Diseases of urinary tract 2

Question 1

What are the common causes of obstruction at the renal pelvis?

Answer 1

Calculi - renal stone

Tumour

Ureteropelvic stricture

Question 2

What stones are large, difficult to remove and have to be broken down?

Answer 2

Staghorn

Question 3

What are the main intrinsic causes of acute obstruction at the level of the ureter?

Answer 3

Calculi

Tumours

Slough (from inflammation)

Clots (usually road traffic accidents)

Question 4

What type of obstructions are there?

Answer 4

Intrinsic

Extrinsic - from outside the ureter

Question 5

What are the main extrinsic causes of obstruction at level of ureter?

Answer 5

Pregnancy

Tumours e.g. cervix

Retriponeal fibrosis

Question 6

What is vesicoureteral reflux?

Answer 6

Usually occurs in young gilder (male, congenital)

Reflux of urine due to dysfunction; ureteral valves)

Question 7

What is an important cause of obstruction in older males? (>60yrs)

Answer 7

Prostate - hyperplasia, carcinoma, prostatitis - constricts urethra

Question 8

What happens if there is an obstruction at level of urethra?

Answer 8

Whole system gets dilated (children)

Question 9

Name a functional cause of renal obstruction?

Answer 9

Neurological conditions e.g. spinal cord injury

Question 10

What are the main sequelae of renal obstruction and renal stasis?

Answer 10

Stone/calculi formation

Urinary tract infection - cystitis, pyelonephritis

Kidney damage

Question 11

What can obstruction at the urethral level cause? What it caused by?

Answer 11

Bladder hypertrophy (detrusor hypertrophy)

Due to prostatic hyperplasia

Question 12

What is the main consequence of obstruction to the kidney? Whats it characterised by?

Answer 12

Hydronephrosis

• Cortical atrophy
• Dilated pelvis and calyces

Question 13

What can acute complete obstruction cause to the kidney? How is it characterised?

Answer 13

Can reduce GFR and cause acute renal failure

Mild hydronephrosis mild dilatation of pelvis and calyces (not enough time for large dilation)

Question 14

What can chronic intermitted obstruction cause to the kidney? How is it characterised?

Answer 14

Eventual (slow) cortical atrophy, reduced renal filtration and renal failure

Question 15

What are the clinic features of complete acute obstruction?

Answer 15

• Acute renal failure
• Anuria
• Pain (VERY)

Question 16

What are the clinical features of chronic unilateral obstruction?

Answer 16

• asymptomatic

- Eventual cortical atrophy and reduced renal function

Question 17

What are the features of bilateral partial obstruction?

Answer 17

Polyuria and progressive scarring/reduced function

Question 18

What is the pathogenesis for renl calculi?

Answer 18

Excess substances in URINE precipitating out e.g. calcium

Change in urine constituents causing substance precipitation e.g. pH

Poor urine output - supersaturation

• reduced citrate

Question 19

What are the main types of renal stones that can occur?

Answer 19

Calcium (80%)

Struvite (15%) - infections (staghorn)

Urate (5%) - acidic urine

Cystine (1%)

Question 20

What are the main causes of calcium stones?

Answer 20

• Hypercalcaemia due to bone disease, excessive PTH, sarcoidosis
• Excessive Ca absorption from intestine
• Inability to reabsorb tubular Ca

Idiopathic

Gout - allows Ca to accumulate!

Question 21

Whats the pathogenesis of struvite stones?

Answer 21

Urease producing bacteria infection -> convert urea to ammonium -> increases urine pH -> precipitates Mg ammonium phosphate salts -> stag horn stones

Question 22

What are the main cause of urate stones?

Answer 22

Gout -Hyperuricaemia

Idiopathic

Question 23

What are the main cause of cystine stones?

Answer 23

Rare

Inability of kidneys to reabsorb AAs

Question 24

What is the gold standard means of investigating for renal calculi?

Answer 24

Non-contrast CT scan

Question 25

What are the sequelae of renal calculi?

Answer 25

Obstruction Haematuria Infection Squamous metaplasia (squamous cell carcinoma)

Question 26

What is the most common type of renal carcinoma?

Answer 26

Clear cell carcinoma

Question 27

What is the most important risk factor for renal carcinoma?

Answer 27

- TOBACCO - obesity - hypertension - oestrogen - Acquired cystic kidney disease - asbestos exposure

Question 28

What is the most common cancer syndrome observed in renal cell carcinoma?

Answer 28

Von Hippel Lindau syndrome

Question 29

What are the clinical presentations of renal cell carcinoma?

Answer 29

Haematuria Palpable ab mass Vertebral pain MOSTLY INCIDENTAL finding Metastasis Paraneoplastic syndromes

Question 30

Provides some examples of paraneoplastic syndromes associated with RCC

Answer 30

Cushing syndrome - ACTH Hypercalcamia - PTH Polycythaemia - EPO production

Question 31

What is the characteristics of a clear cell carcinoma?

Answer 31

Well defined, yellow tumour Often with haemorrhagic areas May extend into perinephric fat or into renal vein (poorer prognosis)

Question 32

Where do the majority of urothelial cell carcinomas arise?

Answer 32

Most commonly bladder but can come from the renal pelvis to urethra

Question 33

What is the most common risk factor for urothelial carcinoma?

Answer 33

Smoking

Question 34

How do urothelial cancers present?

Answer 34

Haematuria Urinary frequency Pain on urination Urinary tract obstruction

Question 35

What if the cancer has invaded the lamina propria, what is the treatment?

Answer 35

Removal of the bladder (resection if lower)