Renal 4 Flashcards
Which cancer?
- Papillary neoplasms of renal pelvis that resemble carcinomas of the urinary bladder
- Classified as low to high grade lesions
- Most tumors present w/ hematuria or urinary obstruction early in the course
Transitional Cell Carcinoma
- Surgical removal of Transitional Cell Carcinoma yields good results for which grade?
- What is the 5 year survival %?
- Who does grading?
- Grade 1 or 2
- 70%
- Pathologist
(grade 3 is less favorable)
Which cancer is more likely to metastasize?
(TCC or RCC)?
TCC (looks like meatball in pelvis)
- The most common solid tumor in infants and children (1 out of 10,000)
- Is present at birth and manifests clinically between 2nd and 4th yrs of life
- Grows so big, it compresses abdominal contents to other side of abdomen
Wilms Tumor
- Presents as solitary or multinodular abdominal mass that replaces the kidney and is usually palpable
- Highly malignant tumors composed of blastic or immature cells
Wilms Tumor
What is the prognosis of Wilms Tumor?
- Good w/ surgery and chemo.
- 85% w/ complete cures
(they are usually taken out before they metastasize)
- What is the MOST COMMON urinary tract neoplasm?
Cancer of Urinary Bladder
Who is bladder cancer most common in?
Men 60 -80
Which cancer is 2 times more common than RCC?
- Urinary Bladder Cancer is 2 times more common with the same # of deaths (52,000 new cases/year)
- RCC had 27,000 cases/ year with same # deaths = silent killer
Which cancer has unknown etiology, but the most imprortant risk factor is smoking and is proportionate to total # of cigarettes smoked?
Urinary Bladder Cancer
Azo dyes and chemicals used in rubber industry , and textile printing have been linked to which cancer?
Bladder cancer
In Egypt, infection w/ Schistosoma haematobium (a parasite) can lead to what cancer?
Urinary Bladder
- 90% of bladder cancers are _____
- 7% are ______
- The other 2 types are what?
- 90% Transitional Cell Carcinomas
- 7% Squamous Cell Carcinoma
- Adenocarcinoma and Sarcomas
On gross exam, what cancer tumor is either “papillary or flat” or “invasive or non-invasive” by histologic examination of tissue
Urinary Bladder Cancer
Progression of bladder cancer leads to extension of tumor into which 2 places?
- Muscle layers of bladder (3)
- Adjacent pelvic organs
Bladder Cancer usually metastasizes initially to where?
Pelvic lymph nodes
- Pts with bladder cancer present w/ what 3 sxs?
- How is dx made?
- Hematuria
- Dysuria
- Lower abdominal pain
Dx made by:
- Cystoscopy
- Histologic biopsy
The treatment of bladder cancer is based on what 2 things?
- Surgical resection
- Chemotherapy
The prognosis of bladder cancer is based on what 3 things?
- Histologic grade
- Histologic type
- Clinical staging (A-D)
- 5 year survival rate of Stage A/Grade 1 bladder cancer?
- Survival rate of Stage D tumors (distant metastasis)?
- 98%
- 15%
- Classified on the basis of morphology, pathogenesis, or clinical presentation of disease
Glomerular Disease
On the basis of pathogenesis, glomerular diseases are classified into what 3 disorders?
- Immunologic diseases
- Metabolic Disorders
- Circulatory Disorders
Mediated by antibodies and characterized by deposits of Ig’s in the glomeruli
If the deposition of Ig’s evokes an inflammatory reaction, the disease is classified as _____.
Immunologic disease classification of Glomerular Disease
Glomerulonephritis
What is the #1 cause of nephritic syndrome?
Strep throat or strep skin infection
(2 weeks after infection, kid urinates cola colored urine)
Glomerular Disease
- What is the antigen?
- What is the antibody?
- Antigen: strep
- Antibody: IgG
(these make up the immune complex and they stick together and get stuck at GFM)
CL:
F:
BM:
D:
US:
CL: Capillary Loop
F: Fenestrations
BM: Basement Membrane (cream filling)
Podocytes (cookie)
D: Desmosomes (slit pores)
US: Uroniferous Side
Occurs in the course of systemic disorders such as DM or Amyloidosis
Metabolic Disorder classification of Glomerular Disease
- Atherosclerosis of renal arteries is associated with hypoperfusion which leads to hyalinization of the glomeruli
- The sudden onset of HTN may cause ___ _____ of the glomerular capillaries.
Circulatory Disorders classification of Glomerular Disease
Fibrinoid necrosis
- What are the 4 most common categories of Glomerular Disease?
- How many are there total?
- Acute Renal Failure
- Nephrotic Syndrome
- Nephritic Syndrome
- Chronic Renal Failure
- 17
What is the #1 cause of Acute Renal Failure?
ATN (acute tubular necrosis)
Acute Renal Failure
- Is it reversible?
- Sudden or gradual onset?
- Results in what 2 things?
- Is it pre-renal or post-renal?
- Yes
- Sudden
- Oliguria or Anuria
- Either
Acute Renal Failure caused by shock or heart failure caused by an MI
Pre-renal
Acute Renal Failure caused by sudden obstruction to urine outflow, or renal which is a consequence of glomerular destruction (glomerularnephritis)
Post-renal
Characterized by:
- heavy proteinuria
- hypoalbuminemia
- edema
- hyperlipidemia
- lipiduria
Nephrotic Syndrome
What is the major pathogenetic abnormality of Nephrotic Syndrome?
- A permeability defect in the glomerular capillaries that allows protein to be lost from plasma into the urine (proteinuria)
- –> which results in a decreased amt of protein (Albumin) circulating in the blood (hypoproteinemia)
Nephrotic Syndrome
- Proteinuria and Hypoproteinemia causes a decrease in plasma oncotic pressure leading to what?
- This decrease in pressure allows fluid to escape into the tissues causing edema
- This also lowers plasma volume (kidneys sense this and activate RAS, which further contributes to edema)
Which organ produces proteins (including Albumin), which were lost (Ig’s Complement, clotting factors) and also produces ___ which circulate in the blood and urine?
Liver
Lipoproteins
Minimal Change Disease is also called?
Nils Disease
- What is the #1 reason/disease for Nephrotic Syndrome in kids? (70% children) (20% adults)
- The GFM allows what to pass through?
- How is this observed?
- Minimal Change Disease (Nils Disease)
- Large proteins
- Electron microscopy (not visible on light microscopy)
What is responsible for a “considerable portion” of cases of Nephrotic Syndrome in adults? (20-30%)
(this rarely ever causes NS in kids)
Systemic diseases that involve the kidney:
- DM
- Amyloidosis
- SLE (Systemic lupus erythematosus)
Besides systemic diseases and Nils Disease, what other 3 things are associated w/ Nephrotic Syndrome?
- Malignancies
- Infections
- Drugs (Heroin)
Characterized by 7 things:
- hematuria
- variable degrees of proteinuria
- decreased GFR
- elevated BUN & serum creatinine
- Oliguria
- Mild edema
- HTN
Nephritic Syndrome
Glomerular diseases that cause this syndrome, are characterized by inflammatory changes in the glomeruli, w/ _______ and ______.
Nephritic Syndrome
- Leukocytosis
- Necrosis
Which syndrome?
- Mild proteinuria
- Mild hematuria
(Due to injury of glomerular capillaries)
Nephritic Syndrome
Which syndrome?
- Classic presentation involved in Acute Post-Streptococcal Glomerulonephritis
Nephritic Syndrome
T/F
- All glomerular diseases cause a mixed Nephrotic and Nephritic type pictures
False, all EXCEPT: Minimal Change disease
What is the only means of DEFINITIVE dx for all glomerular diseases?
Renal Biopsy
****What 3 things are needed for kidney biopsy to dx any glomerular nephritis?****
- H & E stains
- Immunofluorescence to light up antibodies which are affected membrane
- Electron Microscopy
An immune mediated inflammatory glomerulopathy that occur 1 to 2 weeks after a strep throat infection OR strep skin infection w/ GABHS (St. pyogenes)
Acute Post-Streptococcal GMN
(GMN = glomerulonephritis)
- Reflects the deposition of immune complexes in the glomerular basement membrane.
- What 2 things make up the immune complex?
- Acute Post-Streptococcal Glomerulonephritis
- Antigen + Antibody
- Acute Post-Streptococcal Glomerulonephritis affects who mostly?
- How is it treated?
- Children 6-10 yrs (but can affect adults)
- Kids do great w/ steroids
T/F
- Acute Post-Streptococcal GMN is common in the US
False, we have good abx. Still seen in underdeveloped areas though.
The disease is caused by glomerular localization of immune complexes generated by an antibody response to circulating antigens. The antigen-antibody complexes are trapped in GBM where they activate ____ and _____ into the glomeruli.
Acute Post-Strep GMN
- Complement
- Inflammatory Cells
Acute Post Strep GMN
- The complement activation is so extensive, that over 90% of pts have ________ because of consumption within the glomeruli.
Hypo-complementemia
- Inflammatory mediators attract/activate ___ and ____.
- Stimulate proliferation of _____ and ______
(all resulting in marked hypercellularity of glomerulus)
***Diffuse Process***
- neutrophils & monocytes
- mesangial & endothelial cells
(Acute Post Strep GMN)
Acute Post-Strep GMN
- What 2 things are seen on this slide?
- Collapsed capillary loops
- Segmented PMNs
Acute Post Strep GMN
- What does this slide depict?
Enlarged Hypercellular Glomeruli
What is the #1 way to make dx of Acute Post Strep GMN?
Electron Microscopy
Subepithelial dense deposits (on podocyte side), that are shaped like Humps on the epithelial side of basement membrane that are the deposits of immune complexes
Seen on electron microscopy when diagnosing Acute Post Strep GMN
Granular deposits seen on both IgG and Complement C3 along the basement membrane
Seen on IF (immunofluorescence) microscopy to dx Acute Post Strep GMN
What is uncommon, but a possible complication of Acute Post Strep GMN?
Crescent formation
