Week 3 - Pathology Tutorial of the 3 Pathology lectures

Question 1

How does polycystic kidney disease present?

Answer 1

Big

Bilateral

Berry aneursyms

Causing secondary hypertesnion and haematuria

Question 2

What can the secondary hypertension cause to size of the heart in polycystic kidney disease?

Answer 2

Can cause left ventricular hypertrophy as the heart has to work harder to pump blood around the body

Question 3

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?

Answer 3

This is adult polycystic kidney disease

Question 4

What type of inheritance is adult polycystic kidney disease?

Answer 4

It is a type of autosomal dominant inheritance commonly in chromomse 16 or 4

Question 5

What percentage of patients on dialysis does ADPKD account for?

Answer 5

Accounts for 10% of patients on dialysis

Question 6

What other organs are typical for cysts to grow in, in a person with ADPKD?

Answer 6

Liver, pancreas and lung - usually does not impair function of these organs

Question 7

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?

Answer 7

This would be due to the kidney failure which is preventing it from filtering urea and creatinine efficiently

Question 8

What is the blood pressure for malignant hypertension?

Answer 8

180/120

Question 9

How may glomerulonephritis present?

Answer 9

Hameaturia and proteinuria

Question 10

How does minimal change glomerulnephritis present? What causes minimal change glomerulonephritis?

Answer 10

Caused by effacement of podocytes - fusion of podocytes

Presents as nephrotic syndrome

(no.1 cause of nephrotic syndrome in kids)

Question 11

Describe the features of nephrotic syndrome? How does this lead to proteinuria?

Answer 11

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

Question 12

How is nephritic syndrome characterized?

Answer 12

Blood in urine (haematuria), oliguria (small volumes of urine), Elevated BP and mild facial oedema

Question 13

What colour is the urine in nephritic syndrome?

Answer 13

It is a mild dusky colour

Question 14

What type of infection predisposes to glomerulonephritis as a complication?

Answer 14

Post-streptococcal infection - Glomerulonephritis can cause both of nephritic and nephrotic

Question 15

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?

Answer 15

Diabetic nephropathy is a microvascular complication of diabetes

Question 16

What is the name given to the round shaped eosinophilic (pink) lesion arrowed, which is a manifestation of diabetic nephropathy?

Answer 16

This is a Kimmelstiel Wilson Nodule - sign of diabetic nephropathy

Question 17

What can the increased risk of infection in diabetes lead to?

Answer 17

Can increase the risk of pyelonephritis in diabetes

Question 18

What type of staining is used for the deposition of amyloid? and in what conditions?

Answer 18

Congo Red staining in myeloma and AL amyloidosis

Question 19

What type of birefringence is seen under polarised light in congo red staining for amyloid deposition?

Answer 19

Apple-green birefringence

Question 20

How can myeloma affect the kidneys causing renal failure? (it involves the protein which can be measured in the urine for myeloma)

Answer 20

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

Question 21

How can myeloma cause renal calculi?

Answer 21

Myeloma causes increased calcium which can cause renal stones to form

Question 22

Large abundant tumour cells seen with clear cytoplasm on histology of testicle What type of tumour is this?

Answer 22

This is a seminoma

Question 23

What is the treatment of seminoma?

Answer 23

Treat with orchidectomy with radiotherapy

Question 24

What can be used to measure seminoma? What age group is it usually seen in?

Answer 24

Measure placental alkaline phosphatase

Usually never before puberty and around 30-50 years of age

Question 25

What nodes does seminoma spread to if it spreads by lympahtics?

Answer 25

The para-aortic lymph nodes

Question 26

What is used to measure teratoma with yolk sac elements and what for highly malignant teratoma containing trophoblastic tissue?

Answer 26

Yolk sac elements - alpha fetoprotein

Trophoblastic tissue - bHCG

Question 27

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?

Answer 27

Primary prostatic adenocarcinoma with metastatses to bone

Question 28

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

Answer 28

Prostate specific antigen (PSA)

Carry out PR after as this can interfere with results and have to wait around 6 weeks after (false positives)

Question 29

What is peculiar about skeletal metastases of prostatic carcinoma? What is the order of the 5 most likely metastases to bone?

Answer 29

It is osteosclerotic instead of osteolytic

Breast Prostate Lung Kidney Thyroid

Question 30

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?

Answer 30

Malignant hypertension

Question 31

name some causes of secondary hypertension?

Answer 31

Renal artery stenosis

Any renal parenchymal disease

Question 32

What is autoregulation of the kidneys?

Answer 32

Regulation of renal blood flow to maintain a stable glomerular filtration rate (GFR) despite changes in systemic blood pressure

Question 33

Why are ACEi not given in renal artery stenosis? (autoregulation, efferent artiole, angiotensin II - these are clues)

Answer 33

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

Question 34

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?

Answer 34

Thi is known as hydronephrosis