What is seen here?
Acute pyelonephritis
What is seen here?
Acute pyelonephritis
What is seen here?
Xanthogranulomatous Pyelonephritis
What is seen here?
Xanthogranulomatous Pyelonephritis
What are some congenital anomalies involving the kidney?
- Agenesis (absence)
- Hypoplasia (small): no scars and fewer lobules
- Ectopic (out of place)
- Horseshoe (abnormal form)
What is seen here?
Horseshoe kidney
What can cause polycystic kidneys?
- Cystic renal dysplasia
- Polycystic kidney
- Medullary cystic kidney
- Acquired (dialysis)
Describe kidney structure with cystic renal dysplasia
Persistence of abnormal structures (cartilage mesenchyme, immature collecting ducts)
What are the forms of polycystic kidney?
Describe genetics and other features
Autosomal dominant: Adult
- High penetrance
- Bilateral, large homogeneous cysts
- Liver cysts, berry aneurysms
Autosomal Recessive: Infantile
- Longitudinal parallel peripheral cysts
- Hepatic fibrosis
What is seen specifically in medullary cystic kidney?
Cystic dilation of the collecting ducts
What can cause acquired polycystic kidneys?
Dialysis
What is seen here?
Polycystic kidney disease- AD
What is seen here?
Polycystic kidney disease- AR
What is seen here?
Polycystic kidney disease- AR
What is urolithiasis (broadly)
Stones in urinary tract
Describe the common stone types, the preidsposing conditions, and their prevalence
Calcium oxalate/phosphate: 75%
- Hypercalciuria and hypercalcemia
- Hyperuricosuria
- Hypocitraturia
Magnesium ammonium phosphate (struvite): 15%
Uric acid: 6%
- Hyperuricemia/hyperuricosuria
Cystine 1-2%
What can predispose you to kidney stones?
- Family history
- Male gender
- Dehydration
- Urease positive bacterial infections (struvite)
Are the following stones radiolucent or radioopaque?
- Calcium oxalate/phosphate
- Magnesium ammonium phosphate
- Uric acid
- Calcium oxalate/phosphate: opaque
- Magnesium ammonium phosphate: opaque
- Uric acid: lucent
What is seen here?
Nephrolithiasis
What is seen here?
Kidney: staghorn calculus
What are some renal tumors?
- Renal cell carcinoma
- (Renal oncocytoma?)
- Urothelial carcinoma of renal pelvis
- Angiomyolipoma (benign)
- Can get fairly large; if rupture, the hemorrhage may be life threatening
- Soft tissue tumors of renal capsule
- Leiomyosarcoma
Describe the etiology of Renal Cell Carcinoma
- Sporadic risk factors/causes
- Syndromes
Sporadic:
- Tobacco
- Obesity
- Unopposed estrogen
Von Hippel-Lindau Syndrome (VHL gene)
- Hemangioblastoma of cerebellum and retina
- Renal cysts
- Renal cell carcinoma
What are the different types (and percentages) of renal cell carcinoma?
- Clear Cell Carcinoma: 80%
- Deletion or unbalanced translocation of chromosome 3 (VHL gene) or methylation. The “internist’s tumor”.
- Chromophobe: 5%
- Papillary: 10-15%
- Collecting Duct Carcinoma (1%)
Describe the genetics of Von Hippel Lindau syndrome
- Gene
- Chromosome
- VHL gene
- Chromosome 3
- Caused by deletion/unbalanced translocation or methylation
Describe renal cancer staging
- Stage I: limited to kidney (under 7 cm)
- Stage II: limited to kidney (> 7cm)
- Stage III: beyond capsule into perinephric tissue (not beyond Gerota's fascia), major veins, adrenal gland
- Stage IV: tumor beyond Gerota's fascia, > 1 LN involved, and/or 1+ distant met
What is seen here?
Renal cell carcinoma: clear cell type
- Left: multilobulated tumor with hemorrhagic cut surface
- Right: yellow appearance; this yellow color is pretty diagnostic
What is seen here?
Renal cell carcinoma: clear cell type
- Clear space due to great amounts of fat removed during processing
What is seen here?
Renal cell carcinoma: chromophobe type
What is seen here?
Renal cell carcinoma: papillary type
What is seen here?
Renal oncocytoma
- Mahogany brown appearance
