uroological pathology Flashcards
where do renal calculi typically form?
collecting duct
what are kidney Stones typically made of?
Calcium Oxalate (Weddellite) – 75%
Magnesium Ammonium Phosphate (Struvite) – 15%
Uric Acid – 5%
list the MOA for hypercalcicuria?
Absorptive hypercalciuria – excessive calcium absorption from gut
Renal hypercalciuria – impaired absorption of calcium in proximal renal tubule
what are triple stones? why do they form? give examples
Magnesium ammonium phosphate stones
eg staghorn calculi - when they become really large
Form as a consequence of infection with urease-producing organisms Proteus sp. ‘infection stones’
which organisms are implicated in ‘infection stones’? most common?
most common - Proteus mirabilis
otehr proteus sp. Klebsiella Staph sap Staph A H. Pylori
and many more!!
what is the aetiology of uric acid stones?
Majority - because they produce slightly acidic urine
Hyperuricaemia: Gout, Rapid cell turnover
How do urinary calculi present depending on character?
Small stones:
- Asymptomatic:
- stay in kidney
- detected when haematuria, or recurrent UTIs - Colic
- if leaves kidney
Large stones:
- Obstruction, Chronic renal failure, Infection
- As remain in kidney
list the areas where small kidney stones can become lodged?
Pelvi-ureteric junction,
Pelvic brim,
Vesico-ureteric junction
list the beningn renal tumours?
Papillary Adenoma
Renal Oncocytoma
Angiomyolipoma
A patient with a hx of T2DM and HTN passes away. On autopsy, a tumour is found in his kidney. which tumour is it most likely to be?
Papillary Adenoma
- usually incidental find when ivx kidney + associated
with other kidney disease eg CKD
A patient presents with flank pain and haemorrhage. Obs show: BP 108/50, HR 120.
He has a PMH of tuberous sclerosis. What is the likely diagnosis and what are thee characteristics?
Angiomyolipoma
this is the typical presentation + shock
Can be seen in tuberous sclerosis
which malignancy has larger tumours (> 4cm) ?
Angiomyolipoma
Which tumour is by definition, 15mm (1.5cm) or less in size?
Papillary Adenoma
size is a key defining feature
name a benign epithelial kidney tumour
Papillary Adenoma
Renal Oncocytoma
name a benign mesenchymal kidney tumour
Angiomyolipoma
Which tumours are associated with the following:
Trisomy 7, Trisomy 17, Loss of Y chromosome
Papillary Adenoma
Papillary Renal Cell Carcinoma
list some malignant renal neoplasms - most common?
Renal Cell Carcinoma:
- Clear Cell RCC - 70%
- Papillary RCC
- Chromophobe RCC
Nephroblastoma - aka Wilm’s Tumour
note: most end with carcinoma
Renal Cell Carcinoma is a malignancy of ___?
Of the DCTubules
a patient presents with haematuria what could be the cause?
- KIDNEY:
Calculi - lodged in kidney
Benign tumour - Angiomyolipoma
Malignant tumour - RCC (painless)
- Urothelial carcinomas/TCCs
Histology and genetic testing for a tumour on kidney reveals:
Appears grossly as a golden yellow tumour with haemorrhagic areas
Genetically shows loss of chromosome 3p
which is it most likely to be?
Clear Cell Renal Cell Carcinoma
what is the difference between
Papillary Renal Cell Carcinoma &
Papillary adenoma
Size!!
Papillary Renal Cell Carcinoma: above 15mm (1.5cm)
P Adenoma: below 15mm (1.5cm)
which kidney tumour is composed of
sheets of large cells that display distinct cell borders, reticular cytoplasm and a thick-walled vascular network
Chromophobe Renal Cell Carcinoma
which kidney tumour presents in childhood?
characteristics?
Blastema (small round blue cells)
presents as an abdominal mass in children aged 2-5 years old
excellent prognosis
Group of malignant epithelial neoplasms arising in urothelial tract (Bladder, Renal Pelvis, Ureters) are known as?
associations?
Transitional Cell Carcinomas or Urothelial Carcinomas
Associations: Aromatic amines, smoking
how do Urothelial Carcinomas present?
haematuria
what is the aetiology of BPH - Benign Prostatic Hyperplasia?
Increased oestrogen levels in blood, which rises with age, may induce androgen receptors and stimulate hyperplasia - note, on histology, the architecture is the same but there are now MORE CELLS
how does BPH present?
Lower Urinary Tract Symptoms” LUTZ
Frequency
Urgency
Nocturia
Hesitancy
Poor flow
Terminal Dribbling
May also present with urinary tract infection, acute urinary retention or renal failure - due to obstruction
What is the Most common malignant tumour in men?
Prostatic Adenocarcinoma
what is the aetiology of Prostatic Adenocarcinoma?
Arises from Prostatic Intraepithelial Neoplasia - PIN
Mutations in PTEN, AMACR, GST-pi, p27 and more… BRCA
how does Prostatic Adenocarcinoma present?
Usually asymptomatic; usually diagnosed on biopsy following raised serum PSA prostate-specific antigen or digital rectal examination
May have lower urinary tract symptoms
Rarely may present with metastatic disease
-Pathological fracture
what is the Most powerful prognostic indicator in Prostatic Adenocarcinoma?
The Gleason score - grading system - g for grade
how is the Gleason score calculated?
2 most common areas/ worst areas on biopsy are number 1-5 then the 2 numbers are added x+y=z
Higher scores correlate with aggressive behaviour
High volume tumours scoring 8-10 in particular
What are the most important prognostic factors in Renal Cell Carcinoma?
Staging and Grading :
- ISUP Nuclear Grade (1-4) - clear cell & papillary RCC
- TNM 8th Ed
- Risk progression index - clear cell
