Urinary pathology

Question 1

Pyelonephritis

Answer 1

Inflammation/infection of the renal cortex and interstitium

Possible dysuria and frequency
Fever and chills, N/V, flank pain, CVA tenderness

Chronic pyelonephritis assoc w/ recurrent acute pyelonephritis, kidney stones, or vesicoureteral reflux

Thyroidization of kidney – tubules fill w/ eosinophilic casts resembling colloid

Question 2

Simple vs complex renal cysts

Answer 2

Simple:
fluid filled
asx
inconsequential
peripheral

Complex:
solid component
separations
serial imaging needed
surgical removal

Question 3

Autosomal dominant polycystic kidney disease (ADPKD)

Answer 3

presents in adulthood

PKD1 on Chr 16 or PKD2 on Chr 4

numbers b/l renal cysts with massive enlargement of the kidney

HTN
progressive renal insufficiency -> ESRD
hemorrhage into cysts -> flank pain +/- hematuria

increased risk of kidney stones and UTI

Assoc w/ hepatic cysts, intracranial aneurysm, mitral valve prolapse

Question 4

Autosomal recessive polycystic kidney disease (ARPKD)

Answer 4

PKHD1 on Chr 6

Presents in infancy or dx on prenatal u/s

b/l renal cysts, enlarged and echogenic kidneys

Oliguria -> oligohydramnios -> Potter sequence
HTN, renal insufficiency, hepatomegaly

Question 5

Autosomal dominant tubulointerstitial kidney disease (aka medullary cystic kidney disease)

Answer 5

AD

small, shrunken kidneys and interstitial fibrosis

rarely produces cysts in renal medulla

progressive renal failure

Question 6

Calcium oxalate stones

Answer 6

MC

hypercalcinuria
hyperoxaluria
-ethylene glycol ingestion
-crohn's dz
hypocitraturia
Vit C ingestion

Radioopaque on XR

Envelope shape

Prevent w/ thiazine diuretics

Question 7

Struvite stones (NH4MgPO4)

Answer 7

urease-positive bacteria

• proteus mirabilis pH >8
• Klebsiella
• S. saprophyticus

Radiopaque staghorn calculi

coffin lid shape

eradicate infection to prevent

Question 8

Cystine stones

Answer 8

hereditary impairment of cystine reabsorption -> cystinuria

presents in childhood

Radiolucent staghorn calculi

hexagon shape

aklalinize urine to prevent

Question 9

uric acid stones

Answer 9

hyperuricemia and gout

radiolucent

rhombus or rosette shape

allopurinol prevention

Question 10

Renal cell carcinoma

Answer 10

MC primary renal malignancy

arise from PCT in the cortex

Risfactors:
mean 50-70, smoking, obesity, htn

deletion on Chr 3
-sporadic or part of von Hippel-Lindau disease

often asx, incidental finding

classic triad: flank pain, hematuria, palpable abdominal mass
-less than 10% of cases

paraneoplastic syndromes: polycythemia, anemia, hypercalcemia

Solid tumor w/ “clear cells” full of lipids/carbohydrates

Question 11

Renal ocnocytoma

Answer 11

benign

densely packed eosinophilic cells
-nests

Question 12

Wilms tumor (nephroblastoma)

Answer 12

MC renal malignancy of early childhood 2-4 yo

palpable abdominal/flank mass
possible abd pain or hematuria

WT1 or WT2 mutation on Chr 11

WAGR complex:
wilms tumor
aniridia
genitourinary malformations - cryptochidism, bicornate uterus
mental Retardation

Question 13

transitional cell carcinoma (urothelial carcinoma)

Answer 13

MC malignancy of the urinary tract

Occur in Renal calyces or pelvis, ureters, and urinary bladder

Painless hematuria

Major risk factors:
Smoking
Aniline dyes
Naphthylamine dyes
cyclophosphamide

Question 14

Squamous cell carcinoma of bladder

Answer 14

Smoking
chronic or recurrent UTIs
bladder stones
cyclophosphamide

Chronic irritation -> metaplasia -> dysplasia -> carcinoma

Schistosoma haematobium
Middle East