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Pathology > Renal > Flashcards

Renal Flashcards

1
Q

Kidney function?

A
  • filters 25% blood
  • excretes nitrogenous waste products
  • cleans blood
  • regulates water & electrolytes
  • maintains acid/base balance
  • secretes hormones
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2
Q

What hormones does the kidney secrete & what do they do?

A
  • erythropoietin: proliferative effect on bone marrow to make RBC
  • renin: BP
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3
Q

Functional unit of kidney?

A

nephron: glomeruli, convoluted tubules & collecting ducts

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4
Q

What is the function of the juxtaglomerular complex?

A

controls BP

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5
Q

How does the juxtaglomerular complex work?

A
  • JG cells in wall of afferent arteriole
  • sensitive to BP
  • drop in BP –> secrete Renin
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6
Q

What is azotemia?

A
  • elevation of blood urea nitrogen & creatine
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7
Q

What is azotemia usually related to?

A

GFR
– primary renal disorders
– some extra-renal disorders (pre vs post renal)

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8
Q

Difference between pre-renal & post-renal azotemia?

A

pre: hypoperfusion of kidneys decreases GFR in absence of parenchymal damage
post: urine flow obstructed below level of kidney

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9
Q

What is uremia?

A

progression of azotemia to produce clinical manifestations & systemic biochemical abnormalities
– failure of renal excretory function
– metabolic & endocrine alterations
– involvement of 2ndary organ systems

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10
Q

What are common organs uremia spreads to?

A
  • heart, GI, nerves
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11
Q

What is nephrotic syndrome?

A

Glomerular syndrome (non-specific)
- heavy proteinuria
- hypoalbuminemia
- severe EDEMA (puffy eyes = early)
- hyperlipidemia & lipiduria

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12
Q

What is nephritic syndrome?

A

Glomerular syndrome acute onset
- visible hematuria (brown color)**
- mild-moderate proteinuria
- azotemia
- edema
- hypertension**
**post-streptococcal glomerulonephritis

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13
Q

What is acute renal failure?

A
  • oliguria or anuria
  • recent only azotemia
    *may result from glomerular injury OR acute tubular necrosis
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14
Q

What is chronic renal failure?

A
  • prolonged symptoms & signs of uremia
    – end result of all renal disease
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15
Q

What is a UTI?

A
  • bacteremia & pyuria
  • symptomatic or asymptomatic
  • kidney (pyelonephritis) or bladder (cystitis)
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16
Q

What is nephrolithiasis?

A

kidney stones

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17
Q

What is glomerulonephritis? How is it tx?

A
  • immune mediated dx of glomeruli
  • steroids
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18
Q

What is pyelonephritis? How is it tx?

A
  • infection of kidney (not glomeruli)
  • usually by bacteria (e.coli)
  • retrograde origin (ascending infection most common)
  • antibiotics
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19
Q

What is more common glomerulonephritis or pyelonephritis?

A

pyelonephritis

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20
Q

How does acute vs chronic pyelonephritis appear on kidney specimen?

A
  • acute = abscess
  • chronic = severe scarring
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21
Q

Symptoms of nephrolithiasis (kidney stones)? Tx?

A

*common
- obstruction
- pain
- hematuria
- pyuria
- possible hypercalcemia
TX: lithotripsy = ultrasound waves for small ones

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22
Q

What is a staghorn calculus?

A
  • large, untreated kidney stones
    – cause damage & chronic kidney dx
    *ischemic kidney –> activation of RAAS
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23
Q

What is hydronephrosis?

A
  • secondary to kidney stone / obstruction leads to urine accumulation in kidney
  • calyces are dilated & thinned out
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24
Q

**Renal atrophy secondary to atherosclerosis of renal artery = hypertensive disorder

A

atrophy occurs due to ischemia

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25
Q

Describe RAAS

A
  • drop in BP
  • JG cells detect & release renin
  • converts angiotensinogen to angiotensin I
  • ACE converts to angiotensin II (active)
  • vasoconstriction, increase aldosterone secretion, Na & water retention
  • increased blood pressure
26
Q

End organ damage & complications of hypertension?

A
  • CV
  • peripheral vascular
  • renal
  • CNS
  • visual
27
Q

Why can kidney levels be normal even with extreme hypertension?

A
  • huge reservoir of glomeruli
  • left untreated, leads to major mulitsystem issues
28
Q

What are the types of arteriosclerosis?

A
  • Hyaline: benign HTN & DM
    –> wall grows outwards
  • Hyperplastic: malignant HTN
    –> sm. m. grows in constricting lumen
    –> more sinister/serious
29
Q

What is benign nephrosclerosis?

A
  • mostly asymptomatic
  • kidney slightly smaller
  • granular surface appearance
  • some glomeruli non-functional
  • often still functioning to high degree
30
Q

What is malignant nephrosclerosis?

A
  • pinpoint bleeds all over kidney
  • senses ischemic change more so than benign type
31
Q

What is a simple renal cyst?

A
  • asymptomatic (often never know)
  • on renal cortex
  • filled with clear fluid
  • can rupture & cause hemorrhage/some blood in urine
32
Q

What is AD polycystic renal disease?

A
  • more serious
  • multiple cysts –> enlarged immensely
  • uncomfortable
  • kidney parenchyma replaced by cysts
    TX: transplant or dialysis
33
Q

What is acute transplant rejection?

A
  • very serious
  • must take immunosuppressants//still can reject
    *entire kidney is hemorrhagic & destroyed
34
Q

Where do renal cell carcinomas arise from?

A
  • renal tubular epithelium
35
Q

How do renal cell carcinomas progress?

A
  • often silent
  • can grow into renal vein
    *metastasis: kidney is not a usual site
36
Q

What is a Wilm’s tumor?

A

Nephroblastoma
- children <5 years
- abdominal mass (very enlarged kidney)
- chronic low grade fever

37
Q

What is the histopathology of a wilm’s tumor?

A

several cell types: some resemble abortive glomeruli & others resemble skeletal muscle

38
Q

Survival rate for Wilm’s tumor?

A

> 90% 5-year

39
Q

Where do urothelial carcinomas arise?

A
  • urinary tract lining epithelium (transitional epithelium)
    **Bladder is most common site
    *bladder, ureter, calyces
40
Q

Describe urothelial carcinomas?

A
  • painless hematuria
  • clinical significance depends on histologic grade, differentiation, & depth of invasion
41
Q

What can cause urothelial carcinomas?

A
  • cigarette smoking
  • industrial solvents
  • chronic cystitis
  • schistosomiasis
  • drugs
42
Q

Where is the prostate?

A
  • lower level of bladder
    – base touches bladder & apex is the point
43
Q

Describe the zones of the prostate & the types of dx associated with them?

A
  • central = benign hyperplasia
    –> experience symptoms due to pressing on urethra
  • peripheral = malignant
    –> symptoms take longer to progress
44
Q

Three major diseases of the prostate?

A
  • prostatitis
  • benign prostatic hyperplasia
  • adenocarcinoma of prostate
45
Q

Describe screening for prostate dx?

A
  • PSA: protein in serum at <4ng/mL
  • increased levels or velocity of change may suggest cancer
46
Q

Function of PSA (prostate specific antigen)?

A
  • liquefy semen to allow sperm to swim
  • dissolution of cervical mucous cap
47
Q

What is prostatitis and how do you tx?

A
  • acute bacterial dx
    –> potentially from habitual instrumentation (catheter)
  • antibiotics
48
Q

Describe nodular (benign) prostatic hyperplasia

A
  • obstruction to flow & urinary frequency
  • ascending infections
  • rule-out neoplasia
    *tx with drugs or surgery (TURP)
    –trans urethral resection
49
Q

How to tell the difference between a benign & malignant prostatic nodule?

A

must sample lots of peripheral tissue to catch it

50
Q

Describe adenocarcinoma of the prostate

A
  • 70% men develop by 70-80yrs
  • biopsy multiple cores
    **wide variety of clinical behavior
    Use Gleason grading (microscope)
51
Q

How to examine the prostate?

A

digital exam from rectum

52
Q

Where does metastatic prostatic adenocarcinoma migrate?

A
  • pretty much anywhere other than brain
    – common in bone (intervertebral)
    !osteoBLASTIC lesions = bone forming!
53
Q

What is cryptorchidism? complications/

A

undescended testes / absence of 1 or both in scrotum
– infertility & increased risk for neoplasia

54
Q

What is Seminoma?

A
  • most common germ cell tumor (malignant)
  • young adults
  • unilateral mass in testis
  • normally good prognosis when resected / radiation/ chemo (one of most treatable & curable cancers) - ->95% long-term survival
55
Q

What are infections associated with the testis?

A
  • Tuberculosis, mumps, syphilis, gonorrhea
56
Q

Complications of mumps?

A
  • orchitis
  • oophoritis & mastitis
  • meningitis
  • thyroiditis
  • pancreatitis
  • sterility
  • hearing loss
    **rare in young, more common in older people
57
Q

What is hypospadias?

A
  • developmental defect of urethra
  • abnormally placed urethral meatus opens at glans penis (most common)
  • can be corrected
58
Q

What is Peyronie’s disease?

A
  • fibrous issue formation in deep penile tissue
  • if painful & problem with sex seek help
59
Q

What is phimosis?

A
  • foreskin cannot be fully retracted from head
    *can lead to infections & uncomfortable
60
Q

What is priapism?

A

Erect penis / clitoris does not return to flaccid state despite absence of stimulation within 2 hours
*medical emergency (ischemia)

61
Q

What can cause priapism?

A
  • hematologic diseases (sickle cell, leukemia)
  • trauma
62
Q

What is erythroplakia of queret?

A

pre-malignant lesion / dysplastic epithelium
*similar to oral erythroplakia (mucous membrane)
– must resect entirely
– HPV is most common etiology

Pathology (9 decks)

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