Urological pathology

Question 1

Renal cell carcinoma

Answer 1

• Cancer of the kidney that arises from renal tubular epithelium
• 2 types - Clear cell (75%) Papillary (10%)

Question 2

Epidemiology of renal cell carcinoma

Answer 2

• 3% of cancers, 65-80

- PMH of smoking, obesity

Question 3

Von Hippel-Lindau Syndrome

Answer 3

• loss of VHL gene function causes cell growth and increased cell survival
• Tumours develop in kidneys, blood vessels, pancreas
• Inherited

Question 4

Presentation of renal cell carcinoma

Answer 4

• haematuria, palpable abdominal mass

- Paraneoplastic syndromes - Signs and symptoms that are not related to local effects of the tumour (weight loss)

Question 5

Wilms’ Tumour

Answer 5

• Nephroblastoma - Cancer of the kidney

Question 6

Epidemiology of Wilms Tumour

Answer 6

• Children under 5
• 5-10% genetic syndromes:
  WAGR syndrome, Beckwith-Wiedemann Syndrome

Question 7

Aetiology of WT

Answer 7

• Caused by inherited genetic mutations - WT1

Question 8

Clinical features of WT

Answer 8

• Abdominal distention especially if bilateral (10%), haematuria

Question 9

Urolithasis

Answer 9

• Urinary tract stones

- Usually calcium stones forming in the lumen of UT

Question 10

Aetiology of Urolithiasis

Answer 10

• Too high conc of a solute in urine

Question 11

Pathogenesis

Answer 11

• Too high conc of soluble material
• Urine becomes saturated
• Soluble material precipitates out
• Stones form

Question 12

Clinical features of Urolithiasis

Answer 12

• Haematuria

- Loin to groin pain, lower abdominal pain, dysuria

Question 13

Vesicoureteral reflux

Answer 13

• When urine flows backwards from the bladder to the ureter

Question 14

Epidemiology of VUR

Answer 14

• 10% of population
• Young people, under 2
• Family history of VUR

Question 15

Aetiology of VUR

Answer 15

• Congenital abnormality of Vesicoureteric junction

Question 16

Pathogenesis of VUR

Answer 16

• Ureter enters bladder at normal angle
• When urinating, not enough muscle contraction to compress ureter
• Ureter remains patent
• Urine flows wrong way

Question 17

Clinical features of VUR

Answer 17

• stasis = UTI

- Back pressure and ascending infection = renal damage

Question 18

Urothelial Carcinoma

Answer 18

• Transitional cell carcinoma

- Cancer arising from urothelium

Question 19

Epidemiology of Urothelial carcinoma

Answer 19

• Adults aged over 60
• Smokers
• Industrial chemicals
• male more than female

Question 20

Urothelial carcinoma aetiology

Answer 20

• Environmental factors smoking, arylamines

Question 21

Clinical features of Urothelial carcinoma

Answer 21

• Haematuria, dysuria

- Urinary obstruction

Question 22

Neurogenic bladder - 2 types

Answer 22

• Inability to properly empty bladder due to neurological damage
• Spastic - damage to brain or spinal cord
• Flaccid - damage to peripheral nerves

Question 23

Aetiology of Neurogenic bladder

Answer 23

• Damage to nervous system
• Stroke, MS
• Diabetes, pregnancy

Question 24

Pathogenesis of NB

Answer 24

• Disruption to afferents from stretch receptors or efferents to internal sphincter

Question 25

Clinical features of NB

Answer 25

• Urinary retention, abdominal distention

- Can cause UTI, urinary stones, renal function impairment