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Year 2 > Renal pathology 3 > Flashcards

Renal pathology 3 Flashcards

1
Q

What are the two types of nephritis that we must distinguish between?

A

Glomerulonephritis

Pyelonephritis

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2
Q

What is glomerulonephritis?

A

Non infective inflammation of the kidney often caused by autoimmune conditions

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3
Q

What does glomerulonephritis cause?

A

Glomerular tufts with secondary tubulointerstitial changes

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4
Q

Is glomerulonephritis diffuse or focal?

A

Diffuse (usually)

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5
Q

What is pyelonephritis?

A

Bacterial infection of renal pelvis, calycs, tubules and interstitium

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6
Q

Is pyelonephritis acute or chronic? Diffuse or focal?

A

Acute or chronic (chronic more common)

Usually patchy focal

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7
Q

What is the commonest cause of pyelonephritis? Name two other causes

A

E. coli

Step. faecalis
Pseudomonas

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8
Q

Which sex more commonly is affected by pyelonephritis?

A

Females

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9
Q

When does opportunistic pyelonephritis occur?

A

Immunocompromised patients (fungus, etc)

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10
Q

What is the pathogenesis of pyelonephritis?

A

Septicaemia (rare)
Post surgery
Ascending infection from distal UT

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11
Q

What is often present along with pyelonephritis?

A

Cystitis

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12
Q

What are the risk factors for pyelonephritis?

A 
Female (length of urethra) 
Post instrumentation 
Pregnancy 
Urinary tract obstruction
Duplex systems 
Vesico-ureteric reflux
Diabetes
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13
Q

Cystitis and pyelonephritis is common in pregnant woman. T/F

A

True - hormonal & anatomic influence –> ureteric dilation & urinary stasis

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14
Q

What are the two main causes of urinary stricture?

A

Stones

Inflammatory disorders

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15
Q

What is the vesico-ureteric reflux?

A

Normal - Ureters enter bladder in oblique direction normally so orifice closed during contraction of bladder (i.e micturation)

Reflux - Perpendicular ureter entrance into bladder so contraction does not completely close orifices allowing reflux of urine

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16
Q

What are the causes of vesico-ureteric reflux?

A

Congenital

Acquired (post bladder surgery)

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17
Q

Which immune cell is the most numerous during an acute inflammatory reaction?

A

Neutrophil

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18
Q

How does chronic pyelonephritis present?

A 
Vague symptoms
Often no preceding UTI (insidious onset)
Large urine volume
Hypertension
Uraemia
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19
Q

How does chronic pyelonephritis present on renal imaging?

A

Cortical scarring
Distortion of calyces
Shrunken in severe disease

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20
Q

Why might patients with chronic pyelonephritis produce large volumes of urine?

A

Damaged kidney cannot concentrate urine

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21
Q

Which immune cells are most numerous during a chronic inflammatory reaction?

A

Lymphocytes

Plasma cells

22
Q

How does tubercular pyelonephrosis start?

A

Haematogenous spread from other source (lung)

23
Q

How does tubercular pyelonephrosis present?

A 
Vague symptoms
Loin pain
Dysuria
Weight loss
Fever
24
Q

Which pathology is sterile pyuria associated with? What does it mean?

A

Pus in urine but negative culture (culture should be positive in later stage infection)

25
Q

How is TB diagnosed?

A

PCR

26
Q

What type of granulomas does TB produce?

A

Caseating

27
Q

What type of histology stain can TB be seen on? Is this diagnostic?

A

Zeehl - Neilson (acid fast bacilli)

Yes but negative stain is not exclusion criteria

28
Q

How does TB affect the kidneys?

A

Slow destruction of kidney +/- spread to ureter, bladder and other viscera

29
Q

What kind of necrosis does TB cause?

A

Caseous (“cheese-like”)

30
Q

Which immune cells are often seen along with TB of the kidney?

A

Multi-nucleated giant cells

31
Q

What are the most common organisms causing cystitis?

A

E.coli
Klebsiella
Proteus
Pseudomonas

32
Q

Is cystitis acute or chronic?

A

Acute but necrotising if associated with outlet obstruction

33
Q

What are ureteritis cystica and cystitis cystica respectively?

A

Multiple fluid filled cysts projecting into lumen of viscera

34
Q

Ureteritis cystica and cystitis cystica are both neoplastic processes. T/F

A

False - they are reactive processes which can sometimes resemble tumours

35
Q

How common is cystitis?

A

Common

36
Q

Who usually gets necrotising cystitis?

A

Elderly males with prostatic bladder outflow obstruction

37
Q

How does tubuerculosis cystitis occur?

A

Urinary spread of mycobacterium from the kidneys

38
Q

What is schistosomiasis caused by?

A

S. haematobium (chronic urinary tract infection)

39
Q

Schistomomiasis is common in the UK. T/F

A

False - common in tropical countries

40
Q

What does schistosomiasis predispose to?

A

Urothelial malignancy (squamous cell)

41
Q

Which sex is almost primarily affected by ureteric obstruction?

A

Males

42
Q

What are the main causes of ureteric obstruction?

A

Stricture
Prostate pathology
Posterior urethral valves

43
Q

What does prolonged bladder outflow obstruction cause?

A

Hypertrophy of detrusor –>

Diverticula formation

44
Q

What is the cause of posterior urethral valve?

A

Congenital abnormality

45
Q

What is hydronephrosis?

A

Dilation of pelvicalycael system with parenchymal atrophy

46
Q

What is the cause of hydronephrosis?

A

Urinary tract obstruction

Prolonged reflux

47
Q

What are the causes of unilateral and bilateral hydronephrosis respectively?

A

Unilateral
- calculi
- neoplasm
- pelvi-ureteric obstruction (surgery or congenital)
- strictures
Bilateral
- urethral obstruction
- neurogenic disturbance (paraplegic, etc)
- vesico-ureteric reflux
- bilateral ureteric obstruction (e.g cancer)

48
Q

What are the effects of sudden complete urinary tract obstruction and gradual and partial, respectively?

A

Sudden & complete - urine production ceases, no dilation

Gradual & partial - dilation

49
Q

What is a secondary complication of hydronephrosis?

A

Infection (pyonephrosis - pus in kidney)

50
Q

What are the pathological effects on the kidney in severe hydronephrosis?

A

Cortical thinning
Atrophy
Fibrosis

Year 2 (72 decks)

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