Day 12 5/29/15 Flashcards Preview

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Flashcards in Day 12 5/29/15 Deck (15):
1

UTI Routes of Infection

-ascending infection (70%)
-hematogenous infection

2

UTI Organism Virulence Factors

-bacterial adhesion: pili
-"O" antigens (certain strains are more resistent)
-endotoxin: dec. ureteric perstalsis

3

UTI Host Defense Mechanisms

-mechanical: bladder emptying, ureteric peristalsis, mucus

-chemical: prostatic secretions, urine osmolality, blood groups Ag's

-immunological: PMNs, shedding urothelial cells

4

UTI Predisposing Factors

-females>males
-catheterization
-dec. urine flow/urine stasis
-calculi
-vesicoureteral reflux
-immune compromise
-kidey/UT disease
-pregenancy

5

UTI Clinical Manifestations

-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

6

UTI Complications

-recurrence
-acute pyelonephritis
-renal/perinephric abscess
-papillary necrosis (diabetes)
-staghorn calculi (proteus)
-chronic pyelonephritis/renal scarring

7

Chronic Pyelonephritis Causes (2)

-UTI that has reached the kidneys
-urinary tract tract obstruction
-vesicoureteral reflux (VUR)

8

Vesicoureteral Reflux (VUR)

• 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

9

Reflux Nephropathy

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

10

Papillary Renal Cell Carcinoma
-incidence:
-gross pathology:
-microscopic pathology:
-staging and prognosis:

-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

11

Clear Cell Renal Cell Carcinoma
-incidence:
-clinical features:
-imaging features:
-gross pathology:
-microscopic pathology:
-staging and prognosis:

-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

12

Renal Medullary Carcinoma
-incidence:
-clinical features:
-imaging features:
-urinary findings:
-gross pathology:
-microscopic pathology:
-staging and prognosis:

-incidence:
-clinical features:
-imaging features:
-urinary findings:
-gross pathology:
-microscopic pathology:
-staging and prognosis:

13

Chromophobe Renal Carcinoma

-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

14

Chromophobe Renal (Bellini Duct) Carcinoma
-incidence
-pathology
-prognosis:

-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

15

Familial Renal Cell Carcinoma (RCC)

-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