension
DM
AI disease eg systemic lupus erythematosus
obstruction of urinary tract

Question 8

what is glomerulosclerosis

Answer 8

glomeruli scarred, can cause renal failure (ass chronic inflammation)

Question 9

causes of urinary tract obstruction

Answer 9

calculi or stones
stricture of ureter
stricture of urethra
benign prostatic hyperplasia 
cancer of bladder or prostate

Question 10

how does renal cell cancer present

Answer 10

haematuria
loin discomfort
60-70
M>F

Question 11

what does renal cell cancer look like

Answer 11

yellow and pale variegated appearance

epithelial cells, not columnar or squamous

Question 12

what is the urothelium/transitional cell epithelium

Answer 12

lines bladder, ureters, pelvis-calyceal system
consists of 4 cells or more
acts as a barrier and prevents back diffusion of urine
different from squamous as more cuboidal than flat

Question 13

symptoms of cystitis

Answer 13

pain when peeing
peeing more often 
constant urge
dark, cloudy, smelly pee
pain in lower abdomen 
generally unwell

Question 14

signs of bladder cancer

Answer 14

present with frank haematuria or microscopic haematuria ( urine dipstick)

Question 15

investigations for bladder cancer

Answer 15

U/S
Cystoscopy and biopsy or resection cancer
MRI to assess local spread and lymph node status
CT Scan – staging to look for metastasis in other organs
Histology: Transitional cell carcinoma/urothelial carcinoma

Question 16

what is benign prostate hyperplasia

Answer 16

Cause unknown – may be related to androgens
Affects over 50% of men over 60 years
Symptoms due to urethral obstruction
present with urinary symptoms or raised PSA

Question 17

symptoms og BPH

Answer 17

Frequency in micturition
Nocturia
Poor stream
Difficult in starting & stopping stream (prostatism)
UTIs
Bladder outlet obstruction leads to hydronephrosis

Question 18

Types of specimens from the prostate

Answer 18

Needle core biopsies for diagnosis in patients with raised PSA, biopsies taken per rectum us guidance (CA)
Transurethral resection of prostate for treatment of BPH or palliation in CA prostate if patient presents with obstructive symptoms
Radical prostatectomy for early prostatic cancer

Question 19

investigations for prostatic cancer

Answer 19

PSA 
MRI - local spread
Needle core biopsy with transrectal US
CT for distant metastasis
Bone scan