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Year 2 Clinical Pathology > Renal diseases 2 > Flashcards

Renal diseases 2 Flashcards

1
Q

What 3 things can obstruct the renal pelvis?

A

1) Calculi (stones)
2) Tumours
3) Ureteropelvic stricture

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2
Q

What 5 things cause intrinsic obstruction of the ureter?

A

1) Claculi
2) Tumours
3) Sloughed papillae
4) Clots - from trauma
5) Inflammation

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3
Q

What 3 things cause extrinsic obstruction of the ureter?

A

1) Pregnancy
2) Tumours
3) Retroperitoneal fibrosis

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4
Q

What are the 4 types of causes of obstruction of the urinary tract?

A

1) Obstruction within the lumen (calculi, strictures, neoplasia)
2) Abnormalities of the wall (congenital, neoplasia)
3) External compression
4) Functional obstruction (neurological conditions, severe reflux)

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5
Q

What are the 3 types of strictures which can cause obstruction of the urinary tract?

A

1) Post-procedure
2) Post infective
3) Congenital

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6
Q

What is hydronephrosis?

A

Kidney swells due to obstruction to kidney outflow

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7
Q

What are the 3 key appearances of kidney in hydronephrosis?

A

1) dilated calyces
2) dilated pelvis
3) Cortical atrophy

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8
Q

What are the 2 possible outcomes of acute complete ureteric obstruction?

A

1) Could just get mild dilatation and mild cortical atrophy

2) Could lead to reduction in GFR which can cause acute renal failure

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9
Q

Through what 2 pathways does chronic and intermittent renal obstruction lead to fall in renal function?

A

1) Get continues glomerular filtration - dilation of pelvis and calyces - leading to eventual cortical atrophy and fall in renal filtration
2) Obstruction causes filtrate to pass back into interstitium - leading to compression of medulla - impaired concentrating ability - eventual cortical atrophy with a fall in renal filtration

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10
Q

What are the 2 clinical features of acute bilateral obstruction?

A

1) Pain

2) Acute renal failure and anuria

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11
Q

What are the 2 clinical features of chronic unilateral obstruction?

A

1) Asymptomatic initially

2) If unresolved, cortical atrophy and reduced renal function

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12
Q

What is the clinical feature of bilateral partial obstruction?

A

Initially polyuric with progressive renal scarring and impairment

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13
Q

In which gender and age group are renal calculi most common?

A

Males aged 20-30

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14
Q

Where do calculi most commonly form?

A

In the kidney but can form anywhere in the urinary tract

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15
Q

What are the 4 pathogenic mechanisms of renal calculi formation?

A

1) Due to excess of substances which may precipitate out eg. Ca2+
2) A change in the urine constituents causing precipitation of substances eg. change in pH
3) Poor urine output - supersaturation
4) Decreased citrate levels - citrate combines with calcium and prevents stone formation

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16
Q

What are the 4 classifications of renal stones?

A

1) Calcium stones - 70% - calcium oxalate +/- calcium phosphate
2) Struvite stones - 15% - magnesium ammonium phosphate
3) Urate stones - 5% - uric acid
4) Cystine stones

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17
Q

What are the 4 most common causes of calcium stone formation?

A

Hypercalcuria due to:

1) Hypercalcaemia - bone disease, PTH excess, sarcoidosis
2) Excessive absorption of intestinal Ca+
3) Inability to reabsorb tubular Ca+
4) Idiopathic

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18
Q

Name 2 risk factors for calcium stone formation?

A

1) Gout - forms a core for Ca+ crystal formation

2) Hyperoxaluria - hereditary or excess dietary intake

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19
Q

What are the steps in struvite stone formation?

A

1) Urease producing bacterial infection (proteus)
2) Urease converts urea to ammonia
3) Causes a rise in urine pH
4) Precipitation of magnesium ammonium phosphate salts
5) Large ‘staghorn’ calculi

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20
Q

What are the 2 pathogenic mechanism of urate stone formation?

A

1) Hyperuricaemia - gout, patients with high cell turn over eg. lerkaemia
2) Idiopathic

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21
Q

In what situations do cystine stones form?

A

Occur In presence of an inability of kidneys to reabsorb amino acids

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22
Q

What are the 3 investigations for renal calculi?

A

1) Non contrast CT scanning is gold standard - sensitivity of >95%
2) US in pregnancy or where CT is not possible - 30-67% sensitivity
3) IV urography 70% sensitive for stones

23
Q

What is the gold standard imaging technique for renal calculi?

A

Non contrast CT scanning

24
Q

Renal cell carcinoma accounts for what percentage of cancers?

A

3%

25
Q

The vast majority of renal carcinomas are what kind?

A

Clear cell

26
Q

What are the 2 rarer variants of renal carcinomas?

A

1) Papillary

2) Chromophobe

27
Q

What is the peak age for incidence of renal carcinoma, which gender is it most common in?

A

Males

Aged 65-80 years old

28
Q

What is the main risk factor for renal carcinomas?

A

Tobacco

29
Q

What are the 6 risk factors for renal carcinoma?

A

1) Tobacco
2) Obesity
3) Hypertension
4) Oestrogens
5) Aquired cystic kidney disease (due top chronic renal failure)
6) Asbestos exposure

30
Q

What is Von Hippel-Lindau Syndrome?

A

The most common of several cancer syndromes observed in renal cell carcinoma. Mutations in VHL gene - tumours develop in kidneys blood vessels and pancreas

31
Q

Other than Von Hippel-Lindau syndrome what other condition have VHL mutations been commonly seen?

A

Clear cell renal cell carcinoma

32
Q

What is the VHL gene responsible for, why does this lead to development of tumours in kidneys, blood vessels and pancreas?

A

VHL gene required for the breakdown of Hypoxia Inducible Factor- 1 (HIF-1) oncogene
Loss of gene function causes cell growth and increased cell survival

33
Q

What are the 3 local symptoms of renal cell carcinoma?

A

1) Haematuria
2) Palpable abdominal mass
3) Costovertebral pain

34
Q

What would be the symptoms on late presentation of renal cell carcinoma?

A 
Systemic symptoms
or Metastases (25%)
35
Q

What are paraneoplastic syndromes?

A

Clinical syndromes caused by tumours
Not related to the tissue that the tumour arose from
Not related to invasion by the tumour itself or metastases

36
Q

Give 6 common paraneoplastic syndromes associated with RCC?

A

1) Cushing’s syndrome
2) Hypercalcaemia
3) Polycythaemia
4) ACTH
5) Parathyroid hormone related peptide
6) Eryhthropoietin

37
Q

What is the macroscopic morphology of clear cell renal cell carcinoma? 3

A

1) Well defined yellow tumours
2) Often with haemorrhagic areas
3) May extend in perinephric fat or renal vein

38
Q

What is the macroscopic morphology of papillary renal cell carcinoma? 2

A

1) More cystic

2) More likely to be multiple

39
Q

What is the microscopic appearance of clear cell renal cell carcinoma? 3

A

1) Clear cell has clear cells
2) Delicate vasculature
3) Usually small bland nuclei

40
Q

What is the microscopic appearance of papillary renal cell carcinoma? 2

A

1) Cuboidal, foamy cells

2) Surrounding fibrovascular cores often containing foamy macrophages or calcium

41
Q

What is the overall 5 year survival rate for renal cell carcinoma?

A

~45%

42
Q

What is the 5 year survival rate for organ confined renal cell carcinoma?

A

> 70%

43
Q

What is the 5 year survival rate for renal tumours extending into perinephric fat or renal vein?

A

~50%

44
Q

Why in renal cell carcinoma with distant metastases is the prognosis so poor?

A

Renal cell carcinoma tends to be chemo-resistant

45
Q

Urothelial cell carcinoma account for what percentage of bladder tumours?

A

95%

46
Q

What is the most common site of urothelial cell carcinoma?

A

Bladder but may arise anywhere from renal pelvis to urethra

47
Q

What are the 6 risk factors for urothelial cell carcinoma?

A

1) Age
2) Gender (male >female)
3) Smoking
4) Arylamines (dyes)
5) Cyclophosphamide (Drug)
6) Radiotherapy

48
Q

What is the most common symptom on presentation with urothelial cell carcinoma?

A

Haematuria

49
Q

What are the 4 most common symptoms on presentation with urothelial cell carcinoma?

A

1) Haematuria
2) Urinary frequency
3) Pain on urination
4) Urinary tract obstruction

50
Q

What are the 4 main histological patterns in urothelial cell carcinoma?

A

1) Papilloma - papillary carcinoma
2) Invasive papillary carcinoma (invaded below lamina propria/muscle layer)
3) Flat non invasive carcinoma (CIS)
4) Flat invasive carcinoma

51
Q

What are the 7 catergories in T staging of bladder carcinoma?

A 
Ta = noninvasive, papillary
Tis = carcinoma in situ (non invasive flat)
T1 = lamina propria invasion
T2 = Muscularis propria invasion
T3a = microscopic extra-vesicle invasion
T3b = grossly apparent extra-vesicle invasion
T4 = invades adjacent structures
52
Q

What is the 5 year survival for low grade TCC (bladder carcinoma)?

A

98%

53
Q

What is the 5 year survival for muscle invasive bladder carcinoma?

A

60%

54
Q

What is urolithiasis?

A

Formation of renal calculi

Year 2 Clinical Pathology (64 decks)

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