pathology of urinary tract & kidney Flashcards
what is renal function impairment?
decreased ability of the kidney to excrete nitrogenous waste and regulate of water and electrolytes
what 6 parameters need to be looked at to asses renal function?
1) urea
2) creatinine
3) Na+
4) K+
5) Cl-
6) estimated glomerular filtrate rate (eGFR)
what causes acute renal failure?
- hypovolaemic shock
- drugs
- congestive cardiac failure
what causes chronic renal failure?
- several types of glomerulonephritis
- chronic use of some drugs such as aspirin
- chronic pyelonephritis
- hypertension
- diabetes mellitus
- autoimmune disease
- obstruction of urinary tract
what causes urinary tract obstruction?
1) calculi or stones
2) stricture in the ureter
3) stricture in the urethra
4) bengin prostatic hyperplasia
5) cancer of the bladder or prostate
what do patients usually present with, with renal cell cancer?
- haematuria
- loin discomfort
when is renal cell cancer more common?
- 60-70 years
- males
what is the appearance of large renal cell cancer?
yellow and pale variegated
what is the histology of renal cell carcinoma?
the cells are not epithelial but not columnar or squamous
what does the urothelium line?
- bladder
- ureters
- pelvi-calyceal system
what is the function of the urothelium?
acts as a barrier and prevent back diffusion of urine
what are the symptoms of cystitis?
- pain, burning or stinging when urinating
- needing to urinate more often and urgently than usual
- feel like you need to urinate shortly after going to the toiet
- urine that is dark, cloudy or strong smelling
- pain low down in tummy
- feeling generally unwell, achy, sick and tired
what investigations are done for bladder cancer?
- ultrasound scan
- cystoscopy and biopsy or resection cancer
- MRI to assess local spread and lymph node status
- CT scan: for staging to look for metastasis to other organs
what is the histology of bladder cancer?
transitional cell carcinoma/urothelial carcinoma
how or bladder cancers often removed?
Transurethral Resection of Bladder Tumour
what are the symptoms due to urtheral obstruction?
- frequency in micturition
- nocturia
- poor stream
- difficulty in starting and stopping stream (prostatism)
- urinary tract infections
- bladder outlet obstruction leads to hydronephrosis
what is the most common cancer in men?
prostate cancer
what is a key indication of prostate cancer?
raised prostatic specific antigen (PSA)
what are the 3 cancers that are routinely screened for in the UK?
- breast
- cervical
- bowel
what are the 3 types of specimens from the prostate?
1) needle core biopsies for diagnosis of Ca prostate in patients with raised PSA; biopsies taken per rectum under ultrasound guidance
2) transurethral resection of prostate for treatment of benign prostatic hyperplasia or palliation in Ca prostate if patient presents with obstructive symptoms
3) radical prostatectomy for early prostatic cancer
what is an MRI used for in prostatic cancer?
to identify the cancer and assess for local spread
what is a CT used for in prostatic cancer?
to seek for distal metastasis
why is a bone scan used in prostatic cancer?
prostate cancer spreads to the bones
what cancers spread to the bones?
- breast
- kidney
- lung
- lymphomas
- multiple myeloma
- prostate
- thyroid
what is a needle core biopsy used for and how is it done?
- used for prostate cancer
- done under guidance of trans-rectal ultrasound
what are the complications of vertebral bone metastasis?
- if it goes into spinal chord itself it can cause cord compression
- weakness
- paralysis in parts of body
- unusual sensations
- problems with urination or bowel function
