Genitourinary 1

Question 1

vitamin D

Answer 1

absorption of Calcium

Question 2

renal activation of vit D

Answer 2

secondary to hyperparathyroidism and bone disease (renal osteodystrophy) w/out kidney

Question 3

renal osteodystrophy

Answer 3

bone mineralization deficiency

Question 4

nephrotic syndrome

Answer 4

• glomerular filtration increases
• abnormality in GBM/mesangium
• glomerulus loses capacity for selective retention of proteins in blood

Question 5

nephrotic syndrome leads to

Answer 5

1 proteinemia (mostly albumin)
2 hypoalbuminemia causing generalized edema by decreasing plasma colloid pressure or oncotic pressure
3 hyperlipidemia bc of reduced serum apolipoproteins (proteins that bind lipids)

Question 6

nephritic syndrome

Answer 6

• disturbance of glomerular structure that involves reactive cellular proliferation
• reduced glomerular flow
• oliguria, hematuria, proteinuria, uremia (retention of waste prdts)
• activation of renin-angeiotensin system w/ fluid retension and mild hypertension
• mild edema, not as prevalent as nephrotic syndrome

Question 7

glomerular perfusion failure

Answer 7

nephritic syndrome

Question 8

3 signs of nephrotic syndrome

Answer 8

1 massive proteinuria
2 hypoalbuminemia
3 generalized edema

Question 9

Interruption of the capillary walls of the glomeruli which leads to increase permeability of plasma proteins leads to

Answer 9

nephrotic syndrome

Question 10

structural or physiochemical alteration of the GBM allows protein to escape from blood…this occurs in

Answer 10

nephrotic syndrome

Question 11

edema

Answer 11

extension of salt and water in kidneys

Question 12

Good pasture syndrome

Answer 12

a rare autoimmune disease in which antibodies attack the basement membrane in lungs and kidneys, leading to bleeding from lungs and to kidney failure

Question 13

primary causes of nephrotic syndrome

Answer 13

1 minimal change nephropathy - everything looks normal under a microscope but in an electron microscope, there’s a problem with the nephrons
2. membranous neuropathy- slowly progressive disease of the kidney affecting adults 30-50 yrs

Question 14

membranous nephropathy

Answer 14

• slowly progressive
• 30-60 yrs
• subepithelial Ig deposits along GBM, -thickening capillary wall
• 85% idiopathic
• antibodies reacting to endogenous or implanted glomerular antigens

Question 15

minimal change nephropathy (lipid nephropathy)

Answer 15

1 pathology is detected only w/ electron microscope

2 T cells produce a cytokine that attacks foot processes and nephrins so proteins can seep through

Question 16

Nephritic syndrome**

Answer 16

1 hematuria= elevation of blood urea
2 azotemia= high creatine or N-compds in blood
3 oliguria= little urine
4 crescent shaped

Question 17

what has an acute onset, hypertension, and proteinuria, but not like nephrotic

Answer 17

nephritic syndrome!

Question 18

chronic glomerulonephritis**

Answer 18

develops insidiously, discovered late in its course after onset of renal insufficiency, compensatory metabolic regulation hides the disease until late

Question 19

nephritic vs. nephrotic

Answer 19

nephritic= acute diffuse proliferative glomerulonephritis, crescent glomerulonephritis
nephrotic= membranous glomerulopathy and minimal change glomerulopathy

Question 20

Glomerular diseases

Answer 20

• structural changes in GBM

- damage to both basement membrane and cell proliferation (mixed nephritic and nephrotic syndrome)

Question 21

benign nephrosclerosis

Answer 21

1. hyaline thickening of small arteries and arterioles
2. leads to decreased blood flow
3. ischemia + diffuse tubular atrophy

Question 22

malignant nephrosclerosis

Answer 22

1. leads to malignant hypertension
2. rapid increase in BP
3. the glomerular capillary netowrk–> segmental tufts necrosis

Question 23

fibrinoid necrosis

Answer 23

looks like onion skin, malignant hypertension or malignant nephrosclerosis

Question 24

most common cause of renal infarction

Answer 24

1 emboli going down renal arterial branches like emboli from a mural thrombus (recent MI)
2 thrombotic vegetations on mitral/aortic valves /prosthesis
3 thrombus from left atrium of patients with atrial fibrillation

Question 25

wedge shaped subscapular areas of necrosis with broad base at capsular surface

Answer 25

renal infarction

Question 26

wedges of renal infarction

Answer 26

- first, wedge intially red and slightly raised - 4-5 days later, wedge is yellow white center with rim of hyperemia - old infarcts are narrow, wedge shaped, depressed sacs

Question 27

**what is the most common cause of end stage renal disease?

Answer 27

diabetusssss!

Question 28

complications of diabetic vascular disease

Answer 28

1 increase severity of small, med, large arteries (general renal ischemia) 2 hyaline atherosclerosis in afferent arterioles (ischemic glomerular damage)

Question 29

diabetic glomerular damage

Answer 29

red stained coagulated fibrin protein ("protein cap") on the surface of glomerulus

Question 30

kimmelstiel-wilson nodules only seen in

Answer 30

Diabetes!!!

Question 31

kimmelstiel wilson nodules description

Answer 31

excess mesangial matrix formation first as an even pattern throughout the glomerulus, but later as laminated spheres or nodules

Question 32

diabetic renal disease

Answer 32

- BM thickens - exudative lesions as fibrin like material (fibrin caps - fibrin caps over tips of glomerular capillary loops

Question 33

adult polycystic disease

Answer 33

autosomal dom, manifestation in adults, 2 genes on chrom #2 and #16, kidneys enlarged bilaterally, partial parenchyma replaced w/ cysts

Question 34

In what disease do cysts enlarge over the years but are asymptomatic until # and size become so great that abdominal mass is observed

Answer 34

adult polycystic disease

Question 35

Wilm's tumor

Answer 35

nephroblastoma, tumor of kidney in children (1-4 yrs)

Question 36

renal adenocarcinoma symptoms

Answer 36

hematuria (blood in urine) flank pain (dull pain in lower part of body) after 50 years; men -palpable mass

Question 37

renal adenocarcinoma

Answer 37

1. 90% of primary malignant renal tumors in adults 2. from tubular epithelium 3. majority are sporadic 4. molecular classification advances help us understand etiology, often in poles (especially upper)

Question 38

gross renal adenocarcinoma

Answer 38

round, yellow cut surface w/ hemorrhage + necorsis

Question 39

histiology of renal adenocarcinoma (SEEN IN ADULTS)

Answer 39

polygonal clear cell

Question 40

Wilms tumor description

Answer 40

from primitive metanephros w/ at least 3 diff genetic alterations - less frequently hematuria - abdominal palpable, often huge mass

Question 41

reflux nephropathy

Answer 41

- chronic reflux- associated pyelonephritis - scarring and atrophy results from superimposition of a UTI on congenital vesiculouretal reflux - unilateral or bilateral

Question 42

vesiculouretal reflux

Answer 42

constant UTI b/c valves stop functioning

Question 43

**What is the most comomn cause of acute renal failure?

Answer 43

acute tubular necrosis

Question 44

*How old is the peak incidence of Wilm's tumor?

Answer 44

peaks incidence 1-4 yrs (children!)

Question 45

glomerular damage associated with proliferation of endothelial or mesangial cells is associated with

Answer 45

microhematuria or nephritic syndrome

Question 46

deposition of excessive mesangial matrix leads to

Answer 46

abnormal loss of protein in urine or to nephrotic syndrome

Question 47

If glomerular damage is RAPID, what develops?

Answer 47

acute renal failure

Question 48

diverticula of urethra

Answer 48

outpouching of bladder mucosa

Question 49

megaureter

Answer 49

enlarged ureter, dilated, dilation of pelvicalyceal system (dydronephrosis)

Question 50

end stage hydronephrosis

Answer 50

- unilateral obstruction of ureter | - renal fxn maintained by nonobstructed kidney

Question 51

bilateral obstruction

Answer 51

usually w/ lesions of bladder base or retroperitonial tissues

Question 52

What occurs before severe atrophy of both kidneys?

Answer 52

renal failure

Question 53

bilateral kidney obstruction also predisposes to

Answer 53

infection and stone formation

Question 54

urinary calculi

Answer 54

kidney stones

Question 55

predisposing factors of urolithiasis

Answer 55

1. increase solute in urine 2. metabolite or low fluid 3. reduced solubility bc abnormal PH 4. stony concentrations in bladde or urinary tract

Question 56

What is the second most common type of urinary calculi made of ?

Answer 56

struvite ( Mg, NH4+, Calcium Phosphate)

Question 57

What is the most common symptom of transitional cell carcinoma of the bladder ?

Answer 57

hematuria

Question 58

transitional cell carcinoma of the bladder

Answer 58

- most common tumor of urinary collecting system (calyces, pelvis, ureter, bladder) - often multifocal

Question 59

What causes transitional cell carcinoma of the bladder?

Answer 59

environmental agents excreted in high concentration in urine like aniline dye, cigarettes, cyclophosphamide

Question 60

are multiple tumors common in transitional cell carcinoma of the bladder

Answer 60

yes, field change in all of urothelium so multiple tumors are common

Question 61

what is the men:female of transitional cell carcinoma of the bladder

Answer 61

3:1

Question 62

what is the growth pattern of transitional cell carcinoma of the bladder

Answer 62

papillary growth pattern with cauliflower appearance

Question 63

Susceptibilities of nephrotic syndrome

Answer 63

1 susceptibility of infection b/c low Ig and complement | 2 susceptibility to thrombosis bc increased fibrinogen in blood

Question 64

most frequent cause of nephrotic syndrome in children

Answer 64

minimal change nephropathy (lipid nephropathy)

Question 65

What does malignant nephrosclerosis do to large muscular vessels?

Answer 65

large muscular vessels w/ loose fibroelastic proliferation of the intima- the afferent arterioles exposed to sudden high prressure frequently undergo necrosis, w/ fibrin in damaged walls (fibrinoid necrosis)

Question 66

acute renal failure- when sufficient nephrons are destroyed (damage to tufts and afferent arterioles) leads to

Answer 66

malignant nephrosclerosis

Question 67

What nodules are seen in diabetic renal disease?

Answer 67

kimmelstiel wilson nodules

Question 68

infarction

Answer 68

is tissue death (necrosis) caused by a local lack of oxygen, due to an obstruction of the tissue's blood supply