Week 3 - Pathology Tutorial of the 3 Pathology lectures Flashcards
How does polycystic kidney disease present?
Big
Bilateral
Berry aneursyms
Causing secondary hypertesnion and haematuria
What can the secondary hypertension cause to size of the heart in polycystic kidney disease?
Can cause left ventricular hypertrophy as the heart has to work harder to pump blood around the body
Presentation usually occurs in middle age but occasionally in young adults. Patients may present with features of chronic renal failure, an abdominal mass or subarachnoid haemorrhage due to rupture of a berry aneurysm in the Circle of Willis, a well recognised associated feature. Left ventricular hypertrophy is related to systemic hypertension as a result of chronic renal failure.
What is this?
This is adult polycystic kidney disease
What type of inheritance is adult polycystic kidney disease?
It is a type of autosomal dominant inheritance commonly in chromomse 16 or 4
What percentage of patients on dialysis does ADPKD account for?
Accounts for 10% of patients on dialysis
What other organs are typical for cysts to grow in, in a person with ADPKD?
Liver, pancreas and lung - usually does not impair function of these organs
A 48 year old man presented to his general practitioner with a six month history of abdominal “fullness” and general lethargy. Abdominal examination suggested a large mass and the blood pressure was 195/120. Preliminary blood tests showed normochromic anaemia and high serum levels of urea and creatinine.
What would cause the high urea and creatinine?
This would be due to the kidney failure which is preventing it from filtering urea and creatinine efficiently
What is the blood pressure for malignant hypertension?
180/120
How may glomerulonephritis present?
Hameaturia and proteinuria
How does minimal change glomerulnephritis present? What causes minimal change glomerulonephritis?
Caused by effacement of podocytes - fusion of podocytes
Presents as nephrotic syndrome
(no.1 cause of nephrotic syndrome in kids)
Describe the features of nephrotic syndrome? How does this lead to proteinuria?
Nephrotic syndrome - proteinuria, hypoalbuminaemia, hyperlipidaemia, hypercoagulability and oedema
The effacement of podocytes means their negative charge is lost and therefore they cannot repel the negatively charged albumin from entering the urinary filtration - leads to low albumin in the blood
* This causes the loss of capillary oncotic blood pressure leading to fluid leakage causing oedema
How is nephritic syndrome characterized?
Blood in urine (haematuria), oliguria (small volumes of urine), Elevated BP and mild facial oedema
What colour is the urine in nephritic syndrome?
It is a mild dusky colour
What type of infection predisposes to glomerulonephritis as a complication?
Post-streptococcal infection - Glomerulonephritis can cause both of nephritic and nephrotic
A 46 year old man with a long history of diabetes mellitus presented to his General Practitioner with generalised swelling of both legs and abdomen. Preliminary analysis of a urine specimen showed heavy proteinuria and he was referred to a Renal Unit for further investigation. Is this nephropathy micro or macro vascular?
Diabetic nephropathy is a microvascular complication of diabetes
What is the name given to the round shaped eosinophilic (pink) lesion arrowed, which is a manifestation of diabetic nephropathy?
This is a Kimmelstiel Wilson Nodule - sign of diabetic nephropathy
What can the increased risk of infection in diabetes lead to?
Can increase the risk of pyelonephritis in diabetes
What type of staining is used for the deposition of amyloid? and in what conditions?
Congo Red staining in myeloma and AL amyloidosis
What type of birefringence is seen under polarised light in congo red staining for amyloid deposition?
Apple-green birefringence
How can myeloma affect the kidneys causing renal failure? (it involves the protein which can be measured in the urine for myeloma)
It can cause the formation of abnormal light chains (Bence-Jones proteins) produced by malignant plasma cells. This is toxic to the kidneys and can lead to acute kidney failure
How can myeloma cause renal calculi?
Myeloma causes increased calcium which can cause renal stones to form
Large abundant tumour cells seen with clear cytoplasm on histology of testicle What type of tumour is this?
This is a seminoma
What is the treatment of seminoma?
Treat with orchidectomy with radiotherapy
What can be used to measure seminoma? What age group is it usually seen in?
Measure placental alkaline phosphatase
Usually never before puberty and around 30-50 years of age
What nodes does seminoma spread to if it spreads by lympahtics?
The para-aortic lymph nodes
What is used to measure teratoma with yolk sac elements and what for highly malignant teratoma containing trophoblastic tissue?
Yolk sac elements - alpha fetoprotein
Trophoblastic tissue - bHCG
A 75 year old man presented with a history of disturbance of urinary flow and back pain. Rectal examination showed that the prostate gland was firm and irregular. A skeletal survey revealed the presence of multiple lesions, particularly in the lumbar vertebrae. What does this patient likely have?
Primary prostatic adenocarcinoma with metastatses to bone
Which serum marker is important in the diagnosis and treatment of prostatic carcinoma? Do you carry out a PR exam before or after measuring this if suspecting prostate carcinoma
Prostate specific antigen (PSA)
Carry out PR after as this can interfere with results and have to wait around 6 weeks after (false positives)
What is peculiar about skeletal metastases of prostatic carcinoma? What is the order of the 5 most likely metastases to bone?
It is osteosclerotic instead of osteolytic
Breast Prostate Lung Kidney Thyroid
A 55 year old man presented as an acute emergency with severe headache,blurred visionsigns of cardiac failure and haematuria Clinical examination revealed: A very high diastolic blood pressure of165mmHg Papilloedema and retinal haemorrhages Shortly after admission to hospital he suffered a cerebral haemorrhage and died. What is the condition?
Malignant hypertension
name some causes of secondary hypertension?
Renal artery stenosis
Any renal parenchymal disease
What is autoregulation of the kidneys?
Regulation of renal blood flow to maintain a stable glomerular filtration rate (GFR) despite changes in systemic blood pressure
Why are ACEi not given in renal artery stenosis? (autoregulation, efferent artiole, angiotensin II - these are clues)
In renal artery stensois the affernet arteriole is narrowed and therefore the kidney depends on auto-regulation to maintain renal blood flow
Angiotensin II causes constriction of the efferent arteriole therefore reducing filtration rate and stopping too much blood flow
ACEi cause dilation of the efferent arteriole (post glomerula arteriole) therefore losing arteriolar tone and causing glomerular perfusion to fail resulting in ischaemia and nephropathy
A 48 year old man presented with a history of intermittent, vague right sided abdominal pain. A plain abdominal X- ray showed a calcified lesion in the right kidney with evidence of dilatation of the pelvicalyceal system. What is the name for pelvicalyceal dilatation?
Thi is known as hydronephrosis
