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Urogenital > Urogenital 1 > Flashcards

Urogenital 1 Flashcards

1
Q

State and explain pathogenesis of TWO examples of developmental defects that arise from abnormalities in size or number of kidneys.

A
  1. Renal Agenesis
    - lack of metanephric primordium
    - failure of ureteral bud development
    - failure of contact of ureteral bud and metanephros
  2. Renal Hypoplasia
    - reduced number of lobules and calyces (<5; normal >10)
    - small kidney
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2
Q

Can one have bilateral renal agenesis?

A

No. Incompatible with life, infants with this are stillborn

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3
Q

What is the ratio of males and females with bilateral renal agenesis?

A

25.1 : 1

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4
Q

What is the ratio of males and females with unilateral renal agenesis?

A

2 : 1

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5
Q

What is an adaptation to unilateral renal agenesis?

A

Opposite kidney enlarged due to compensatory hypertrophy

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6
Q

How does renal hypoplasia appear microscopically?

A

Primitive but hypertrophied (oligomeganephronia) glomeruli and tubules in dense fibrous or fatty interstitium

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7
Q

State TWO examples of abnormalities in kidney position or shape.

A
  1. Displacement of Kidney
  2. Horseshoe Kidney
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8
Q

What is the complications of displacement of kidneys?

A
  1. Kinking or tortuosity of ureters, resulting in obstruction with urinary infection
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9
Q

What is the pathogenesis of horseshoe kidney?

A

Fusion of lower (90%) or upper (10%) poles of kidneys

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10
Q

What is the incidence of horseshoe kidney?

A

1:500 to 1:1000

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11
Q

What is a complication of horseshoe kidney?

A

Renal calculi

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12
Q

Can cystic disease of kidney be congenital and acquired?

A

Yes

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13
Q

State 5 types of cystic kidney disease.

A
  1. Cystic Renal Dysplasia
  2. Polycystic Kidney Disease
    - Autosomal Dominant (Adult)
    - Autosomal Recessive (Childhood)
  3. Medullary Cystic Disease
  4. Acquired Cystic Disease (Dialysis associated)
  5. Localised (simple) renal cysts
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14
Q

What is the pathogenesis of cystic renal dysplasia?

A

Abnormal metanephric differentiation, with persistence of primitive/abnormal structures

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15
Q

What TWO conditions might cystic renal dysplasia be associated with?

A

Ureteric Atresia
Renal Agenesis

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16
Q

What is the gross appearance of cystic renal dysplasia?

A

Enlarged, irregular shape, multicystic

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17
Q

What are microscopic findings of cystic renal dysplasia?

A
  1. Lobar Disorganisation
  2. Multiple Cysts lined by flattened epithelium
  3. Presence of primitive/immature structures
    - Islands of undifferentiated mesenchymal cells
    - islands of cartilage tissue
    - primitive ductal structures
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18
Q

What is the pathogenesis of polycystic kidney disease (autosomal dominant)?

A
  1. Mutations in PKD1 and PKD2 genes, which code for proteins polycystin 1 and polycystin 2
  2. Develop multiple cysts in both kidneys, starting as small cysts that gradually enlarge
  3. Eventually kidneys are composed almost entirely of cysts with very little parenchyma left
  4. Leads to renal failure in mid to late adulthood
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19
Q

How common is polycystic kidney disease?

A

1/400 to 1/1000 live births

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20
Q

What is urolithiasis?

A

Formation of calculus or calculi (stones) within the urinary tract

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21
Q

Where does urolithiasis usually begin?

A

Calyces and Pelvis, some in lower urinary tract

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22
Q

What is the primary cause of urolothiasis?

A

Supersaturation of urine with crystalline material (commonly calcium salts)

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23
Q

What are 4 secondary causes of urolithiasis?

A
  1. UTI - crystalline material encrust on a necrotic focus on mucosa calyx, pelvis or bladder
  2. Indwelling catheter or foreign body in the bladder
  3. Vitamin A deficiency producing squamous metaplasia of upper urinary tract mucosa
  4. Low urinary pH predisposes to formation of uric acid stones
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24
Q

What are the 4 types of renal calculi

A
  1. Calcium stones (calcium oxalate mixed with calcium phosphate) (65-70%)
  2. ‘Triple stones’ magnesium ammonium phosphate (15%): usually after infection
  3. Urate stones (from uric acid) (5-10%): Gout, Leukaemia
  4. Cystine Stones (1-2%): Genetic Defect in Renal Transport or Amino Acids
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25
Q

What is the cause of calcium stones?

A

Supersaturation secondary to hypercalciuria.

26
Q

What are causes of hypercalciuria?

A
  1. Idiopathic (55%)
    - Absorptive Hypercalciuria: Hyperabsorption of calcium from the intestine, with prompt increased renal output without hypercalcemia
    - rebal hypercalciuria due to intrinsic impairment in renal tubular reabsorption of calcium
  2. Hyperparathyroidism, diffuse bone disease, Vit D intoxication, Sarcoidosis, Milk-Alkali Syndrome, Renal Tubular Acidosis of Cushing’s Syndrome
27
Q

What is the pathogenesis of magnesium ammonium phosphate stones?

A
  1. Infections by urea splitting bacteria ie proteus
  2. Urea converted to ammonia resulting in alkaline urine
  3. Precipitation of magnesium ammonium phosphate salts
  4. Urea often is large qtys so form large stones (staghorn calculi)
28
Q

What are 6 effects of calculi?

A
  1. Urinary Stasis
  2. Ulceration
  3. Bleeding
  4. Infection
  5. Pain
  6. Fistula Formation
29
Q

State 8 disorders of renal tubules/interstitium

A
  1. Acute Tubular Necrosis
  2. Acute Interstitial Nephritis
  3. Acute Pyelonephritis
  4. Chronic Pyelonephritis
  5. Xanthogranulomatous Pyelonephritis
  6. Tuberculosis
  7. Sarcoidosis
  8. Neoplastic Infiltrates (Leukemia, Myeloma)
30
Q

What is acute tubular necrosis?

A

Tubular epithelial cell injury/death, resulting in loss of tubular function

31
Q

Is acute tubular necrosis reversible?

A

Yes, damaged tubular epithelial cells can be replaced by regenerating residual viable cells

32
Q

What are the three phases of acute tubular necrosis?

A
  1. Oliguric Phase: Renal Phase, Oliguria
  2. Polyuric Phase: Polyuria, Tubular Cells Regenerating
  3. Recovery Phase: Renal Function Recovering
33
Q

What are the causes of acute tubular necrosis?

A
  1. Ischemic Causes: cause hypotension or hypovolemia leading to reduced renal perfusion
    - shocl
    -hemorrhage
    - major surgery
    - severe burns
    - dehydration
  2. Toxic Causes
    - Endogenous Products: Myoglobin, Hemoglobin
    - Drugs
    - Heavy Metals (lead, mercury)
    - Organic Solvents
    - Other toxins
34
Q

What is the microscopic appearance of acute tubular necrosis?

A
  1. Varying degrees of swelling, vacuolation, flattening, sloughing, loss of PAS-positive brush border, necrosis
  2. Tubular Dilation
  3. Interstitial Edema
35
Q

What is acute interstitial nephritis caused by?

A
  1. mainly DRUGS
  2. toxins
  3. metabolic causes
  4. autoimmune disease
  5. infections (non-kidney)
  6. idiopathic
36
Q

How do patients present with acute interstitial nephritis?

A

renal impairment/failure

37
Q

What would one find in a urinalysis of a patient with acute interstitial nephritis?

A

RBCs, WBCs, Eosinophils, Proteinuria, Fever & Rash (for drug induced AIN)

38
Q

What is the pathogenesis of drug-induced AIN? What drugs cause it? When do symptoms arise after taking the drug?

A

Allergic or T-cell mediated hypersensitivity reaction. Antibiotics, Diuretics, NSAIDs, ‘traditional’, ‘herbal’ remedies; 1-2 weeks after

39
Q

What is acute pyelonephritis?

A

Infection of the kidney usually due to bacterial infections

40
Q

What is the pathogenesis of acute pyelonephritis?

A
  1. Ascending (retrograde) spread from bladder
  2. Hematogenous Spread
41
Q

What are predisposing factors to retrograde spread of bacteria from bladder?

A
  1. Lower Urinary tract Obstruction (stone, enlarged prostate, tumour)
  2. Vesicoureteric Reflux
  3. Diabetes Mellitus
  4. Pregnancy
42
Q

What are 6 clinical features of acute pyelonephritis?

A
  1. Chills, Fever
  2. Flank tenderness and pain
  3. Dysuria
  4. Frequency of micurition
  5. > 100,000/ml bacteria in urine
  6. Pyuria (pus casts)
43
Q

What are 4 complications of acute pyelonephritis?

A
  1. Acute Renal Failure
  2. Septicemia
  3. Pyonephrosis - pus filled
  4. Perinephric abscess - can rupture into retroperitoneum
44
Q

What is the gross appearance of acute pyelonephritis?

A

Microabscesses

45
Q

What is the microscopic view of acute pyelonephritis?

A

Pus, neutrophils in lumen and interstitium

46
Q

What are two causes of chronic pyelonephritis?

A
  1. Reflux (vesico-ureteric) - predispose to scarring that is more prominent at renal poles
  2. Obstruction
47
Q

What is the gross appearance of chronic pyelonephritis?

A
  1. Granular
  2. Depression of cortical surface
  3. Fibrosis, Atrophy
48
Q

How does chronic pyelonephritis look microscopically?

A
  1. Dilated thyroidised tubules
  2. Shrunken glomeruli; periglomeruli fibrosis
49
Q

What causes xanthogranulomatous pyelonephritis?

A

Proteus

50
Q

What other kidney condition does xanthogranulomatous pyelonephritis mimic

A

Renal Cell Carcinoma

51
Q

What is the gross appearance of xanthogranulomatous pyelonephritis?

A

Enlarged kidney, replaced by yellow nodules with firm, grayish white tissue

52
Q

What is the microscopic view of xanthogranulomatous pyelonephritis?

A

Macrophages with vacuolated cytoplasm (foam cells), giant cells, lymphocytes and plasma cells

53
Q

3 broad categories of classifying diseases that cause obstruction to the urinary system?

A
  1. Congenital
  2. Acquired
  3. Functional
54
Q

3 congenital diseases causing obstruction to urinary system

A
  1. Urethral Valves/strictures
  2. Bladder neck obstruction
  3. Uretero-pelvic junction narrowing or obstruction
55
Q

5 reasons for acquired obstruction to urinary system

A
  1. BPH
  2. Calculi
  3. Tumours - carcinoma of prostate, bladder tumours, carcinoma of cervix/uterus
  4. Inflammation of prostate, ureter, urethra
  5. sloughed papillae or blood clots
56
Q

2 functional disorders causing obstruction of the urinary system

A
  1. neurogenic (spinal cord damage)
  2. Functional obstruction along urinary tract
57
Q

What is hydronephrosis?

A

Dilation of renal pelvis and calyces with progressive enlargement of the kidney with parenchymal atrophy due to obstruction of urine outflow

58
Q

What is the gross appearance of a kidney with hydronephrosis?

A

Enlarged kidney; changes in pelvis with dilation; later renal cortex is thinned and atrophic

59
Q

What is the microscopic appearance of kidney with hydronephrosis?

A

1.tubules and bowmans spaces dilated;
2.tubular epithelium flattened
3. later tubular atrophy with fibrosis
4. glomeruli disappear

60
Q

What is pyonephrosis and pyoureter?

A

Pyonephrosis: Infected hydronephrosis with frank pus in dilated calyces and pelvis

Pyoureter: Hydroureter infected and contains pus

Urogenital (3 decks)

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