Diseases of the Renal System 2

Question 1

Causes of obstructive uropathy in the pelvis and kidney

Answer 1

Calculi
Tumours
Stictures

Question 2

dilated calyces, dilated pelvis, corticol atrophy

Answer 2

Hydronephrosis

Question 3

A type of obstruction with pain and acute renal failure and anuria

Answer 3

Acute bilateral obstruction

Question 4

A type of obstruction which is asymptomatic initially with corticol atrophy and decreased renal function

Answer 4

Chronic unilateral obstruction

Question 5

A type of obstruction which is initially polyuric with progressive renal scarring and impairment

Answer 5

Bilateral partial obstruction

Question 6

Another name for renal calculi

Answer 6

Urolithiasias

Question 7

Are renal calculi more common in males or females?

Answer 7

Males

Question 8

4 causes of renal calculi

Answer 8

Excess of substances
Change in urine constituents
Supersaturation
Decreased citrate levels

Question 9

Why does decreased citrate levels predispose you to renal calculi?

Answer 9

Citrate combines with Ca2+ and prevents calcification.

Question 10

Not peeing for a long tiem

Answer 10

Supersaturation

Question 11

What conditions can cause renal calculi though precipitation of excess substances?

Answer 11

Bone disease
Increased PTH
Sarcoidosis

Question 12

Name 4 things that renal calculi can be made of

Answer 12

Calcium (70%)
Struvite-produced by bacteria
Urate stones-uric acid
cystine stone

Question 13

Describe the pathogenesis of struvite stones

Answer 13

Urease producing bacterial infection-converts urea to ammonia.
Ammonia increases the urine pH
Precipitation of magnesium ammonium phosphate salts

Question 14

What component are struvite stones made out of?

Answer 14

Magnesium ammonium phosphate salts

Question 15

Describe the calculi that form from struvite

Answer 15

Large ‘staghorn’ calculi

Question 16

Who is predisposed to developing urate stones?

Answer 16

People with hyperuricaemia (a consequence of gout or patients with a high cell turnover e.g. leukaemia)

Question 17

What kidney stones do you get if you can’t reabsorb amino acids?

Answer 17

Cysteine stones

Question 18

3 ways you can investigate for renal calculi

Answer 18

Non-contrast CT scanning
Ultrasound in pregnancy where CT is not possible
IV urography- inject dye

Question 19

4 complications of renal calculi

Answer 19

Obstruction
Haematuria-destroys lining of endothelium
Infection
Squamous metaplasia-chronic irritation. Precursor for squamous cell carcinoma

Question 20

What is the most common type of renal cell carcinoma

Answer 20

Clear cell

Question 21

Apart from clear cell, name 2 other types of renal cell carcinoma

Answer 21

Papillary

chromophobe

Question 22

Is renal cell carcinoma more common in males or females?

Answer 22

Males

Question 23

What are the main risk factors for renal cell carcinoma

Answer 23

Smoking
obesity
hypertension
oestrogens
acquired cystic kidney disease
asbestos exposure

Question 24

A genetic disease associated with renal cell carcinoma, especially clear cell

Answer 24

Von Hippel Lindau Syndrome

Question 25

Von Hippel Lindau syndrome is a malfunction of what gene?

Answer 25

VHL gene required for breakdown of hypoxia-inducible factor 1 (HIF-1) tumour suppressor gene. Loss of gene function causes cell growth and T cell survival (Von Hippel in Hifi)

Question 26

Where do tumours commonly develop in Von Hippel lindae syndrome

Answer 26

Kidneys, blood vessels, pancreas

Question 27

How does renal cell carcinoma present

Answer 27

``` Haematuria palpable abdominal mass costovertebral pain If late presentation-systemic symptoms or metaplasia paraneoplastic syndromes ```

Question 28

what paraneoplastic symptoms are seen in renal cell carcinoma

Answer 28

Cushings-ACTH Hypercalcaemia-PTH Polycythaesia-erythropoietin

Question 29

Describe the morphology of clear cell carcinoma

Answer 29

Clear cells- nucleus/cytoplasm are dissolved during processing Well defined yellow, often with haemorrhagic areas May extend into perinephric fat or into renal vein

Question 30

Describe the morphology of papillary carcinomas

Answer 30

More cystic, multiple, bilateral Cuboidal, foamy cells. Surround fibrovascular cores often containing foamy macrophages or calcium

Question 31

Prognosis with renal cell carcinoma

Answer 31

Chemo-resistant-v.poor prognosis with metastases

Question 32

Where do 95% urothelial cell carcinomas develop

Answer 32

Bladder

Question 33

Risk factors for urothelial cell carcinomas

Answer 33

Age Male Carcinogens (smoking, cylamines, radiotherapy)

Question 34

Presentation of urothelial carcinomas

Answer 34

Haematuria Urinary frequency Pain on urination Urinary tract obstruction

Question 35

What are the 2 types of urothelial carcinomas

Answer 35

Papillary (more common) | Flat (usually high grade)

Question 36

If the tumour invades the muscularis propria (T2) of the bladder, what is the treatment

Answer 36

Resect bladder

Question 37

Prognosis for urothelial carcinomas

Answer 37

Recurrences are common | Cytoscopy-regular follow up