UG I

Question 1

Name Congenital Diseases of Kidneys

Answer 1

Size - Hypoplastic/Dysplastic; Polycystic
Shape - Horseshoe, fusion of poles
Number - agenesis - failure of ureteral BUD development
Location - displacement; leads to ureter kinking

Question 2

Brief description of Kidney Embrology

Answer 2

Metanephric Primordium + contacting Ureteral Bud

Metanephros - permanent kidney

Question 3

Horseshoe Kidney Cx

Answer 3

Drainage impaired - UTI + Calculi

Question 4

Name Inherited Cystic Diseases [2]

- associations?

Answer 4

Polycystic Renal Disease (AD, PKD1 PKD2 mutations)

• Cysts small @ childhood, enlarge into adulthood + new ones
• non-functioning tubules: CRF
• Kidney large, parenchymal compressed
• • associated w aneuryms, cos global gene
• • Cx: Subarachnoid hemorrhage along w Aortic Coarctation

Cystic Renal Dysplasia

• abnormal differentiation of metanephros w primitive structures still present
• hence Histo: cartilage, islands of undifferentiated mesenchymal cells

Question 5

Cystic Kidneys Gross Appearances, Histology

Answer 5

ENLARGED KIDNEY, Irregular, Cystic
Cysts lined by flattened epithelium

• Abdominal Distension
• Simple Cuboidal epithelium!

Question 6

Urolithiasis causes

[6] secondary causes

Answer 6

Primary - Supersaturation, commonly calcium

Secondary

• Obstruction, foreign bodies
• Functional
• Squamous metaplasia - keratin; from Vit A deficiency
• UTI (nidus of formation)
• Low pH - Uric acid stones
• Infection - Triple stones

Question 7

Types of Stones

Answer 7

Calcium

Triple Stones - Mg, NH4, PO4 - AKA Struvite AKA Infection stones

Uric Acid

Question 8

When can calcium stones form
- Idiopathic and Non-idiopathic

When can Triple Stones and Uric Acid stones form

Whats the presentation of Triple Stones

Answer 8

• Hypercalcemia (blood) - 2nd to hyper PTH, Milk-Alkali
• Without hypercalcemia (blood): increased secretion, decreased reabsorption,

Triple: infection Proteus, urea splitting - Ammonia, high pH allowing precipitation

• present as Staghorn Calculi
• magnesium ammonium phosphate (MgNH4PO4 · 6H2O)

Uric Acid stones: Low pH

Question 9

Categorize Kidney diseases [3]

- based on location + mode of damage

Answer 9

Acute Tubular Necrosis - Ischemia and Toxins

Acute Interstitial Nephritis/ Acute Tubulointerstitial Nephritis

• Toxins, Allergy, Drugs
• • Most commonly DRUGS

Infective - Bacteria

• Acute Pyelonephritis
• Xanthogranolomatous Pyelonephritis
• • unique w abscess, granulomatous abscess, foam cells

Question 10

Effects of Stones

Answer 10

Urinary Stasis, Ulcers

- Pain, Infection, Fistula, Bleeding

Question 11

What’s Acute Tubular Necrosis

Answer 11

Tubular epithelial death ONLY; Common cause of AKI
- independent of damage to glomeruli/cortical tissue

• Simple Cudoial!

Question 12

AKI Phases

Answer 12

Oliguria - Tubular dead, no pee
Polyuria - Tubular regenerating, cannot concentrate urine, GFR normal - high pee
Recovery - Tubular concentrate urine

Question 13

What can cause ATN [2]:

Answer 13

Ischemic - note tubules v sensitive to hypoxia like brain
- hypotension, hypoperfusion of kidneys

Toxic

• myoglobin, haemoglobin
• drugs, metals, toxins

Question 14

Histology of ATN:

Answer 14

Dilated Tubules, Flattened tubular epithelium
Mitosis, necrosis

• regeneration involves the flattened cells

Question 15

Acute Interstitial Nephritis

Pathophysiology and Key features

Answer 15

Not caused by infections
DRUGS, allergic
- Eosinophilia! Infiltrate of inflammatory cells
- Type 4; AB, NSAIDs, Diuretics

Question 16

Acute Pyelonephritis

Cause and Cx

Answer 16

Bacteria - retrograde from bladder
- hematogenous spread

Cx: abscess, sepsis, AKI

Question 17

Chronic Pyelonephritis
Causes [2]
Histology
- impt!

Answer 17

Obstruction
Vesico-uterine reflux

Atropied, Dilated tubules

• thyrodisation of kidney w colloid-like hyaline cast of protein
• this is a pattern of tubule atrophy; w dilated tubule of flattened epithelium, w abundant protein
• chronic pyelonephritis and reflux nephropathy can see Thyrodisation of kidney

Question 18

Whats Xanthogranulomatous pyelonephritis

Histology
Cause
Presentation

Answer 18

Xantho - golden - yellow

Foam Cells
Granulomatous - w high macrophage; giant cells,

Proteus infection
- Staghorn calculi

Mimics RCC due to enlarged nodules

Question 19

Obstruction Causes [3 categories]

[3] sites of common stone obstruction

Answer 19

Acquired
- BPH, tumor, stones, clots, slough

Functional, Neurogenic
- functional means muscle cannot work;

Congenital abnormalities
- Urethral valves occur when a boy is born with extra flaps of tissue that have grown in his urethra, the tube through which urine exits the urinary tract.

• Pelvi-Ureteric Junction
• As ureter enters pelvis, crossing common iliac split
• Vesico-ureteric Junction

Question 20

What is histology of UT

Answer 20

Simple Cuboidal - Kidney
Transitional - PELVIS Ureter, Bladder, 2/3 of Urethra
SSC - Distal 1/3 of urethra

Question 21

Hydronephrosis Pathology Features

Answer 21

Enlarged kidneys
Dilated pelvis, tubular spaces
Tubular epithelium flattened
Tubular atropy, fibrosis,
Parachymal atropy, compressed - Thin rim

Question 22

Distinct histological feature between

- acute and chronic pyelonephritis

Answer 22

Both have flattened epithelium, atrophied tubules

• chronic nephritis associated w Thyroidisation of tubules w colloid