Renal and Urinary Tract Pathology - Part 2

Question 1

Cystitis - Definition + Major S/Sx (4)

Answer 1

Infection/Inflammation of the Bladder

S/Sx

1) Dysuria
2) Urinary Freqency/Urgency
3) Suprapubic Pain
4) Fever Absent

Question 2

Cystisis - Major Lab Findings (4)

Answer 2

1) Urinalysis is cloud with > 10 WBCs per field
2) Dipstick is positive for leukocyte esterase (pus in urine)
3) Dipstick positive for nitrates (bacteria product)
4) Culture > 100,000 colony forming units

Question 3

Sterile Pyuria - Definition + Causes (2)

Answer 3

Pyuria (WBC > 10 + Leukocyte Esterase) with a negative culture
Usually due to Chlamydia trachomatis or Neisseria gonorrhaeae

Question 4

Pyelonephritis - Definition + S/Sx (4)

Answer 4

Infection of the kidney (usually a bladder infection that rises up)

S/Sx

1) Flank Pain
2) WBC Casts
3) Leukocytosis
4) Fever (vs. none in bladder infection)

Question 5

Chronic Pyelonephritis - Definition + Major Cuases (3)

Answer 5

Interstitial Fibrosis due to mutliple acute pyelonephritis infections

Causes

1) VUR
2) Obstruction - BPH
3) Obstruction - Cervical Carcinoma

Question 6

Nephrolithiasis - Definition + S/Sx (3)

Answer 6

Urinary stone - usually due to highly concentrated urine

1) Unilateral Flank Pain
2) Hematuria
3) Stone Passing (if not passed may need surgery)

Question 7

Calcium Oxalate Stones - Keys (3)

Answer 7

1) Most Common Form
2) Usually due to hypercalcemia
3) Pyramid Shaped on Microscope

Question 8

Ammonium Magnesium Phosphate (AMP) Stones - Keys (3)

Answer 8

1) Urease-Positive Infection (Protease + Klebisella) - Alkaline Urine Causes Stone
2) Staghorn Calculi Stones
3) Metal Bar Shaped on Microscope

Question 9

Uric Acid Stones - Keys (4)

Answer 9

1) Radiolucent on X-Ray
2) Acidic Urine pH required to produce
3) Spacy Stones on Microscope
4) Most common is diseases/circumstances that increase cell turnover or make urine acidic

Question 10

Cystine Crystals - Keys (3)

Answer 10

1) Cystinuria (genetic defect of renal tubules)
2) May for staghorn too + treatment involves hydration + alkanation of urine
3) Red Hexagons on Microscope

Question 11

Chronic Kidney Disease - 5 Major Results

Answer 11

1) Uremia (Build up of BUN)
2) HTN from Salt/Water Retention
3) Hyperkalemia with AG Metabolic Acidosis
4) Anemia due to decreased Renal EPO Production
5) Hypocalcemia due to Loss of Vitamin D Hydroxylation

Question 12

Impacts of Uremia in CKD

Answer 12

1) Nausea
2) Anorexia
3) Platelet Dysfunction (inhibited aggregation and adhesion
4) Urea Crystal Deposits

Question 13

Renal Cell Carcinoma - Definition + Classic Triad

Answer 13

Malignant Epithelial Tumor of the Kidney Tubules

Triad

1) Hematuria
2) Palpable Mass
3) Flank Pain

Question 14

Renal Cell Carcinoma - S/Sx (5)

Answer 14

1) Hematuria
2) Palpable Mass
3) Flank Pain
4) Paraneoplastic Syndromes (EPO, Renin, ACTH, PTH-Producing Hormone)
5) Possible Left Sided Varicocele

Question 15

Renal Cell Carcinoma - Invasion Pattern

Answer 15

Commonly invades the Renal Vein (vs. normal carcinoma invades lymphatics)

Invasion on left can cause varicocele due to drainage of spermatic vein (right drains into IVC)

Question 16

Renal Cell Carcinoma - Pathogenesis

Answer 16

Loss of VHL Tumor Suppressor Gene –> Increased HIG and VEGF

Question 17

Renal Cell Carcinoma - 2 Major Forms

Answer 17

Sporadic Tumors –> Adult Males (Age > 60) in a unilateral upper pole

Hereditary Tumor –> Usually bilateral + younger –> Von Hippel-Lindau increases risk

Question 18

Wilms Tumor - Description + Key Population

Answer 18

Malignant kidney tumor of blastema (immature kidney mesenchyme)

Most common renal tumor in children (average age = 3 y/o)

Question 19

Wilms Tumor - S/Sx (3) + Mutation

Answer 19

1) Unilateral Flank Mass
2) Hematuria
3) HTN

WT1 Mutation