Session 10 - Pathology of the urinary system Flashcards
Define, in relation to glomerular injury, focal
Involves less than 50% of glomeruli on light microscopy
Define, in relation to glomerular injury, diffuse
Involves more than 50% of glomeruli on light microscopy
Define, in relation to glomerular injury, segmental
Involves part of the glomerular tuft
Define, in relation to glomerular injury, global
Involves the entire glomerular tuft
Define, in relation to glomerular injury, membranous
Thickening of the entire glomerular tuft
Define, in relation to glomerular injury, proliferative
An increased number of cells in the glomerulus; can be inflammatory cells or proliferative glomerular cells
Define, in relation to glomerular injury, crescent
Accumulation of cells within the bowman’s space; crescents compress capillary tuft and are associated with more severe disease
Define, in relation to glomerular injury, glomerulosclerosis
Segmental or global capillary collapse, presumed to be little filtration across sclerotic area
Define, in relation to glomerular injury, glomerulonephritis
Any condition associated with inflammation in the glomerular tuft
What 4 things occur clinically in nephrotic syndrome?
- Proteinurea (>3.5 g loss in 24 hrs) – Urine looks frothy
- Hypoalbuminaemia
- Oedema
- Hyperlipidaemia – liver compensates loss of albumin by producing more, but has consequence of producing more lipids
What 4 things occur clinically in nephritic syndrome?
- Haematuria – micro or macroscopic
- Small proteinuria
- Mild hypertension
- Low urine volume
Give 3 primary causes which result in nephrotic syndrome
- Minimal change Glomerulonephritis (GN)
- Focal Segmental Glomerulosclerosis (FSGS)
- Membranous glomerulonephritis
Give 2 secondary causes which result in nephrotic syndrome
- Diabetes Mellitus (Microvascular complications affect kidneys)
- Amyloidosis
Describe goodpasture syndrome
- V rapidly progressing glomerular nephritis
- Autoantibody to collagen 4 in BM of glomerulus
- Associated with deafness (collagen 4 found in BM of inner ear)
- Characterised by IgG deposition but no ECM deposit
- Treatable to immunosuppressants
Describe vasculitis in the kidney
- Systemic Inflammation of blood vessels affects highly vascularised kidney
- Blood vessels attacked directly in glomerulus by Anti neutrophil cytoplasmic antibody (ANCA)
- Treatable if caught early
What are subepithelial deposits in the glomerulus? Give an example disease
Antigen abnormally recognised on podocytes, circulating IgG binds to it, forming immune complexes in the glomerulus (Not circulating immune complexes causing damage). e.g. membranous glomerulonephritis
What are mesangial deposits in the glomerulus? Give an example disease
Immune complexes can be deposited directly in the mesangium, as there is no podocytes or basement membrane to act as a barrier. e.g. IgA nephropathy
Give the usual and unusual presentation of prostate cancer
Usual presentation:
- Asymptomatic
- Or some urinary symptoms e.g. bladder over activity
- Advanced – bone pone due to metastases
Unusual: • Haematuria in advanced prostate cancer
How would you diagnose prostate cancer?
- Digital rectal examination (DRE)
- Serum PSA
- If any indication via serum PSA or DRE then biopsy of prostate taken via transrectal ultrasound
How would you treat a prostate cancer?
o Radical prostatectomy
o Radiotherapy – external beam or brachytherapy High dose brachytherapy
How would you treat a metastatic prostate cancer
hormones and palliation (chemo and radiotherapy)
How would you treat bladder cancer?
chemotherapy, radiotherapy, immunotherapy
How would you treat a renal cell carcinoma?
Radical / partial nephrectomy Immunotherapy
