Renal Pathology 2 Flashcards
What causes ANALGESIC NEPHROPATHY? What is the most common compound that causes it?
- Abuse of analgesics long term ( >4g day for 3-5 years)
PHENACETIN (however several compounds are required to cause it)
How do phenacetin, paracetamol and aspirin abuse damage the kidneys?
Which part of the kidney is especially prone to damage?
- Phenacetin & paracetamol: directly toxic to tubular & red blood cells —> oxidative damage
- Aspirin: inhibits vasodilatory affects of prostaglandins —> vasoconstriction
- The RENAL PYRAMIDS
What 5 physical complications occur as a result of analgesic nephropathy?
- Necrosis of renal pyramids: tubules draining to this area therefore become obstructed and local inflammation occurs. Calcification of the necrotic tissue can also occur.
- Necrotic segment of papilla breaks off: can cause pain (colic) or obstruction
- Damaged counter current flow concentrating mechanism: hard to concentrate (or dilute urine) —> diminished salt & dehydration occurs
- Hypertension: renal damage can cause renal artery stenosis (narrowing)
- Carcinoma
What are CALCULI?
Kidney stones
What are the 2 most common types of calculi?
- Calcium oxalate
2. Calcium phosphate
What are 8 risk factors for the formation of calculi?
- Low urine volume: dehydration –> more concentrated urine –> supersaturation of the stone constituents
- Urine pH: acid –> calcum oxalate stones, basic –> calcium phosphate stones
- Rate of solute excretion: e.g. gout = excessive retention of urate
- Urinary stasis: encourages salt precipitation
- Abnormal urothelium: inflammation, tumours
- “Foreign” bodies: protein, bacteria
- Depletion of factors that prevent mineral deposition
- Genetics
What are 3 consequences of calculi?
- Passage of small stones
- Passage of large stones - which can lead to (3)
- Hydronephrosis: dilation of renal pelvis & calyces (balloon-like) due to urinary obstruction leading to atrophy of renal parenchyma (medulla). Can be CONGENITAL or ACQUIRED. Usually only unilateral.
What is another name for Renal Cell Carcinoma?
Grawitz Tumour
What percentage of kidney cancer does RCC make up? What percentage of all types of cancer does RCC make up?
- 80-90%
- 2%
What are 2 symptoms most people with RCC present with?
What are 5 more symtpoms?
- Haematuria
- Flank pain, mass in loin
- Weight loss, fever, hypertension, hypercalcemia
What is the 5 year prognosis for RCC if:
- No metastasis has occurred?
- Metastasis has occurred?
What 2 parts of the body is the RCC most likely to metastasise to?
- 70%
- 10%
Emboli to LUNG and BONE
What are the 3 treatment options for RCC?
- Surgical removal
- Radiation therapy
- Immunotherapy
What are 5 DEVELOPMENTAL ABNORMALITIES of the kidney?
- Polycystic disease
- Hypoplasia: small kidney, usually unilateral
- Dysplasia: cysts, cartilage, abnormal tissue
- Fusion: horseshoe
- Ectopia: in iliac fossa
What are the 2 forms of polycystic disease?
- Adult autosomal dominant
2. Recessive childhood form - die as a baby
What is POLYCYSTIN-1 and what does a mutation in it cause?
- An adherin protein which allows epithelial cells to ‘glue’ themselves to each other
- A mutation results in alterations to tubular growth and differentiation with these tubes forming cyst like structures instead. Also affects polycystin-2.
POLYCYSTIC DISEASE.
