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D&T 3 Test 3 > Urinary Tract obsturction > Flashcards

Urinary Tract obsturction Flashcards

1
Q

Hydronephrosis

A

dilation of renal pelvis/calyces with progressive atrophy of kidney due to obstruction to urine outflow

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2
Q

What does hydronephrosis of kidney show in kidney

A
  • marked dilation of pelvis and calyces

- thinning of renal parenchyma

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3
Q

Obstructive uropathy does what to the kidney

A

renal atrophy

hydronephrosis

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4
Q

what type of obstruction is usually painful

A

acute obstruction

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5
Q

what are clinical symptoms for bilateral complete obstruction

A

oliguria/ anuria

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6
Q

what is obstructive uropathy

A

time course and degree of obstruction determines

  • dilation
  • degree of renal impairment
  • ability to restore renal function following relief
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7
Q

What is Urolithiasis

A

renal calculi

renal stone in kidney

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8
Q

are urolithiasis usually bilateral or unilateral

A

unilateral

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9
Q

where can urolithiasis occur

A

renal calyces
pelvis
bladder

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10
Q

what is a characteristic of a urolithiasis

A

staghorn calculi ( large branching stone)

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11
Q

what is colic

A

smaller stones passed into ureters

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12
Q

What are 4 types of urolithiasis

A

calcium oxalate/phosphate
Struvite
uric acid
cystine

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13
Q

Calcium oxalate/phosphate urolithiasis forms in what type of envirnment

A

acidic

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14
Q

calcium oxalate crystals look like what

A

envelopes

-octahedron

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15
Q

Magnesium ammonium phosphate stones ( struvite) are caused by what bacteria

A

urea-splitting bacteria

  • proteus
  • some staph
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16
Q

What type of environment causes struvite urolithiasis

A

alkaline urine

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17
Q

what does “ triple stone” struvite look like under microscope

A

coffin lids

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18
Q

Uric acid crystals in urolithiasis occurs in what envirnment

A

acidic

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19
Q

how does uric acid crystals show up on X-ray

A

radiolucent ( can’t see)

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20
Q

how does calcium stones show up on X-ray

A

radiopaque ( can see)

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21
Q

What environment does cystine stones show up in

A

-acidic

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22
Q

What causes cystine stones

A

genetic defects in renal reabsorption of AA

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23
Q

What are 3 types of kidney transplant rejection

A

hyperacute
acute: cellular and humoral
chronic

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24
Q

How fast does hyperacute reaction occur

A

minutes to hours

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25
Q

what occurs in hyperacute rejection

A

antigen-antibody rxn at level of vascular endothelium

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26
Q

what is seen microscopically in hyperacute rejection

A

fibrin thrombi and WBC

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27
Q

How long does it take for acute rejection to occur

A

days to weeks

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28
Q

What happens in acute cellular rejection ( acute)

A

T-cell

Interstitial mononuclear cells infiltration, edema and parenchymal injury

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29
Q

what happens in acute humoral rejection

A

rejection vasculitis, antibody mediated
neutrophils, fibrin, thrombi
DEPOSITION OF C4D

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30
Q

when is C4d produced

A

during activation of antibody dependent classical pathway

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31
Q

how do you treat both cellular and humoral rejection

A

cellular: increase immunosuppressive therapy
humoral: B cell depleting agents

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32
Q

Histo: what is seen in acute humoral rejection

A

thickened vessels
fibroblasts
foamy histocytes

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33
Q

How long does chronic rejection occur

A

months to years

34
Q

What happens to the kidney in chronic rejection

A

hyalinization of glomeruli
interstitial fibrosis
tubular atrophy
focal hemorrhage and swollen

35
Q

How can serum indicate chronic rejection

A

increase serum creatinine

36
Q

Name the benign renal tumors

A
  1. renal papillary ademona
  2. renal fibroma or hamartoma
  3. angiomyolipoma
  4. ancocytoma
37
Q

Name malignant renal tumors

A
  1. renal cell carcinoma
    Clear, papillary, chormophobe, collecting duct
  2. urothelial carcinoma
  3. Wilms disease
38
Q

How does one find renal papillary adenoma

A

incidental

39
Q

renal papillary adenoma is associated with what

A
  • long term hemodialysis
  • acquired cystic disease
  • lacks 3p alteration
40
Q

what is the size of renal papillary ademona

A

less than 0.5 cm

41
Q

What is the histo feature for renal papillary ademona

A

finger projections

42
Q

Renal fibroma can produce what? impacts?

A

prostaglandins

- regulate intra-renal blood pressure

43
Q

What are gross features of renal fibroma

A

well circumscribed
gray-white firm nodule
within pyramids

44
Q

what is the micro findings for renal fibroma

A

fibroblastic like cells
collagenous tissue
entrapped tubules at periphery

45
Q

What goes wrong in angiomyolipoma

A

neoplasm composed of

  • thick walled blood vessels
  • smooth muscles
  • fat

includes spindle and epithelioid cells

46
Q

When is angiomyolipoma a tuberous sclerosis

A

angiomyolipoma: one large mass

tuberous sclerosis: multiple masses

47
Q

What chromosome is tuberous sclerosis found on

A

Ch9q ( TSC1)

Ch16 (TSC2)

48
Q

Oncocytoma can coexist with what

A

renal cell carcinoma

49
Q

what does oncocytoma look like gross

A

golden mahogany, brown tumor

50
Q

micro: what does oncocytoma look like

A

pink

prominent nuclei

51
Q

renal cell carcinoma arise from what

A

renal tubular epithelium

52
Q

Von Hippel-Lindau is found in what syndrome

A

chromosome 3

53
Q

What are 3 classical features of renal cell carcinoma

A

costovertebral pain
palpable mass
hematuria

54
Q

genetically what happens in renal cell carcinoma clear type

A

loss of sequence of short arm of Ch3

55
Q

Name a renal cell carcinoma clear type

A

Von Hippel-Lindau disease

56
Q

What are clinical features of von Hippel-Lindau disease

A

hemangioblastoma
cysts in pancreas, liver and kidney
renal cell carcinoma

57
Q

number one mets for kidney

A

lungs

58
Q

Papillary carcinoma sporadic is associated with which genes

A

trisomies 7,16,17

loss of Y in males

59
Q

Papillary carcinoma familial is associated with which genes

A
  • trisomy 7

- locus for MET

60
Q

What is seen histo for papillary carcinoma

A

finger like projections
foamy histiocytes
Somoma bodies - calcifications - black dots

61
Q

What are 3 histo features for chromophobe carcinoma

A
  1. prominent cell membrane
  2. pale eosiniophillic cytoplasm
  3. halo around nucleus
62
Q

what stain is used for chromophobe RCC

A

hale’s colloidal iron

63
Q

Collecting Duct (bellini Duct) carcinoma, has what type of cells and insterstital

A

Hobnail type cells

desmoplastic stroma - fibrosis

64
Q

What are hobnail type cells

A

nucleus protrudes out

65
Q

Who usually gets Xp11 translocation carcinoma

A

young patients

66
Q

what is seen in histo for Xp11 translocation carcinoma

A

clear cytoplasm

papillary architecture

67
Q

what is the treatment of choice for renal cell carcinoma

A

nephrectomy

68
Q

what are 3 clinical findings for urolethial carcinomas of renal pelvis

A
  1. hematuria
  2. hydronephrosis
  3. flank pain
69
Q

what is histo for urolethial carcinomas

A

similar to bladder tumors

arise from urothelium of renal pelvis

70
Q

What is a primary tumor of childhood and 4th most common pediatric malignancy

A

Wilms tumor

71
Q

What are 3 syndromes of Wilm’s tumor

A
  1. WAGR syndrome
  2. Denys-Drash syndrome
  3. Bechwith-Wiedemann syndrome
72
Q

what is WAFR syndrome

A

aniridia
genital anomalies
mental retardation

73
Q

Wilms deletion is on what gene

A

WT1 gene

74
Q

Aniridia deletion is on what gene

A

PAX6 gene

75
Q

WT1 and PAX6 gene are located on what chromosome

A

11

76
Q

what is Denys-Drash syndrome

A 
Gonadal dysgenesis  ( male pseudohermaphroditism)
early-onset nephropathy - diffuse mesangial sclerosis
77
Q

Denys-Drash syndrome is a defect in what gene

A

WT1

78
Q

Bechwith-Wiedemann syndrome clinical feature and chromosome

A

oragnomegaly

11

79
Q

what is histo presentation for Wilms

A

Blastemal cells
stromal cells
epithelial type cells

80
Q

treatment for Wilms

A

surgery

chemotherapy

D&T 3 Test 3 (7 decks)

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