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Year 2: Clinical Pathology > Renal and Urogenital Pathology > Flashcards

Renal and Urogenital Pathology Flashcards

1
Q

Types of Renal Pathology (3)

A

Glomerular, tubular and vascular

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2
Q

What is Radiology used to diagnose in renal pathology (4)

A

Obstructions
Malignancies
Size
Other abnormalities

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3
Q

Types of Renal Biopsy investigations (3)

A

electronmicroscope
immunofluorescence
light microscope

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4
Q

Pathogenesis of most renal pathologies

A

Damage to basal membrane OR epithelial cells OR podocyte cells = disturbances in filtration

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5
Q

Types of Renal Vascular damage (3)

A

Thrombotic microangiopathy (thrombi and endothelial damage)
Vasculitis (inflame)
Renal stenosis - diabetes, hypertension and antheroma

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6
Q

Glomerular damage

A

vascular and basal membrane damage

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7
Q

Immunological Glomerular damage causes (3)

A

Circulating immune complexes = SLE or IgA
Circulating antigens deposit in glomerulus
Antibodies against the Basal membrane (autoimmune)

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8
Q

Immunological response in Glomerulus stimulates? that causes damge (4)

A

complement activation
Neutrophil activation
Reactive O2 species
Clotting factors

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9
Q

Non-immunological Glomerular damage? (3) + examples

A

Enodthelial injury eg. Vasculitis
Altered Basal Membrane eg. hyperglyceamia or inherited disease
Abnormal protein deposition eg. Amyloid

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10
Q

3 types of tubular damage? + examples

A

Ischemic - eg. hypotension
Drug induced eg. Antibiotic, NSAIDs or ACEi
Toxic eg. crystal deposits (gout)

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11
Q

Nephritic VS Nephrotic syndrome - cause

A 
Nephritic = acute nephritis or inflammation
Nephrotic = Due to glomerulus damage
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12
Q

Nephritic Vs Nephrotic - signs and symptoms

A

Nephritic = Haematuria +++ (macroscopic)
Also: proteinuria, hypertension and low urine volume

Nephrotic = Proteinuria +++ (frothy urine)
Also: Hypoalbuminaemia –> oedema, hypertension

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13
Q

Diseases that cause Nephrotic syndrome (3)

A

Membranous nephropathy - thicken Basal membrane
Focal Segmental glomerulosclerosis (FSGS) - hereditary, Heroine and HIV
Minimal Change - in children due to steroids

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14
Q

Disease that cause Nephritis (Nephritic syndrome) = 4

A

Prior infection - strep OR Ecoli (haemolytic-ureamic syndrome in kids),

IgA Nephropathy - autoimmune in young adults

Vasculitis - fever, purpuric rash, myalgia (Henoch-schonein purura in children)

Lupus - autoimmune

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15
Q

Acute (7) VS Chronic renal Failure (5) - presentation

A

Acute = rapid onset, anuria, raised creatinine and urea, malaise, fatigue, N&V and arrhythmias

Chronic = same as above + oedema, hypertension, anemia and bone disease

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16
Q

Acute (pre, renal and post = 7) Vs Chronic renal failure (3) - Causes

A

Acute:
Pre = ischemia
Renal = infection and malignancy = tubular damage
Post (obstructive) = UTI, enlarge prostate, pelvic tumour, stones

Chronic: diabetes, glomerulanephritis, reflux nephropathy

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17
Q

Acute Renal Failure complications (4)

A

Fluid/ Cardiac overload = pulmonary oedema
GI bleeds
Jaundice (hepatovenous congestion)
Infections = lung and urinary

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18
Q

Nephritis Vs Pyelonephritis

A

Nephritis = (Infection and toxins) BUT mainly autoimmune

Pyelonephritis = ascending UTIs reaching the renal Pelvis (more common in women)

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19
Q

Vasculitis - effect on kidneys + other symptoms

A

Inflammation in glomeruli vessels = thrombosis and obliteration of lumen

Rash, weight loss, fever, myaglia

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20
Q

Renal Artery stenosis - Cause + effect on kidneys. Presentation + why?

A

Atheroma and arterial dysplasia = ischemic injury and loss of function

Hypertension = due to hypoperfusion of the kidneys stimulating the angiotensin system

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21
Q

Diabetes - affect on kidneys? –> end stage renal failure (most common cause)

A

Hyperglycemia = Thickening of BM and glomerular damage

Small vessel damage = ischemia and tubular damage

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22
Q

Hypertension = affect on kidneys?

A

Damage vessel walls = thickening and occlusion = ischemia

Hypoperfusion to kidneys = angiotensin and worsens hypertension

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23
Q

Malignancy = type of tumour + affect on kidneys?

A

Plasma cell

Ig G deposits = inflammation and fibrosis = irreversible decline in function

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24
Q

Obstructive uropathy two types

A

Intrinsic = in the urethral lumen - stones, inflammation and infection, malignancy, clots

Extrinsic = outside the ureter (compression) - strictures, tumours, pregnancy

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25
Q

Bladder causes of obstructive uropathy

A

vesicoureteral reflux (valvular issues) = back flow of urine and infections
Tumours
Stones
Neurological = stasis and infection

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26
Q

Complications of Obstructive uropathy (5) - depend on SITE, DURATION and DEGREE

A

Bladder muscle hypertrophy
Hyroureter - dilation of ureter (proximal)
hydonephrosis - CHRONIC = dilated pelvis, calyces, cortical atrophy
Acute renal failure - reduced glomerular filtration
Chronic Renal failure - following hydonephrosis = loss of function

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27
Q

Causes of Urological Calculi or stones (urlithasis) (4)

A

Excess substances that precipitate eg. calcium
Change in urine constitutes eg. pH
Poor urine output eg. supersaturation
Decreased citrate levels

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28
Q

Calcium stones in 70% of patient - composition and causes

A

Calcium oxalate and Calcium Phosphate

Hypercalcaemia - bone disease, PTH excess and sarcoidosis

Excessive intestinal absorption + inability to reabsorb in tubules

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29
Q

Struvite stones in 15% of patients - composition and cause

A

Magnesium ammonium phosphate

Urease producing bacteria = ammonia = rise in pH = precipitation and ‘stag horn’ caliculi on CT

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30
Q

Urate stones 5% of patients - composition and cause

A

uric acid

Hyperuricaemia in patients with gout and leukaemia

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31
Q

Gold Standard diagnosis of Renal stones (>95% of cases)

A

Non-contrast CT (or USS in pregnancy)

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32
Q

Renal Cell Carcinoma risk factors - age, gender etc. (8)

A 
age 60-80
Male (3:2)
tobacco
obesity
hypertension
oestrogens
cystic kidney disease
asbestos
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33
Q

Renal Cell carcinoma - two types - histological presentation

A

Clear cell (most common) = well defined, yellow tumour, small bland nuceali - invade fat and renal vein

Papillary renal cell carcinoma = cystic/ mulitply. Foamy cuboidal cells with fibrovascular cores, macrophages and calcium

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34
Q

Presentation of RCC (renal cell carcinoma)

A

Haematuria, bollatile/ palpable kidneys, costovertibral pain

Usually late presentation due Mets (25% of cases)

Paraneoplasic syndrome = Cushings, hypercalcaemia, polyclythaemia (erythropoietin)

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35
Q

5 year survival for RCC - average, organ contained, invasive and distant mets

A

45% average
70% - confined
50% - invasive
8% - mets = poor response to chemo

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36
Q

Urothelial cell carcinoma - % of bladder cancers?

A

95%

Can present in the rest of system BUT most common in the bladder

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37
Q

Risk factors of UCC (urothelial cell carcinoma) (5)

A 
older age
M>F
Smoking
cyclophosphamide (chemo)
Radiation
38
Q

Presentation of UCC

A

Haematuria
Urinary frequency
pain on urination
Urinary tract obstruction

39
Q

UCC types (progression)

A

Papilloma-papillary carcinoma
Invasive papillary carcinoma
Flat non invasive Papillary carcinoma (CIN) - cells shed in the urine so analysis is necessary
Flat invasive papillary carcinoma

40
Q 
5 year survival for UCC 
Non invasive (Tis)
Muscular invasion (T2)
A

95% - non invasive

60% - muscular invasion

41
Q

Solute concentration depends on:

A

Solute amount and solvent volume

42
Q

Function of the kidneys

A

Excrete - urea and uric acid
Regulate - acid balance and water
Endocrine - renin and erythropoietin

43
Q

3 reasons for kidney function tests

A

Detect damage
Measure functional damage
Distinguish between impairment and function

44
Q

eGFR - what does it measure + involved? When is it used?

A

Estimated Glomerular filtration rate
Clearance of DTPA
Sex, age, creatinine levels and average surface ares (1.73m2)

Only used in dialysis and kidney failure patients

45
Q

Plasma Creatinine - normal range? Unhealthy level? What it signifies?

A

50-140umol/L
1000 umol/L in chronic renal disease
Increases and eGFR decrease BUT is not a proportional to renal damage

46
Q

Creatinine Clearance equation

A

urine creatinine mmol/L x urine volume (ml)/plasma creatinine (umol/L)

47
Q

Normal creatinine clearance? Reasons for different levels?

A

100-130 ml/min
Unreliable
BUT increased due to secretion in tubules and decreases due to reaction to drugs

48
Q

Plasma Urea normal range? measures?

A

5-8 mmol/L

unspecific measure of health

49
Q

Reasons for changes in plasma urea? In health?

A

Intake of protein in GI tract and tissue proteins
Affected by kidney re-absorption, excretion and distribution

Kidney re-absorption is 40% BUT higher with slower tubular flow rate (hypoprofusion)

50
Q

Increased Plasma Urea during?

A

GI bleeds - trauma

Reduced in Renal blood flow and extracellular fluid volume (hypoprofusion) in acute and chronic renal failure

51
Q

Plasma Na normal references range

A

135-145 mmol/L

52
Q

Urine Volume normal range? Different levels?

A

750-2000 ml/25 hours
Oliguria <400 ml
Anuria <100 ml
Polyuria >3000 ml

53
Q

Urine measures (5)

A

Urea
Sodium
Protein
Glucose and Blood

54
Q

ADH level in the blood?

A

Due to renin release stimulating ADH –> aldosterone

High due to hypoprofusion of the kidneys

55
Q

Which zone of the prostate due carcinomas usually reside?

A

Peripheral zone - easy to diagnose on digital rectal exam (DRE)

56
Q

Which zone of the prostate is BPH usually reside in?

A

central and transitional zone - not easy to diagnose

57
Q

BPH - benign prostatic hyperplasia? symptoms (5)? Risk?

A 
Obstruction of the ureter = 
Weak Stream (size and length), 
Increased urgency and frequency
Incomplete bladder emptying
Nocturia
Hesitancy

Increased age

58
Q

Most common cancer of the prostate

A

Adenoma carcinoma

59
Q

Risk factors for prostate cancer (6)

A 
Age 40 - 50
African race
Family history
Diet 
Hormones
Exposure to chemicals?
60
Q

Staging and grading of prostate Cancer

A 
Stage = TMN
Grade = Gleason system
61
Q

Treatments (4)

A

Surgery
Radio
Chemo
Hormone therapy = anti-androgens –> regression of disease and can extend life by 15 years

62
Q

PSA - what used for? what issues?

A

Prostate specific antigen

Blood marker for prostate cancer - increased levels = increased chance

BUT lots of false negatives and positives so NOT used in the UK

63
Q

Testicular cancer Risks (5)

A 
Family history
European/ white descent
Cryptorchidism 
Hormone imbalance
Gonadal dysgenesis
64
Q

Cryptorchidism - what this results in?

A

Failure for testes to descend >1 year after birth
ECTOPIC testes = ab, inguinal or high scrotal. Bilateral or unilateral (more common on the right)

Hormone imbalances and increased temp of ectopic testes

65
Q

Hypogondalsim - what it causes?

A

reduced androgens = testicular atrophy

66
Q

Primary hypogonadism due to? (7)

A 
undescended testes
Klinerfelter syndrome
mumps
trauma
CF 
testicular torsion
varicocele
67
Q

Secondary hypogonadism due to ? (3)

A

Pituitary failure
Drugs - steroids, opiods, chemo
Obesity - adipose turn androgens in to oestrogens

68
Q

Types of Testicular tumour (3)

A

Yolk sac
Seminoma (germ cell)
Paratesticular structures (eg. tunica vaginalis)
Mesenchymal tumours

69
Q

Yolk sac tumours - most common in? Presentation?

A

Children or mixed germ cell tumours in adults

alpha fetoprotein elevated in blood and testes replaced with a gelatinous mass

70
Q

Seminoma - age? presentation? blood markers?

A

35-45 years old
testicular enlargement with or with out pain - RARE = inferitliy and gynecomastia
PLAP and hCG

71
Q

Inflammatory conditions of the testes (5 - long confusing words = just need to be able to recognize them)

A 
Epididymoorchitis
Granulomatous orchitis
Sarcoidosis
Malakoplakia
sperm granulomas
72
Q

Normal Flora of the Urogenital tract
Kindeys and ureter
Bladder
urethra

A

STERILE = kindeys, ureter and bladder (usually)

Urethra = perineal flora

1) skin = staph
2) lower GI = aerobic (enterobacteriaceae and gram negative coliforms) and Gram positive cocci

73
Q

UTIs Complicated Vs uncomplicated

A

Complicated = due to underlying abnormality (structure or function) eg. insertion of foreign body (catheter) OR results in urinary stasis

Uncomplicated = not due to any of the above

74
Q

Cystitis Vs pyelonephritis

A

Cystitis = inflammation of the bladder = LUTI

Pyelonephritis = inflammation of the ureter, renal pelvis and kidneys = UUTI

75
Q

Symptoms of Cystitis

A

dysuria, urgency increase, frequency, nocturia, suprapubic pain, polyuria, haematuria

76
Q

Symptoms of pyelonephrits

A

same as LUTI + loin and unilateral flank pain, fever, N&P, CRP and WBC elevated

77
Q

Urethral syndrome - what is it? symptoms? ages?

A

Abacterial cystitis or frequent dysuria
Same symptoms as UTI no infection
Age 30 - 50

78
Q

Signification Bacteriuria - (KASS criteria level)

A

Bacteria grown in urine culture above the KASS criteria count of 10^5 cfu/ml

79
Q

Asymptomatic Bacteriuria

A

Significant levels of (one species) bacteria cultured but no symptoms

80
Q

Sterile Pyuria

A

puss cells in urine BUT no bacteria cultured

81
Q

Causes of UTIS - sex ratio (5)

A 
Females 10:1
Urinary stasis - pregnancy, BHP, stones, strictures and neoplasm
Instrumental
Sexual intercourse
fistulae
congenital
82
Q

Bacterial causes of UTIs (3)

A

Ecoli
staphylococcus saprophyticus
Enterococcus

83
Q

Causes of Sterile Pyruia (4)

A

Inhibition of bacterial growth by AntiBs
Fastidious - hard to grow organism
UT inflammation - eg. by stones
Urethritis eg. by STIs gonorrhea or chlamydia

84
Q

Catheter UTI = two locations of bacteria? and why?

A

Bacteriuria - due to biofilm of colonization (distinguish from actual infection)
Bacteraemia - on removal = discharge from site. AntiB prophylaxis used

85
Q

Dipstick test for UTI - type of sample? result?

A

Clean catch midstream sample (can aspirate bladders of children) = no normal flora cultured

NITRITE, blood, protein, WBC = cystitis

BLOOD = pyelonephritis suspected

86
Q

Urinary TB test

A

Acid fast bacilli - in 3 early morning urine samples

87
Q

Microbial treatment of LUTI (4) - length of treatment?

A

nitrofurantoin
pivemcillinan
Trimethroprin
fosfomycin

Females = 3 days 
Males = 7 days
88
Q

Microbial treatment for Pyelonephritis (UUTI) (5) - same as LUTI and empiric? length?

A

Pivemicllinan, trimethroprin, fosfomycin

Empiric = cefuroxime, ciprofloxacin

7 - 14 days

89
Q

Treatment for symptomatic bacteriuria

A

Only in pregnant, infant or elderly with catheter

90
Q

Non - microbial treatment of UTIs (4)

A

remove device
anti- inflammatory
Fluids
drainage of abscesses

Year 2: Clinical Pathology (10 decks)

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