Renal Path 3b Flashcards
Most common cause of hydronephrosis in infants and children
Ureteropelvic Junction (UPJ) obstruction
3 points of ureter narrowing at increased risk of renal calculi impaction
Ureteropelvic junction
Where they cross iliac vessels
As they enter the bladder
Congenital anomalies of ureters
Double and bifid ureters
UPJ obstruction
Diverticulae
Sclerosing retroperitoneal fibrosis is considered an obstructive lesion of the ureters and is considered ____-related (immunologic correlation)
IgG4
Pouchlike evaginations of the bladder wall that may arise as congenital anomalies but more commonly are acquired due to persistant urethral obstruction; d/t increased intravesical pressure, usually multiple with narrow necks
Diverticulae
Differentiate congenital from acquired diverticulae
Congenital form may be d/t focal failure of development of the normal musculature or to some urinary tract obstruction during fetal development
Acquired form most often seen with prostatic enlargement producing obstruction to urine outflow and thickening of bladder wall
Clinical significance of diverticulae
These are sites of urinary stasis, therefore propensity for infection and formation of bladder calculi
May also predispose to vesicoureteral reflux if they impinge on a ureter
Rarely, carcinomas may arise therein, in which case they tend to be more advanced in stage, d/t underlying thinned wall
Developmental failure in anterior wall of abdomen and the bladder; the latter either projects directly through a large defect to the body surface or lies as an unopened sac [M=F, W»B]
Exstrophy of bladder
Clinical significance of bladder exstrophy
Exposed mucosa may undergo colonic glandular metaplasia and is subject to infection that can spread to the upper GU tract
Pts have an increased risk of adenocarcinoma arising in the bladder remnant
However surgery is usually curative
About 1/3 of children with recurrent UTI are found to have what condition?
VUR — ureters enter bladder at unusual angle or length of ureter through bladder is too short —> valve malfunction —> reflux
Reflux becomes a clinical problem when urinary stasis leads to infection that subsequently involves ureter and kidney
A patent urachus may result in complications of infection or what type carcinoma?
Adenocarcinoma
Most common etiologic agents for acute cystitis
Coliforms cause 75-90%: E.coli, proteus, klebsiella, enterobacter
10-15% caused by staph saprophyticus
Much less common: mycobacteria, fungi, viruses, and protozoa, which may cause cystitis, particularly in immunocompromised
Predisposing factors for acute cystitis
Bladder calculi Urinary obstruction Diabetes mellitus Instrumentation Immune deficiency Radiation of bladder
Morphology of acute cystitis
Most cases exhibit non-specific inflammation
May see hyperemia of mucosa, sometimes with associated exudate
What type of cystitis is commonly associated with pts receiving cytotoxic anti-tumor drugs, e.g., cyclophosphamide, as well as those with adenovirus infection
Hemorrhagic cystitis (not associated with bacterial infection!)
Differentiate chronic from acute cystitis
Persistence of acute infection leads to chronic cystitis — differs from acute in nature of inflammatory cell infiltrate and clinical sequelae (thickened bladder wall, bladder stones)
Chronic, persistent, painful form of cystitis most frequently in 30-40 y/o women resulting in intermittent severe suprapubic pain, urinary frequency, urgency, hematuria, and dysuria WITHOUT evidence of bacterial infection (culture negative)
Interstitial cystitis (Hunner ulcer)
Gross and microscopic findings associated with interstitial cystitis
Glomerulations (petechiae)
Hunner’s ulcers
Inflammation and fibrosis of bladder wall, fissures
Varied inflammatory pattern — see MAST cells and lymphocytes
Peculiar pattern of bladder inflammatory reaction characterized by 3-4 cm in diameter soft, yellow, slightly raised mucosal plaques which may involve entire bladder; d/t defective phagosome function and related to chronic infection (usually E.coli)
Malacoplakia
Epidemiology of malacoplakia
F»M; middle aged; occurs with increased frequency in immunocompromised
Most common in bladder but can present in other organs (colon)
Gross and microscopic findings associated with malacoplakia
Marked circumferential bladder wall thickening
Inflammatory exudate and broad, flat plaques
Microscopically, infiltrates of foamy macropahges, multinuclear giant cells, and interspersed lymphocytes, in areas forming granulomas
Laminated mineralized concretions, Michaelis Gutmann bodies, are typically present in macrophages resulting from abnormal, enlarged lysosomes
Inflammatory condition resulting from irritation of the bladder mucosa; indwelling catheters are most common underlying cause; results from extensive submucosal edema and has been misdiagnosed as papillary carcinoma
Polypoid cystitis
What are cystitis cystica (CC) and cystitis glandularis (CG)?
CC and CG are common chronic reactive/inflammatory conditions which occur in the setting of chronic irritation
Metaplasia of the urothelium is incited by irritants such as infection, calculi, outlet obstruction, or even tumor
The urothelium proliferates into buds (nests of von Brunn) which grown down into the CT beneath the epithelium into the LP
The buds then differentiate into cystic deposits of CC or into intestinal columnar mucin-secreting glands (goblet cells) resulting in CG
The histologic features of BOTH are usually present
Epidemiology of CC and CG
Can occur at any age; reported prevalence of 2.4% of children associated with UTIs
Slight male predominance
