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Flashcards in diseases of the urinary system 2 Deck (38):
1

Pelvic causes of urinary tract obstructions

renal stones
renal strictures
renal tumours
stag-horn calculi

2

Intrinsic causes of urinary tract obstructions

calculi
tumour
clots
sloughed papillae
inflammation

3

Extrinsic causes of urinary tract obstructions

pregnancy- obstruction of distal ureter due to utreus and prostaglandins.
tumour- e.g. cervical

4

bladder causes of urinary tract obstructions

calculi
tumours
viscioureteral reflux- valve doesn't work so when the bladder is full urine passes back up the ureter.

5

urethral causes of urinary tract obstructions

valave stricture

6

prostatic causes of urinary tract obstructions

hyperplasia, carcinoma, prostatins.

7

what are the 4 categories of obstructions in any environment

obstruction within lumen
abnormalities of the wall
external compression
functional obstruction

8

define sequeale

a condition which is the consequence of previous disease or injury.

9

what are the consequences of a complete obstruction.

Reduced glomerular filtration rate and mild dilation and cortical atrophy
Acute renal failure.

10

what are the consequences of intermittent obstruction

Filtrate will pass back into the interstitum
Compress the medulla, impairing concentrating ability
Cortical atrophy, fall in renal filtration and renal failure.

OR

Continued glomerular filtration
Dilation of the pelvis and calyces
Cortical atrophy, fall in renal filtration and renal failure.

11

clinical features of acute bilateral obstruction.

pain, acute renal failure and anuria.

12

clinical features of chronic unilateral obstruction.

asymptomatic initially, if unresolved cortical atrophy and reduced renal function.

13

are males or females more likely to get renal calculi

males

14

pathogenesis of renal calculi

Either due to excess of substances which precipitate out e.g. Ca +.
OR
A change in the urine constituents causing precipitation of substances e.g. change in pH.

15

what is the most common type of renal stone

calcium

16

what causes excess calcium to be present.

hypercalcemia- bone disease, excess PTH and sacrodosis,
excessive absorption of intestinal calcium
inability to resorb tubular calcium
idiopathic

17

pathogenesis of striate stones formation

Urease producing bacterial infection (proteus)
Urease converts urea to ammonia
Cause a rise in urine pH.
Precipitation of magnesium ammonium phosphate salts
Large “staghorn” calculi.

18

pathogenesis of urate stones

Hyperuricaemia- gout, high cell turnover (leukaemia), idiopathic

19

pathogenesis of cystine stones

Occur in the presence of an inability of kidneys to reabsorb amino acids.

20

what investigations are carried out for renal caliculi

Non-contrast CT scanning
ultrasound (if CT not possible)
Intraveous urography.

21

sequalae to renal stones

obstruction, haematuria, infections, squamous metaplasia precursor.

22

what cell type are the majority of renal carcinomas

clear cell.

23

what are the risk factors of renal cell carcinoma

tobacco, obesity, hypertension, oestrogen's, acquired cystic kidney disease
asbestos exposure.

24

define von hippel-Lindau syndrome.

most common renal cell carcinoma

25

pathogenesis of von hippel linadau syndromes

VHL gene required for breakdown of Hypoxia Inducible Factor-1 (HIF-1) oncogene
Loss of gene function causes cell growth and increased cell survival
Tumours develop in kidneys, blood vessels, pancreas
VHL mutations also commonly identified in clear cell RCC

26

clinical presentation of the von hippel liandau syndrome

local symptoms- haematuria, palpable abdominal mass, costovertebral pain/
paraneoplastic syndromes

27

paraneoplastic syndromes associated with renal cell carcinoma

Cushings- ACTH
Hypercalcaemia- parathyroid hormone related peptide.
Polycythemia- erthropoietin.

28

morphology of renal cell carcinoma

clear cell- well-defined yellow tumours, often with haemorrhagic areas, may extend to peripnephric fat or renal vein.
Papillary- more cystic, more likely to be multiple.

29

microscopy of a clear cell

Clear cells, Delicate vasculature, small bland nuclei

30

microscopy of papillary tumours

Cuboidal, foamy cells, surrounding fibro vascular cores often containing foamy macrophages or calcium.

31

urothelial cell carcinoma can affect what aspects of the urinary tract

Urothelial lining is over, ureter, bladder and the pelvis.

32

most common site for urothelial cell carcinoma

bladder

33

risk factors for urothelial cancer

age
gender- more common in males

34

carcinogens which cause urothelial cancer

smoking, aryl amines, cyclophosphamide, radiotherapy.

35

diagnosis of urothelial cancer

cytoscopy

36

clinical presentation of urothelial cancer

haematuria, urinary grequency, pain on urination, urinary tract obstruction

37

prognosis of urothelial cancer

recurrence common
out come depends on grade and stage

38

prognosis of renal clear cell carcinoma

5 years, but depends or whether the carcinoma is organ confined, tumour extends into perinephric fat and renal vein and whether it metastasises distally.