5: Pathology 2

Question 1

What is agenesis of the kidneys?

Answer 1

Complete failure of one or both kidneys to develop

Question 2

Hypoplasia describes ___ organs with (normal / abnormal) development.

Answer 2

smaller

normal development

Question 3

Which poles of the kidneys usually fuse to cause horseshoe kidney?

Answer 3

Inferior poles

Question 4

Does horseshoe kidney affect renal function?

Answer 4

Usually not

but can obstruct ureters

Question 5

Congenital abnormalities of the kidney predispose you to ___.

Answer 5

UTIs

Question 6

What neurological presentation is associated with renal agenesis?

Answer 6

Oligohydramnios

Low volume of amniotic fluid in the placenta

Question 7

What abnormal facial appearance is associated with oligohydramnios?

Which congenital renal disorder causes it?

Answer 7

Potter’s facies - low set ears, small jaw, flattened tip of the nose

Renal agenesis

Question 8

What type of kidney disease, with a characteristic appearance, is very common?

Answer 8

Cystic kidney disease

Question 9

What can cysts contain?

Answer 9

Serous fluid

Question 10

Why may cystic kidney disease cause abdominal pain?

Answer 10

Ruptured cysts

Question 11

What are the two types of polycystic kidney disease and how are they inherited?

Answer 11

a) Autosomal dominant PKD - adults, PKD1 on chromosome 16

b) Autosomal recessive PKD - kids, PKDH1, chromosome 6

Question 12

Is polycystic kidney disease unilateral or bilateral?

Answer 12

Bilateral

Question 13

What happens to the kidneys in

a) ADPKD
b) ARPKD?

Answer 13

a) Hyperplasia, damage to tubules

b) Hypoplasia, damage to collecting ducts, fibrosis

Question 14

What is a characteristic feature of ARPKD?

Answer 14

Hypoplasia due to fibrosis

Question 15

What are the symptoms of polycystic kidney disease?

Answer 15

Haematuria

Polyuria

Chronic loin pain

Hypertension

Question 16

Because ADPKD causes hyperplasia, what may be seen on examination?

Answer 16

Abdominal mass

Question 17

What neuro presentation is associated with ADPKD?

Answer 17

Subarachnoid haemorrhage

Question 18

What diseases are associated with

a) ADPKD
b) ARPKD?

Answer 18

a) Loads - subarachnoid haemorrhage, valve disease, diverticulae and hernia

b) Fibrosis of kidneys

Question 19

What are the most common benign kidney tumours?

Answer 19

Fibromas

Question 20

What do fibromas look like?

Answer 20

White

Found in renal medulla

Question 21

What do adenomas look like?

Where in the kidneys are they found?

Answer 21

Yellow

Adrenal cortex

Question 22

What benign kidney tumours are found in tuberous sclerosis?

Answer 22

Angiomyolipoma

blood vessels, muscles and fat

Question 23

Which benign kidney tumours produce renin?

What systemic disease can this cause?

Answer 23

Juxtaglomerular cell tumours

Secondary hypertension

Question 24

What is the commonest malignant kidney tumour in children?

Answer 24

Nephroblastoma

arises from embryological tissue

Question 25

What is the **commonest malignant kidney tumour** found in adults?

Answer 25

**Renal cell carcinoma**

Question 26

**(Men / women)** are at greater risk of RCC.

Answer 26

**Men**

Question 27

What are the symptoms of RCC?

Answer 27

**Abdomnal mass** **Haematuria** **Loin pain** Weight loss, anorexia, fever, fatigue

Question 28

What is **polycythaemia**?

Answer 28

**Increased number of red cells**

Question 29

Why do patients with RCC develop a) **polycythaemia** b) **hypercalcaemia**?

Answer 29

**a) Overproduction of EPO** **b) Overproduction of calcitriol (activated Vitamin D)**

Question 30

Where do RCCs tend to be found?

Answer 30

**Renal cortex**

Question 31

By which vessels can RCCs spread?

Answer 31

**Renal vein**

Question 32

What specific type of RCC is the most common?

Answer 32

**Clear cell RCC**

Question 33

RCCs tend to spread **(haematogenously / lymphatically)**.

Answer 33

**haematogenously**

Question 34

What is seen on histology in RCC?

Answer 34

**Cysts** **Haemorrhage** **Necrosis**

Question 35

Which malignant tumour arises from the **urothelium**?

Answer 35

**Transitional cell carcinoma**

Question 36

Where can **transitional cell carcinomas** be found?

Answer 36

**Renal pelvis** to **Urethra**

Question 37

Which tumour is most commonly found in the **bladder?**

Answer 37

**Transitional cell carcinoma**

Question 38

What are major risk factors for **transitional cell carcinoma**?

Answer 38

**Industrial** - work with **dyes, rubber** **Smoking** **Drugs** - cyclophosphamide, analgesia **Schistosomiasis infection**

Question 39

What is the biggest risk factor for **transitional cell carcinoma**?

Answer 39

**Smoking**

Question 40

What is the main presenting complaint of **transitional cell carcinoma**?

Answer 40

**Haematuria**

Question 41

As **transitional cell carcinoma** can be found in the bladder, what problem may it cause?

Answer 41

**Obstruction**

Question 42

What do **low-grade TCCs** look like? What do **high-grade TCCs** look like?

Answer 42

**Papillary** - like hairs ## Footnote **Solid**

Question 43

How is **TCC** investigated?

Answer 43

**Cystoscopy** or urography/USS kidneys, depends on where it is

Question 44

Which **lymph nodes** may TCCs spread to?

Answer 44

**Obturator nodes**

Question 45

TCC is staged by its invasion of which structures?

Answer 45

**Muscle** **Blood vessels** **Lymph nodes**

Question 46

Which **malignant** tumours are associated with a) glandular metaplasia b) squamous metaplasia?

Answer 46

**a) Adenocarcinoma** **b) Squamous cell carcinoma**

Question 47

What is the commonest **malignant** urinary tract tumour in children?

Answer 47

**Rhabdomyosarcoma** malignant tumour of skeletal muscle