Renal, Genitourinary & Breast Pathology Flashcards
Kidney – Function
Structurally complex - —% of body weight, but filters —% of blood through glomeruli
0.4
25
Excretes nitrogenous waste products of metabolism - cleans the blood – turns — L into urine
1.5
Kidney Function
Regulates (2)
Maintains appropriate —- balance
Endocrine organ – secretes —
body water and electrolytes
acid-base
hormones
Endocrine organ – secretes hormones
Renin –
Erythropoietin –
blood pressure
proliferative effect on bone marrow to make RBCs
Nephron – Functional Unit
Morphologic Components
(3)
Glomeruli
Convoluted tubules
Collecting ducts
Juxtaglomerular cells in wall of afferent arteriole
Sensor for
blood pressure
Macula densa in wall of distal convoluted tubule
Sensor for
sodium
Azotemia – Laboratory Findings
(4)
Elevation of blood urea nitrogen and creatinine levels
Usually related to reduced glomerular filtration rate (GFR)
Associated with many primary renal disorders
May also be associated with extra-renal disorders
skipped
Pre-renal azotemia –
hypoperfusion of the kidneys decreases GFR in the
absence of parenchymal damage
Post-renal azotemia –
urine flow obstructed below the level of the kidney
Uremia – Clinical Findings
(3)
Progression of azotemia to produce clinical manifestations and systemic
biochemical abnormalities
Failure of renal excretory function
Metabolic and endocrine alterations
skipped
Uremia
Secondary involvement of organ systems
(4)
Uremic gastroenteritis
Peripheral neuropathy
Uremic fibrinous pericarditis
Uremic stomatitis
Nephrotic syndrome –
(glomerular syndrome) – heavy proteinuria,
hypoalbuminemia, severe edema, hyperlipidemia and lipiduria
Nephritic syndrome –
(glomerular syndrome) – acute onset of grossly-
visible hematuria, mild-to-moderate proteinuria, azotemia, edema and
hypertension (classic presentation of acute post-streptococcal
glomerulonephritis)
Acute renal failure –
oliguria or anuria with recent onset of azotemia. May
result from glomerular injury or acute tubular necrosis
Chronic renal failure –
prolonged symptoms and signs of uremia – the end
result of all renal disease
Urinary tract infections –
bacteriuria and pyuria –
symptomatic or asymptomatic - kidney (pyelonephritis)
or bladder (cystitis)
Nephrolithiasis –
kidney stones - colic, hematuria
Nephrotic Syndrome
(7)
Glomerular syndrome
A non-specific disorder in which the kidneys are damaged, causing them to leak large
amounts of protein from the blood into the urine.
Heavy proteinuria
Hypoalbuminemia
Severe edema
Hyperlipidemia
Lipiduria
Nephritic Syndrome
(8)
Glomerular syndrome
A non-specific disorder in which the kidneys are damaged, causing them to leak protein and red blood cells from the
blood into the urine.
Acute onset
Grossly-visible hematuria
Mild-to-moderate proteinuria
Azotemia
Edema
Hypertension
Glomerulonephritis -
def
tx
an immune mediated disease of
the renal glomeruli
Treated with steroids
Pyelonephritis -
def
tx
an infection of the kidney (not the
glomerulus) usually caused by bacteria and of
retrograde origin
Treated with antibiotics
Post-Streptococcal Glomerulonephritis
(Postinfectious Glomerulonephtitis)
(2)
Acute onset of nephritic syndrome in 9-14 days following
Streptococcal infection
Type III immune injury (Immune complex-mediated inflammation)
skipped
Pyelonephritis
Pathway of Renal Infection
Hematogenous dissemination –
Ascending infection –
Fecal bacteria from —
Culture and sensitivity –
Pyelonephritis is much more common than —
least common
most common
perineal area
Bactrim
glomerulonephritis
Kidney Stones (Nephrolithiasis)
Urolithiasis
(7)
Common
May cause obstruction
Pain
Ascending infection
Hematuria
Pyuria
Lithotripsy
Kidney Stones (Nephrolithiasis)
Urolithiasis
May be associated with
hypercalcemia (for example,
hyperparathyroidism, metastatic skeletal disease,
multiple myeloma)
Renal Cell Carcinoma
(3)
Arises from renal tubular epithelium
Often silent
May grow into renal vein
Wilm’s Tumor
(Nephroblastoma)
(5)
Children under 5 years
Abdominal mass
Chronic low-grade fever
Histopathology consists of several cell
types, some of which resemble abortive
glomeruli and others that resemble skeletal
muscle
Better than 90% 5-year survival
Urothelial Carcinoma
Arises from the
epithelium (transitional epithelium)
— most common site
Painless —
urinary tract lining
Bladder
hematuria
skipped
Urothelial Carcinoma
from (5)
Cigarette smoking, industrial solvents
(beta-naphthlylamine), chronic cystitis,
schistosomiasis, drugs (cyclophosphamide)
Urothelial Carcinoma
Clinical significance depends on (2)
histologic
grade, differentiation and depth of invasion
Prostate – Three Major Diseases
(3)
Prostatitis
Benign prostatic hyperplasia
Adenocarcinoma of prostate
Prostate-Specific Antigen - PSA
(4)
Protein present in the serum at low levels (nl: < 4 ng/mL)
Increased levels may suggest the presence of prostate cancer
Elevated in prostatitis
Velocity of change significant
Prostate-Specific Antigen - PSA
Physiologic functions
(2)
Liquefy semen, allowing sperm to swim freely
Dissolution of cervical mucous cap