Diseases of the Renal system 2

Question 1

What is obstructive uropathy?

Answer 1

obstruction of the urinary tract
anywhere from the renal pelvis to the urethral meatus
chronic or acute
unilateral or bilateral

Question 2

What are the causes of urinary tract obstruction in the pelvis?

Answer 2

calculi/stones
tumours
ureteropelivic strictures - above becomes distended

Question 3

What are the causes of urinary tract obstruction in the ureter-intrinsic?

Answer 3

calculi
tumours 
clots
sloughed papillae
inflammation

Question 4

What are the causes of urinary tract obstruction in the ureter-extrinsic?

Answer 4

pregnancy
tumours
reteroperitoneal fibrosis

Question 5

What are the causes of urinary tract obstruction in the bladder?

Answer 5

calculi
tumours
functional

Question 6

What are the causes of urinary tract obstruction in the urethra?

Answer 6

posterior valve stricture

tumours (rare)

Question 7

What are the causes of urinary tract obstruction in the prostate?

Answer 7

hyperplasia
carcinoma
prostatitis

Question 8

What is the consequence of obstructions of the urinary tract?

Answer 8

infections e.g. cystitis, pyelonephritis
stones/calculi formation
kidney damage - acute/chronic

Question 9

What can obstruction at the urethral level cause to the detrusor muscle?

Answer 9

hypertrophy and trabeculation

due to bladder contracting hard

Question 10

What is the name of the condition in which the ureter is dilated?

Answer 10

hyroureter

Question 11

What is hydronephrosis?

Answer 11

dilated calyces
dilated pelvis
cortical atrophy - thin cortex

Question 12

What can complete acute obstruction cause to the kidney?

Answer 12

Reduction in glomerular filtration rate
Mild dilatation and mild cortical atrophy
can lead to acute renal failure

Question 13

What can chronic and intermittent obstruction cause to the kidney?

Answer 13

Filtrate passes back into interstitium → Compression of medulla
Impaired concentrating ability → Eventual cortical atrophy, fall in renal filtration and renal failure
OR
Continued glomerular filtration → Dilatation of pelvis+calyces → Eventual cortical atrophy, fall in renal filtration and renal failure

Question 14

What are the clinical features of acute bilateral obstruction?

Answer 14

pain
acute renal failure
anuria - no urine

Question 15

What are the clinical features of chronic unilateral obstruction?

Answer 15

Asymptomatic initially

unresolved = cortical atrophy and reduced renal function

Question 16

What are the clinical features of bilateral partial obstruction?

Answer 16

polyuric

progressive renal scarring and impairment

Question 17

How does Renal calculi/Urolithiasis form?

Answer 17

excess substance precipitates out e.g. Ca2+
change in urine constituents causing precipitation i.e. change in pH
poor urine output
decreased citrate levels

Question 18

How are Renal calculi/Urolithiasis classified?

Answer 18

by composition
e.g. Calcium stones (70%) - calcium oxalate +/- calcium phosphate
Struvite stones (15%) – magnesium ammonium phosphate
Urate stones (5%) – uric acid
Cystine stones (1%)

Question 19

What are the main causes of calcium stones?

Answer 19

hypercaliuria due to:
hypercalcaemia - Bone disease, PTH excess, sarcoidosis
excessive absorption of intestinal Ca+
inability to reabsorb Ca+
idiopathic

Question 20

How does struvite stones produce staghorn calculi?

Answer 20

urease converts urea to ammonia → rise in urine pH → precipitation of magnesium ammonium phosphate salts → staghorn calculi

Question 21

What are the main causes of urate stones?

Answer 21

hyperuriceamia - gout, patients with high cell turnover e.g. leukaemia
idiopathic

Question 22

What are the main causes of cystine stones?

Answer 22

rare

inability for kidney to reabsorb amino acids

Question 23

What investigations are undertaken when suspecting renal calculi?

Answer 23

Non-contrast CT scanning = gold standard
Ultrasound in pregnancy or where CT not possible
Intravenous urography

Question 24

What can renal calculis lead to?

Answer 24

obstruction
haematuria
infection
squamous metaplasia +/- squamous cell carcinoma

Question 25

What are majority of renal cell carcinomas?

Answer 25

clear cell

Question 26

What are the risk factors for renal cell carcinoma?

Answer 26

``` Tobacco Obesity Hypertension Oestrogens Acquired cystic kidney disease (due to chronic renal failure Asbestos exposure ```

Question 27

What is Von Hippel-Lindae Syndrome?

Answer 27

most common cancer syndrome in renal call carcinoma VHL gene affected - controls the breakdown of hypoxia inducible factor 1 oncogene loss of gene causes cell growth and survival common in clear cell renal cell carcinoma tumours in kidneys, blood vessels, pancreas

Question 28

What is the presentation of Von Hippel-Lindae Syndrome?

Answer 28

``` haematuria palpable abdominal mass costovertebral pain systemic symptoms metastases (later) Paraneoplastic syndromes ```

Question 29

What are Paraneoplastic syndromes?

Answer 29

Clinical syndromes caused by tumours e.g. Cushings Not related to the tissue that the tumour arose from but what it secretes Not related to invasion by the tumour itself or its metastases

Question 30

What paraneoplastic syndromes are associated with renal cell carcinomas?

Answer 30

Cushing’s syndrome - produced ACTH Hypercalcaemia - parathyroid hormone related peptide Polycythaemia - Erythropoietin

Question 31

What is the morphology of clear cell renal cell carcinoma?

Answer 31

well defined yellow tumours haemorrhagic areas may extend into perinephric fat/renal vein

Question 32

Where is Urothelial cell Carcinoma located?

Answer 32

Most common in the bladder but may arise anywhere in renal parachyme arise from specialised multilayer epithelium

Question 33

What are the risk factors for urothelial cell carcinomas?

Answer 33

age gender - more common in males carcinogens e.g. smoking, radiotherapy

Question 34

What are the signs and symptoms of urothelial cell carcinomas?

Answer 34

HAEMATURIA - most common urinary frequency pain on urination urinary tract obstruction

Question 35

Which histological patterns of transitional cell carcinoma are non invasive?

Answer 35

papilloma-papillary carcinoma | flat non invasive carcinoma

Question 36

Which histological patterns of transitional cell carcinoma are invasive?

Answer 36

invasive papillary carcinoma | flat invasive carcinoma