Urogenital Flashcards
what are causes of acute renal failure
- Pre-renal
- Hypotension
- Haemorrhage
- Renal
- Glomerulonephritis
- Acute tubular necrosis (most common)
- acute interstitial nephritis
- Post-renal
- Acute urinary tract outlet obstruction
clinical features of acute renal failure
- Oliguria: marked decrease in urine production, or absence of urine production
- Azotaemia: progressive, usually rapid, rise of blood urea nitrogen (BUN) and serum creatinine
causes of chronic renal failure
- Diabetic nephropathy (MOST COMMON)
- Glomerulonephritis
- Hypertension
- Pyelonephritis
- Polycystic kidney disease
morphology of chronic renal failure
- Bilateral small contracted kidneys
- Widespread glomerulosclerosis
clinical features of chronic renal failure
- Terminal oliguria
- Pale and Sallow complexion
- Hypertension/
- Peripheral edema
- Anaemia
morphology of acute tubular necrosis
- tubular dilation
- interstitial oedema
what is urolithiasis
Formation of a calculus or calculi (stones) within the urinary tract
causes of urolithiasis
- Primary causes:
- Supersaturation of the components of the stone- most commonly calcium salts
- Secondary causes:
- Urinary tract infection
- Indwelling catheter or foreign body in bladder
3 types of renal calculi and their predisposing factors
Calcium oxalate stones:
Hypercalcemia -> hypercalciuria -> supersaturation in urine -> calcium oxalate stones.
Magnesium ammonium phosphate stones:
(Staghorn calculi)
Urinary tract infection -> infection by urease splitting bactria which convert urea to ammonia -> increased pH of urine -> precipitation of magnesium ammonium phosphate stones
Uric acid stones:
Hyperuricemia -> hyperuricosuria -> increased formation of uric acid stones
pathological effects and complications of renal calculi
- Urinary colic, loin to groin pain
- Urinary tract obstruction -> Urinary stasis -> UTI
- Ulceration, bleeding & fistula formation
definition of acute tubular necrosis
Tubular epithelial cell injury/death → resulting in reduction/loss of tubular function
causes of acute tubular necrosis
- Ischaemic causes
- Shock, haemorrhage, major surgery, severe burns, dehydration
- Toxic causes
- Endogenous products (haemoglobin released in haemolysis; myoglobin released in crush injuries & rhabdomyolysis)
causes of acute interstitial nephritis
- Drugs
- NSAIDs
- Antibiotics (rifampicin)
- Diuretics (thiazides)
morphology of acute interstitial nephritis
- Interstitial oedema
- Focal tubular necrosis
complications of acute interstitial nephritis
- Acute renal failure
what is angiomyolipoma
most common benign mesenchymal tumour of the kidney
morphology of angiomyolipoma
- Gross
- Unencapsulated — EVEN though it is benign
- Histology
- Mixture of myoid spindle cells, epithelioid cells, adipocytes & blood vessels (often thick walled)
clinical features of angiomyolipoma
- Clinical Features
- Can be accurately diagnosed on CT scan due to its large fat content (appears radiolucent)
what is renal cell carcinoma and its epiD
- Definition: Malignant tumour arising from the renal tubular epithelium
- EpiD & Associations
- Accounts for 85% of malignant renal tumours in adults
- Mostly occurs in the 6th & 7th decades of life
- Male : female = 2 : 1
most common type of renal cell carcinoma
clear cell carcinoma
morphology of clear cell carcinoma
- Gross
- Yellowish cut surface with foci of necrosis & haemorrhage - Histology
- Polygonal cells arranged in tubular architecture
clinical features of renal cell carcinoma
- Painless haematuria
- Mass in flank
what is nephroblastoma (wilms tumour) and its epiD
- Paediatric renal tumour
- Usually diagnosed between ages 2 & 5
morphology of nephroblastoma
Histology
- Sheets of small blue cells
- Striated muscle & cartilage may be found
clinical features of nephroblastoma
- Large abdominal mas
- Haematuria
- Fever
which group of people most commonly get benign prostatic hyperplasia
extremely common condition in men over the age of 50
morphology of BPH
Gross
- Diffuse enlargement of prostate gland
- enlarged kidneys
Histology
- hyperplastic nodules composed of fibromuscular stroma
- hyperplastic glands lined by tall, columnar epithelial cells
complications of BPH
- Urinary tract obstruction leading to:
- Bladder distention & hypertrophy
- Hydronephrosis & Hydroureter
- Urinary tract infections
- Urolithiasis
what is serum PSA level testing used for
differentiate BPH from prostatic carcinoma
- PSA is usually elevated in around 70% of prostatic carcinoma cases
However, Not very sensitive and not very specific
what are the different types of testicular neoplasms
- Germ Cell tumours (Seminomatous vs Non-seminomatous) ~95%
- MOST COMMON
- Epithelial Cell tumours (rare)
characteristics of Seminomatous germ cell tumours
- Very radiosensitive
- Spread by lymphatics
example of seminomatous germ cell tumours and its morphology
- Seminoma (commonest germ cell tumour; peak in 4th decade)
- Creamy, tan coloured
characteristics of Non-seminomatous germ cell tumours (NSGCT)
- Radioresistant
- Spreads via haematogenous route
examples of Non-seminomatous germ cell tumours (NSGCT) and their features
- Yolk sac tumour (most common testicular tumour in infants; good prognosis)
- Express aFP
- Teratoma
- Embryonic carcinoma (peak between ages 20 & 30; more aggressive than seminomas)
polycystic kidney disease morphology
- Gross
- Cysts evident from external surface
- Cysts containing turbid, red to brown fluid
- Histology
- Cysts lined by cuboidal epithelium
