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Clinical Pathology > Renal and Urological Pathology > Flashcards

Renal and Urological Pathology Flashcards

1
Q

presentation of acute renal failure

A

unwell - malaise, fatigue, nausea, vomiting, arrhythmias
anuria/ oliguria
rapid rise in creatinine and urea

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2
Q

pre-renal causes of acute renal failure

A

reduced blood flow to kidney - severe dehydration, hypotension

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3
Q

renal causes of acute renal failure

A

damage to kidney

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4
Q

post-renal causes of acute renal failure

A

urinary tract obstruction - urinary tract tumours, pelvic tumours, calculi, prostatic enlargement

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5
Q

complications of acute renal failure

A 
cardiac failure - fluid overload 
arrhythmias - electrolyte imbalance 
GI bleeding 
Jaundice - hepatic vein congestion 
Infection - esp. lung and urinary tract
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6
Q

what is chronic kidney disease

A

permanently reduced GFR = reduced number of functional nephrons

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7
Q

causes of chronic kidney disease

A

adults - diabetes, glomerulonephritis, reflux nephropathy

chlidren - developmental abnormalities, glomerulonephritis, reflux nephropathy

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8
Q

presentation of chronic kidney disease

A

reduced urine output: excretion of water electrolytes > oedema and hypertension
reduced excretion of toxic metabolites
reduced epo production = anaemia and renal bone disease

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9
Q

renal manifestation of hypertension

A

damages renal vessels > wall thickening and reduced lumen size > reduced perfusion > ischaemia and activation of RAAS = ^HTN

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10
Q

renal manifestation of diabetes

A

damage due to hyperglycaemia
BM thickens
glomerulus produces excess extracellular matrix
small vessel damage causs ischaemia and tubular damage

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11
Q

renal manifestation of myeloma

A

excess Igs deposit in tubules which cause inflammation and fibrosis
renal tubule loss = irreversible decline in renal function

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12
Q

renal manifestation of vasculitis

A

inflammation in glomerular vessels can cause clotting and obliteration of capillary lumena and glomerulus destruction
inflammation of larger renal arterioles can cause tubule hypoxia
often part of systemic disease

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13
Q

renal manifestation of renal artery stenosis

A

due to atheroma or arterial dysplasia - ischaemic injury
activation of RAAS = HTN
loss of renal tissue = reduced function

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14
Q

nephrotic syndrome causes

A 
damage to glomerulus
adults: 
membranous nephropathy (idiopathic primary glomerular disorder) 
Focal segmental glomerulosclerosis 
minimal change disease 
diabetes, lupus nephritis, amyloid

children:
minimal change disease
focal segmental glomerulosclerosis

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15
Q

nephrotic syndrome presentation

A 
oedema
proteinuria >3g in 24hs 
hypoalbuminaemia 
\+/- hypertension 
\+/- hyperlipidaemia
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16
Q

acute nepritis presentation

A 
oedema 
haematuria 
proteinuria 
HTN 
acute renal failure
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17
Q

causes of acute nephritis

A 
adults:
post infective glomerulonephritis - after strep throat infection 
IgA nephropathy 
vasculitis 
SLE

children:
post-infective glomerulonephritis and IgA nephropathy
Henoch-Schonlein purpura
haemolytic uraemic syndrome

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18
Q

haematuria causes

A

IgA nephropathy
thin basement membrane disease
alport hereditary nephropathy - type IV collagen cause abnormal BM sometimes with eye and ear problems

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19
Q

what is pyelonephritis

A

infection via haematogenous spread

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20
Q

what is autosomal dominant polycystic kidney disease

A

bilateral cystic change > loss of functional renal parenchyma > chronic renal failure

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21
Q

clinical features of AD polycystic KD

A

HTN, polyuria, end stage renal disease between 40-60

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22
Q

pathenogenesis of AD polycystic KD

A

mutation of PKD1

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23
Q

what is autosomal dominant polycystic kidney disease

A

cystic disease of kidneys and liver in childhood

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24
Q

pathenogenesis of autosomal recessive polycystic KD

A

mutation of PKDH1

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25
Q

most common kidney cancer

A

clear cell carcinoma

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26
Q

male or female renal Ca

A

males

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27
Q

risk factors for renal carcinoma

A

tobacco, obesity, HTN, oestrogens, acquired cystic kidney disease, asbestos

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28
Q

what is the most common several cancer syndrome observed in RCC

A

von hippel-lindau

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29
Q

what happens in V H-L sydrome

A

VHL gene required for breakdown of hypoxia inducible factor-1 oncogene
causes cell growth and survival

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30
Q

presentation of RCC

A

haematuria, palpable abdominal mass, costovertebral pain
incidental
late presentation - systemic or mets

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31
Q

what are paraneoplastic syndromes

A

clinical syndromes that result from substances produced by tumours

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32
Q

paraneoplastic syndromes associated with RCC

A

Cushing’s - ^ACTH
hypercalcaemia - PTH related peptide
polycythaemia - ^epo

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33
Q

morphology of clear cell renal carcinoma

A

well defined yellow tumours
haemorrhagic areas
may extend to perinephric fat
tendency to invade renal vein

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34
Q

morphology of papillary renal cell carcinoma

A

more cystic

more likely to be multiple

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35
Q

overall 5 year survival or RCC

A

45%
organ confined >70%
distant mets = poor prognosis - chemo resitstant

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36
Q

most common bladder tumour

A

urothelial cell carcinoma

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37
Q

risk factors for urothelial cell carcinoma

A 
age 
gender - male 
smoking 
arylamines 
cyclophosphamide 
radiotherapy
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38
Q

presentation of urothelial cell carcinomas

A

haematuria
urinary frequency
pain
urinary tract obstruction

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39
Q

histological patterns in TCC

A

papilloma-papillary carcinoma
invasive papillary carcinoma
flat noninvasive carcinoma
flat invasive carcinoma

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40
Q

causes of UT obstruction at pelvis

A

caliculi
tumours
uretopelvic stricture

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41
Q

causes of UT obstruction at intrinsic ureter

A 
calculi 
tumours
clots 
sloughed papilla 
inflammation
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42
Q

causes of UT obstruction at extrinsic ureter

A

pregnancy
tumours
retroperitoneal fibrosis

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43
Q

causes of UT obstruction at bladder

A

calculi
tumour
functional - neurogenic

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44
Q

causes of UT obstruction at urethra

A

posterior urethral valves

stricture, tumours

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45
Q

causes of UT obstruction at prostate

A

hyperplasia
carcinoma
prostatitis

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46
Q

sequelae of obstruction of UT

A

infection - cystitis, uretitis, pyelitis, ascending pyelonephritis
acute/chronic kidney damage

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47
Q

complications from UT obstruction

A

hydronephrosis - result of chronic obstruction

acute complete obstruction = reduction in glomerular filtration rate > acute renal failure

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48
Q

clinical features of UT obstruction

A

acute bilateral obstruction - pain, acute renal failure, anuria

chronic unilateral obstruction - asymptomatic, cortical atrophy and reduced renal function

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49
Q

pathenogenesis of renal calculi

A

excess of substances which may precipitate out e.g. Ca
change in urine constituents causing precipitation of substances
poor urine output
decreased citrate levels

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50
Q

classification of renal calculi

A

calcium stones - most common
struvite stones - magnesium ammonium phosphate
urate stones - uric acid
cystine stones

51
Q

why do calcium stones form

A 
hypercalciuria due to hypercalcaemia 
excessive Ca absorption from gut 
inability to reabsorb tubular Ca
idiopathic 
RF: gout, hyperoxaluria
52
Q

why do struvite stones form

A

urease producing bacterial infection
urease = urea > ammonia
rise in urine pH
precipitation of magnesium ammonium phosphate salts > staghorn calculus

53
Q

gold standard test for renal calculi

A

non-contrast CT scan

54
Q

sequelae of renal calculi

A

obstruction
haematuria
infection
squamous metaplasia +/- squamous cell carcinoma

55
Q

benign prostatic hyperplasia definition

A

enlargement of the prostate

overgrowth of the epithelium and fibromuscular tissue of the transition zone and periurethral area

56
Q

BPH pathogenesis

A

arises from centrally situated glands

  1. nodule formation
  2. diffuse enlargement of the transition zone and periurethral tissue
  3. enlargement of nodules
57
Q

aetiology of BPH

A

impaired cell death

58
Q

BPH lower uterine symptoms

A 
urgency 
hesitancy 
diminished stream, size and force 
increased frequency 
incomplete bladder emptying 
nocturia
59
Q

cancer of the prostate

A

adenocarcinoma

60
Q

grading for prostatic cancer

A

gleason grade

61
Q

risk factors of prostatic cancer

A 
age
race 
family history 
hormones levels
environmental influences 
androgens 
inherited polymorphisms
62
Q

when do the majority of germ cell tumours occur

A

young males

incidence accelerating rapidly following puberty and peaking close to 30 years of age

63
Q

pre-existing medical conditions that are associated with the development of testicular germ cell tumours

A 
prior TGCT in contralateral testicle 
cryptorchidism 
impaired spermatogenesis 
inguinal hernia 
hydrocele
disorders of sex development 
prior testicular biopsy 
atopy 
testicular atrophy
64
Q

age range of seminoma

A

most commonly 35-45 years old
uncommon in men >50
rare in children

65
Q

clinical presentation of seminoma

A

testicular enlargement with or without pain
mets in 10%
some have no symptoms

66
Q

markers of seminona

A

elevated serum PLAP (40%) and hCG (10%)

67
Q

macro seminoma

A

well demarcated
cream coloured
homogeneous
corsely lobulated

68
Q

teratoma age range

A

first and second decades of life

69
Q

teratoma presentation

A

gradual testicular swelling with or without pain

almost always benign before puberty

70
Q

markers of teratoma

A

pure teratoma = no markers

71
Q

macro teratoma

A

well-demarcated, solid or multicystic

72
Q

what is cryptorchidism

A

one or both testicles fail to descend and reach scrotum before birth
most of the time has reached scrotum by 1 year

73
Q

which side is cryptorchidism most frequent on

A

right

74
Q

complications of cryptochidism

A

testicular atrophy
infertility
carcinoma - TGCT

75
Q

skin flora

A

predominantly coag-neg staphylococci

76
Q

lower GI tract flora

A

aerobic bacteria - enterobacteriaceae

gram positive coccus - enterococcus

77
Q

what is cystitis

A

lower UTI

78
Q

symptoms of cystitis

A 
dysuria 
urinary frequency 
urgency 
supra-pubic pain/ tenderness 
polyuria, nocturia, haematuria
79
Q

what is pyelonephritis

A

Upper UTI - kidney and/or renal pelvis

80
Q

symptoms of pyelonephritis

A

symptoms of lower UTI
loin/abdominal pain/ tenderness
fever
symptoms of systemic infection

81
Q

what is asymptomatic bacteruria

A

significant bacteruria without symptoms of UTI

82
Q

predisposing factors to UTI

A 
female 
urinary stasis 
instrumentation 
sexual intercourse 
fistulae 
congenital abnormalities
83
Q

what is a complicated UTI

A

underlying abnormality

presence of a foreign body

84
Q

most common UTI causing organism

A

E.coli

85
Q

causes of sterile pyuria

A

inhibition of bacterial growth
hard to grow organisms
urinary tract inflammation
urethritis (sexually transmitted pathogens)

86
Q

what is a catheter UTI

A

indwelling catheterisation results in bacteriuria

biofilm formation > colonisation

87
Q

which other devices can also cause UTI

A

urostomies

nephrostomies

88
Q

what can be seen on a urine dipstick

A

blood
protein
nitrite
white blood cells - leucocyte esterase

89
Q

non-antimicrobial management of UTIs

A 
fluid intake 
anti-inflammatories
device removal 
drainage if obstruction/ abscess 
recurrent UTIs - significant recurrent UTIs >3 episodes in 12 months 
cranberry juice
90
Q

requirements for antibiotics in UTI

A 
present in urine 
minimally toxic 
effective against likely organisms 
easily administered 
cheap
91
Q

examples of antibiotics given in UTI

A

Nitrofurantoin
Pivmecillinam
Trimethoprim
Fosfomycin

92
Q

treatment of cystitis

A

females - 3 days antibiotics

males - 7 days

93
Q

pyelonephritis treatment

A

empiric therapy - cefuroxime, ciprofloxacin
piperacillin-tazobactam
7-14 days depending on antibiotic used

94
Q

who should be treated with asymptomatic bacteruria

A

pregnant women
infant - prevent pyelonephritis
prior to urological procedures
elderly

95
Q

perinephric abscess

A

renal stones and/or diabetics
obstruction of infected kidney
gram neg bacilli

96
Q

intrarenal abscess

A

haematogenous spread: unilateral, single, renal cortex
s. aureus
can be associated with classic acute pyelonephritis

97
Q

what is prostatitis

A

inflammation of the prostate

98
Q

symptoms of prostatitis

A

Lower UT symptoms
fever
tender prostate
uropathogens - e. coli

99
Q

laboratory tests of renal function

A 
glomarular filtration rate 
eGFR
creatinine clearance 
plasma creatinine 
plasma urea 
urine volume 
urine urea 
urine sodium 
urine protein 
urine glucose 
haematuria
100
Q

definition of oliguria

A

<400mL/24hrs

101
Q

anuria

A

<100mL/24hrs

102
Q

polyuria

A

> 3000mL/24hrs

103
Q

normal urine output

A

750-2000mL/24hrs

104
Q

plasma urea reference range

A

3-8mmol/L

105
Q

factors influencing plasma urea concentration

A

GIT protein > liver amino acids
Tissue protein > liver amino acids
> plasma urea

distribution volume > plasma urea

Kidney reabsorption/ excretion

kidney filtration

106
Q

how is urea excreted

A

filtered at glomerulus
40% reabsorbed in health
if more is absorbed then tubular flow is slow
tubular flow is slow when there is hypoperfusion

107
Q

causes of increased plasma urea

A 
GI bleed 
trauma 
renal hypoperfusion 
acute renal impairment 
chronic renal disease 
post renal obstruction - calculus, tumour
108
Q

normal range for plasma creatinine

A

50-140 umol/L

109
Q

increase in conc as..

A

GFR increases

110
Q

plasma creatinine in chronic renal disease

A

may increase to 1000umol/L

111
Q

creatinine clearance in health

A

30-40% higher than GFR

112
Q

creatinine clearance in chronic renal disease

A

tubular secretion increased

113
Q

eGFR in stage 1 CKD

A

90+

114
Q

eGFR stage 2 CKD

A

60-89

115
Q

eGFR stage 3A CKD

A

45-59

116
Q

eGFR stage 3B CKD

A

30-44

117
Q

eGFR stage 4

A

15-29

118
Q

eGFR stage 5

A

<15

119
Q

pre-renal oliguria findings

A

GFR reduced
ADH increased - conc urine/low vol
renal hypoperfusion = renin
increase Na reabsorption - urine Na low

120
Q

Pre-renal failure causes

A

dehydration
haemorrhage
renal artery damage
hypotension

121
Q

renal oliguria findings

A

GFR reduced
weak urine/ low volume
renal renin secretion may be raised > HTN, nephrons unable to absorb sodium

122
Q

renal oliguria findings

A

intrinsic damage

  • tubular necrosis
  • chronic infection
  • immunological damage - SLE
  • toxic damage - drugs, heavy metals, poisons
123
Q

features of renal renal failure

A

anaemia
haematuria
proteinuria
urine casts

calcium/ phoshate
bone disease

Clinical Pathology (8 decks)

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