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Renal Path (1/2 GU) Flashcards

1
Q

Ratio of cortex to medulla

A

2:3

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2
Q

What separates the renal calyces?

A

Columns of Bertin

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3
Q

Define hydronephrosis

A
  • Obstruction Resulting in:
  • Dilatation of renal structures proximal to obstruction
  • These can include: Calyces, Renal pelvis, Ureter
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4
Q

External causes of obstructive Hydronephrosis

4

A
  • Lymphadenopathy
  • Retroperitoneal inflammation
  • Retroperitoneal Fibrosis
  • Endometriosis
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5
Q

Most common intramural cause of Obstructive hydronephrosis

A

Transitional Cell Carcinoma

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6
Q

Causes of Internal obstructive hydronephrosis

3

A
  • Renal calculi (stones)
  • Blood clots
  • Renal colic
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7
Q

Define stag horn calculus

A
  • Single calculus occupies the entire calyceal system and renal pelvis
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8
Q

Epidemiology of Stag Horn Calculus

A

Middle-aged to elderly females

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9
Q

Cause of Stag Horn Calculus

A

Pyelonephritis caused by Proteus or E.Coli Infection

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10
Q

Cause of Acute Pyelonephritis

A

Usually Ascending E.Coli infection

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11
Q

Presentation of Pyelonephritis

2

A

Loin Pain

Fever

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12
Q

Complications of acute pyelonephritis

A

Septicaemia –> Sepsis

Mycotic disease

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13
Q

Treatment of acute pyelonephritis

A

Antibiotics

Remove Kidney

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14
Q

Epidemiology of pyelonephritis

A

Young children

UTI usually treated before it gets to this stage

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15
Q

Microscopic features of acute pyelonephritis

A

Neutrophil polymorphs

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16
Q

Macroscopic features of acute pyelonephritis

A

Small studded abscesses throughout the renal parenchyma

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17
Q

Aetiology of chronic pyelonephritis

A

Repeated infections caused by:

  • Reflux
  • Obstruction
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18
Q

Diagnostic feature of chronic pyelonephritis

A

Polar scars (involve the calyx)

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19
Q

Microscopic features of chronic pyelonephritis

A

Thyroidisation of tubules

Dilated tubules containing pink material- looks like thyroid follicles

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20
Q

Macroscopic features of chronic pyelonephritis

A
  • Polar scars
  • Calyceal dilatation caused by hydronephrosis
  • Reduction in renal parenchyma
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21
Q

Inheritance of PKD

A

AD

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22
Q

Epi PKD

A
  • 3rd / 5th / 6thdecade

- FmHx PKD

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23
Q

Presentation PKD

A
  • CKD
  • HTN
  • Renal Mass

Extra-renal:

  • Hepatic cysts
  • Pancreatic cysts
  • Berry aneurysms in circle of Willis
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24
Q

Complications of PKD

A
  • Cyst rupture : Pain + Bleeding
  • 10% develop Cystic Clear Cell Carcinoma
  • 20% berry aneurysm -SAH
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25
Q

Inheritance pattern of Infantile PKD

A

Autosomal Recessive

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26
Q

Epi Infantile PKD

A

Present at birth

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27
Q

Management of Infantile PKD

A

Dialysis from birth

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28
Q

Complication of duplex ureter

A
  • Increased risk of stones and stricture resulting in hydronephrosis
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29
Q

Congenital/Inherited Renal diseases

5

A 
PKD
Infantile PKD
Horseshoe Kidney
Duplex Ureter
Agenesis (1 Kidney)
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30
Q

What percentage of people have 1 kidney?

A

1%

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31
Q

Where are the kidneys located?

A

Retroperitoneal cavils

Upper pole at the 12th rib

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32
Q

Cause of Oligohydramnios

A
  • Bilateral agenesis of Kidneys in fetus (Potter’s syndrome)

- Decreased volume of amniotic fluid caused by no fatal urine production

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33
Q

Define oligohydramnios

A

Reduced amniotic fluid

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34
Q

What chromosomes and genes are involved in PKD?

A
  • 90% a-globin mutation on Chr 16 on PKD-1 gene

- Minority on chr 4

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35
Q

Composition of stag horn stones

A

Magnesium Ammonium Phosphate

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36
Q

Most common renal stone composition

A

Calcium oxalate

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37
Q

Cause of White cell casts

38
Q

Cause of Red cell casts

A

Glomerulonephritis: Nephritic syndrome

39
Q

Cause of Hyaline casts

A

Glomerulonephritis: Nephrotic syndrome (Protein)

40
Q

Name 3 benign Renal Tumours

A

Adenoma
Oncocytoma
Metanephric adenoma

41
Q

Top 3 most common adult renal tumour

A

Clear cell carcinoma -90%

Papillary ca - 10%

Chromophobe ca - 5%

42
Q

What % of all tumours are kidney tumours?

43
Q

Epi of renal tumours

A

M>F (2:1)

5th, 6th, 7th decades

44
Q

RF renal tumours

5

A
  1. Tuberous sclerosis
  2. Von Hippel-Lindau (VHL)
  3. Renal Transplant
  4. Dialysis
  5. Smoking
  6. Cadmium exposure
  7. HTN
45
Q

What tumour is associated with Tuberous sclerosis?

A

Clear cell ca

46
Q

What tumour is associated with Dialysis?

A

Papillary ca

47
Q

Genetics associated with Clear cell ca

A

Majority: - Sporadic 3p del

Minority: - Familial: VHL

48
Q

Genetics associated with Papillary Ca

A
  • Trisomy 7 +/- 17

- Mutations in MET proto-oncogene

49
Q

Clinical Presentation renal tumour

A

Haematuria —> Most common

Renal mass

Flank pain

(Triad = poor prognosis)

50
Q

Ix Renal mass

A
  1. USS (Cystic vs solid)
  2. CT
  3. MRI

Intravenous urogram- not really used

51
Q

Microscopic features of Clear cell carcinoma

A
  • Sheets of clear cells
  • Vacuolated (clear, lipid laden) cytoplasm
  • Pyknotic (dark) nuclei
  • Vascular
  • May be cystic
52
Q

Macroscopic Features of Papillary ca

A

Soft, friable tumour

Multi-focal/ bilateral

53
Q

Microscopic features of chromophobe ca

A
  • Thick cell membrane (like vegetables)

- Perinuclear halo

54
Q

Microscopic features of collecting duct ca

A

Forms glands

Growth of dense CT and stroma

55
Q

Microscopic features of sarcomatoid ca

A

Spindle
Mitotic features
Big nuclei

56
Q

What is the name of the grading system fo renal tumours

A

Fuhrman Grading

57
Q

How are renal tumours graded?

A

Based on size of nuclei

  • Small = low grade
  • Large = high grade
58
Q

Which renal cell tumour is Grade 4?

A

Sarcomatoid

59
Q

How are renal cell tumours staged?

60
Q

Stage 1 renal ca

A

pT1a: confined to kidney, <4cm

pT1b: confined to kidney 4-7cm

61
Q

Stage 2 renal ca

A

pT2: Confined to kidney, >7cm

62
Q

Stage 3 renal ca

A

pT3: Involves renal Vein / Vena Cava

63
Q

Stage 4 renal ca

A

pT4: Spread to adjacent organs

64
Q

Rx Renal ca:

A
  1. Surgery:
    - Radical nephrectomy: mostly
    - Partial nephrectomy: if tumour <4cm and peripheral
  2. Chemo:
    - Distant mets
  3. Interferon:
    - Distant mets
  4. Radio-frequency ablation:
    - Small tumour
    - Patient unfit
65
Q

Prognosis of Staged renal ca

A

pT1: 70%

pT2: 50%

pT3: 25%

pT4: 5%

66
Q

Macroscopic features of TCC

A

Cauliflower tumour: Peduncualted

Yellow-brown

67
Q

What type of tumour is a TCC

A

Papillary tumour

68
Q

How to distinguish between RCC and TCC

A

RCC tumours enhance

69
Q

Presentation of Nephroblastoma (Wilms tumour)

A

Abdo mass

Often bilateral (more likely in familial type)

70
Q

Microscopic features of Nephroblastoma

A 
Contains Foetal Tissue:
Triphasic pattern:
- Stroma
- Blastema (regenerating cells)
- Epithelial cells (forming poor glomerular and tubular structures)
71
Q

Presentation of Nephrotic syndrome:

A

Proteinuria >3.5g/d

Oedema

Hypoalbuminaemia

Hypercholesterolaemia

72
Q

Cause of Nephrotic syndrome in childhood

A

Minimal change disease

73
Q

Cause of Nephrotic syndrome in adults

A

Membranous glomerulonephritis
Focal segmental glomerulonephritis

Secondary:
DM
SLE
Amyloidosis

74
Q

Presentation of Nephritic syndrome

A

Haematuria

Oliguria

HTN

Acive urine sediment

  • WBC casts
  • RBC casts
  • Hyaline (protein) casts
75
Q

Causes of Nephritic Syndrome

A
  • IgA nephropathy
  • Post-Strep Glomerulonephritis
  • Membranous glomerulonephritis
  • Anti-GBM (Good-pastures)
76
Q

Gold standard for diagnosing glomerulonephropathy

A

Renal biopsy under USS

77
Q

When would you request an urgent report on a renal biopsy?

A
  • Acute renal failure

- Acute Transplant rejection

78
Q

What do you send the renal biopsy for?

A

Light microscopy

Immunofluorescence (immune complex formation)

Electromicroscopy (Deposits in GBM and glomerular structure)

79
Q

Where are most RCCs located?

80
Q

Macroscopic features of Clear cell carcinomas

A
  • Yellow/ orange colour

- Areas of cyst formation or haemorrhage

81
Q

Macroscopic features of oncocytoma

A
  • Mahogany colour
82
Q

Inheritance of VHL

83
Q

Where are transitional cell carcinomas usually located?

A
  • Attached to wall of renal pelcis
84
Q

Rx Nephroblastoma/ Wilms’ Tumour

A

Surgery, shemo, radio

85
Q

Survival rate of Nephroblastoma

86
Q

Epi of Nephroblastoma /Wilms’

A
  • 98% in children <10

- Mostly kids aged 2-4

87
Q

Electron microscopic feature of minimal change nephropathy

A

Podocyte foot process fusion

88
Q

Presentation of PKD

A
  • Asymptomatic until 5th/ 6th decade

Then:

  • Abdo masses
  • Abdo and back pain
  • Haematuria
  • Renal insufficiency
89
Q

What is shown on a renal biopsy in Post-strep glomerulonephritis?

A
  • Endothelial and mesangial cell proliferation
  • Fibrin deposits
  • IgG deposits
  • Complement C3 deposits
90
Q

What vessels supply the renal medulla?

A

Vasa Recta

Pathology (6 decks)

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