Day 12 5/29/15 Flashcards

1
Q

UTI Routes of Infection

A
  • ascending infection (70%)

- hematogenous infection

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2
Q

UTI Organism Virulence Factors

A
  • bacterial adhesion: pili
  • “O” antigens (certain strains are more resistent)
  • endotoxin: dec. ureteric perstalsis
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3
Q

UTI Host Defense Mechanisms

A
  • mechanical: bladder emptying, ureteric peristalsis, mucus
  • chemical: prostatic secretions, urine osmolality, blood groups Ag’s
  • immunological: PMNs, shedding urothelial cells
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4
Q

UTI Predisposing Factors

A
  • females>males
  • catheterization
  • dec. urine flow/urine stasis
  • calculi
  • vesicoureteral reflux
  • immune compromise
  • kidey/UT disease
  • pregenancy
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5
Q

UTI Clinical Manifestations

A
  • covert bacteria
  • sx reflective of level of infection
  • recurrent sx in men usually reflects UT disease
  • in early childhood, sx are nonspecific including irritability and convulsions
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6
Q

UTI Complications

A
  • recurrence
  • acute pyelonephritis
  • renal/perinephric abscess
  • papillary necrosis (diabetes)
  • staghorn calculi (proteus)
  • chronic pyelonephritis/renal scarring
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7
Q

Chronic Pyelonephritis Causes (2)

A
  • UTI that has reached the kidneys
  • urinary tract tract obstruction
  • vesicoureteral reflux (VUR)
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8
Q

Vesicoureteral Reflux (VUR)

A
•  Primary
−  Congenital abnormality of VU anatomy
−  Common in infants
−  Decreases in freq & severity during childhood 
−  Usually mild
•  Secondary
−  Congenital malformations
−  Neurogenic bladder (paraplegia, spina bifida) 
−  Obstruction
−  Older children, adults
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9
Q

Reflux Nephropathy

A

Chronic Non-Obstructive Pyelonephritis

• Severe, persistent reflux + infection
− Allows organisms to access renal parenchyma
• Renal scars directly over dilate calyces
− More extensive at poles (compound vs. simple
papillae)
− Often unilateral or unequal bilateral

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10
Q

Papillary Renal Cell Carcinoma

  • incidence:
  • gross pathology:
  • microscopic pathology:
  • staging and prognosis:
A
  • incidence: 10% to 15% of renal cancers
  • gross pathology: unlike clear cell RCCs, papillary carcinomas are frequently multifocal
  • microscopic pathology: Papillary growth pattern
  • staging and prognosis: Better than clear cell RCC
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11
Q

Clear Cell Renal Cell Carcinoma

  • incidence:
  • clinical features:
  • imaging features:
  • gross pathology:
  • microscopic pathology:
  • staging and prognosis:
A

-incidence: Most common type, accounting for 70% to 80% of renal cell cancers, males > females

-clinical features:Clinical:
o Hematuria
o Arises in the renal cortex, has a propensity to invade the renal vein and can extend
into the inferior vena cava up to the heart.
o Regional lymph nodes may be enlarged. Hematogenous spread to lungs may occur

-imaging features:
o Ball-like mass of renal cortex
o Engorged, tumor-filled renal vein with extension to inferior vena cava
o Look for metastatic disease

-gross pathology:
o Most often as single tumor, somewhat spherical, yellowish gray mass, variegated appearance, focal hemorrhage, 20% are cystic

  • microscopic pathology: three cell types are generally recognized -clear, granular, and spindle
  • staging and prognosis: ~5 year survival rate
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12
Q

Renal Medullary Carcinoma

  • incidence:
  • clinical features:
  • imaging features:
  • urinary findings:
  • gross pathology:
  • microscopic pathology:
  • staging and prognosis:
A
  • incidence:
  • clinical features:
  • imaging features:
  • urinary findings:
  • gross pathology:
  • microscopic pathology:
  • staging and prognosis:
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13
Q

Chromophobe Renal Carcinoma

A
  • incidence: Represents 5% of renal cell cancers
  • microscopic pathology: Cells with prominent cell membranes and pale eosinophilic cytoplasm, usually with a halo around the nucleus. Histologic distinction from oncocytoma can be difficult
  • staging and prognosis: Excellent compared with that of the clear cell and papillary cancers
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14
Q

Chromophobe Renal (Bellini Duct) Carcinoma

  • incidence
  • pathology
  • prognosis:
A
  • incidence: 1% or less of renal epithelial neoplasms
  • microscopic pathology:Nests of malignant cells enmeshed within a prominent fibrotic stroma, typically in a medullary location
  • staging and prognosis: Associated with aggressive behavior and poor prognosis. For the majority of patients surgical treatment will not result in a cure, early detection is key
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15
Q

Familial Renal Cell Carcinoma (RCC)

A
  • incidence: 4% of renal cell cancers
  • associated with Von-Hippel-Lindau syndrome
  • clinical findings: hemangioblastomas of the cerebellum and retina, develop renal cysts and bilateral, often multiple, renal cell carcinomas
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