Week 3 - Renal and Male genital pathology tutorial

Question 1

What is glomerulonephritis?

Answer 1

Inflammation of the glomerulus of the kidney

Question 2

Person comes in with a sore throat and is treated sufficiently for it. 3 weeks later presents with headache, oedema and other

Answer 2

The streptococcal sore throat caused the glomerulonephritis

Question 3

What does minimal change glomerulonephritis cause?

Answer 3

This causes nephrotic syndrome

Question 4

What is nephrotic syndrome characterised by?

Answer 4

Proteinuria - greater than 3g/day

Oedema

Hypoalbuminaemia (can also have hyperlipidaemia)

Question 5

What does the urine look like in nephrotic syndrome?

Answer 5

Frothy urine with fatty casts

Question 6

What is IgA mediated nephropathy usually associated with? Presents in children commonly What predisposes to it?

Answer 6

Henoch Schnolein pupura

Classically after a respiratory or a GI infection

Question 7

What is pyelonephritis?

Answer 7

Infection of the kidney, causing inflammation (can be acute or chronic as there is inflammation)

Question 8

What is the most common way a person gets acute pyelonephritis?

Answer 8

infection (retrograde infection from urinary tract, usually from bladder infections, acute cystitis – most commonly due to Ecoli)

– worse form of ascending pyelonephritis could be septicaemia

Question 9

Hypothetically, if we sliced up the kidneys what would we see in pyelonephritis?

Answer 9

Would see pus due to the neutrophils trying to combat the infection

Question 10

What effects does hypertension have on the kidney? (ie the astherosclerosis/RAAS cycle)

Answer 10

Damages the renal artery by leading to renal artery atherosclerosis, will cause decreased blood flow to the kidney reducing the GFR and therefore the cycle continues as RAAS system is activated and this causes further hypertension etc

Question 11

Malignant hypertension – sustained hypertension, medical emergency, BP 180/120 What does this look like on histology of the kidney?

Answer 11

Malignant hypertension on histopathlology has a characterizing lesion of the onion skinning of the interlobular arteries

Can also see the fibrinoid necrosis on histopathology in arterioles and glomerular tufts

Question 12

What pathological lesions may be found in the kidney in a patient with diabetes mellitus?

Answer 12

Kimmelstiel Wilson nodules - due to the nodular glomerulosclerosis cause by diabetes (due to the direct injuries to the capillaries)

Question 13

In association with the pyelonephritis caused by renal artery stenosis, what can be seen in the kidneys? (it is referring to

Answer 13

Can cause renal papillary necrosis

Question 14

What are the 4 main cystic diseases of the kidney?

Answer 14

Simple renal asymptomatic cysts

ARPKD - autosomal recessive PKD (kids)

ADPKD - autosomal dominant PKD (adults)

Renal dialysis associated cyts

Question 15

Which between ARPKD and ADPKD presents in children?

Answer 15

ARPKD - presents in children

ADPKD - presents in adults

Question 16

Kidneys are replaced by cysts and cause destruction of the kidney leading to the functional renal parenchyma being destroyed

What is the presentation/complications of polycystic kidney disease?

Answer 16

Big, Bilateral, Bleeding and Berry anuersysm in the circle of willis that can haemorrhage causing a massive sub arachnoid haemorrhage

Question 17

What is an associated condition with ARPKD?

Answer 17

Associated with congenital hepatic fibrosis

Question 18

What is hydronephrosis?

Answer 18

This is dilatation of the renal pelvis due to an obstruction leading to the backflow of urine in the kidney

Question 19

What is the name of the condition where ureteric valves can cause bacflow of urine causing hydronephrosis?

Answer 19

Vesico-uteric reflux

Question 20

Renal cell carcinoma is a type of adenocarcinoma What is likey to worsen the prognostics of the disease?

Answer 20

If the carcinoma has invaded into the renal vein or perinephric fat

Question 21

What are aetiological factors for bladder cancer? (for both transitional and squamous)

Answer 21

TCC - dyes, rubber and smoking (also long term cyclophosphamide)

SCC - chronic cystitis and schistosomiasis

Question 22

What age group do BPH affect vs prostatic carcinoma? What hormones drive both?

Answer 22

BPH and prostatic carcinoma both affect the elderly

BPH is oestorgen dirven

Prostatic carcinoma is androgen driven

Question 23

Which zone/lobes of the prostate gland does BPH and prostatic carcinoma develop in?

Answer 23

BPH is oestrogen driven and develops in the transitional zone (usually in the middle lobe)

Prostatic carcinoma is androgen drive & develops in the peripheral zone (posterior lobe)

Question 24

What are the two potential serum markers in prostate cancer?

Answer 24

Prostate specific antigen (PSA)

Prostatic acid phosphatase

Question 25

What is the commonest and second commonest germ cell tumour? (testes)

Answer 25

Commonest - seminoma

Second commonest - teratoma

Question 26

What is the peak incidence age group in both seminoma and teratoma?

Answer 26

Seminoma - age 30-50

teratoma - age 20-30

Question 27

What does the macroscopic view of a seminoma look like?

Answer 27

It looks potato like

Question 28

What are the treatments for seminoma and teratoma?

Answer 28

Seminoma - orchidectomy with radiotherapy

Teratoma - orchidecotomy with chemotherapy

Question 29

What are the tumour markers for seminoma?

Answer 29

PLAP -placental alkaline phosphatase

Question 30

What are the tumour markers for teratoma?

Answer 30

bHCG - 100% in trophoblastic malignancy

AFP - alphafeto protein if there is yolk sac remnants (usually choriocarcinomas)

The serum markers can be checked to follow progression of the disease