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Urinary System > Lecture 9.1: Glomerular Pathology and Malignancies of the Urinary Tract > Flashcards

Lecture 9.1: Glomerular Pathology and Malignancies of the Urinary Tract Flashcards

1
Q

What is Glomerulonephritis (GN)?

A

It is a renal disease characterised by inflammation and damage to the glomeruli

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2
Q

What is the effect of Glomerulonephritis?

A

This glomerular damage allows protein (with or without blood) to leak into the urine (proteinuria and haematuria respectively)

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3
Q

What can Glomerulonephritis present with? (5)

A
  • Isolated Haematuria or Proteinuria
  • Nephrotic Syndrome
  • Nephritic Syndrome
  • Acute Renal Failure
  • Chronic Renal Failure (CKD)
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4
Q

What 2 categories can Glomerulonephritis (GN) can be broadly put into?

A
  • Proliferative Disease
  • Non-Proliferative Disease
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5
Q

Pathophysiology of GN

A

Increased permeability of the glomerulus leading to loss of proteins into the tubules

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6
Q

What does characteristics does Nephrotic Syndrome include (in terms of protein and albumin)?

A
  • Loss of significant volumes of protein via
    the kidneys (proteinuria) which results in
    hypoalbuminaemia
  • The definition of nephrotic syndrome
    includes both massive proteinuria (≥3.5
    g/day) and hypoalbuminaemia (serum
    albumin ≤30 g/L)
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7
Q

What are the other associated symptoms as a result of hypoalbuminaemia?

A
  • Oedema (due to reduced oncotic pressure)
  • Hyperlipidaemia
  • Hypercoagulability
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8
Q

Clinical Symptoms of Nephrotic Syndrome (10)

A
  • Peripheral Oedema (more common in adults)
  • Facial Oedema (more common in children)
  • Frothiness of Urine
  • Fatigue
  • Poor Appetite
  • Recurrent Infections (due to immune dysfunction)
  • Venous or Arterial Thrombosis (e.g. myocardial
    infarction, deep vein thrombosis) due to
    hypercoagulability
  • Oliguria
  • Hypertension
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9
Q

Clinical Signs of Nephrotic Syndrome (4)

A
  • Oedema (e.g. peri-orbital, lower limb,
    ascites)
  • Xanthelasma and/or xanthoma
  • Leukonychia
  • Shortness of breath (with associated chest
    signs of pleural effusion)
  • Uraemia (toxins in urine)
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10
Q

What are typical findings on Urinalysis in the context of Nephrotic Syndrome? (2)

A
  • Proteinuria (protein ++++)
  • Frothy appearance of urine
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11
Q

Pathophysiology of Nephrotic Syndrome

A

Thin glomerular basement membrane with pores that allow protein and blood into the tubule

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12
Q

What are some Red Flags of Malignancy in the Urinary Tract? (10)

A
  • Abdominal Pain
  • Fatigue
  • Lower Back Pain
  • Appetite or Weight Loss
  • Iron Deficiency
  • Haematuria
  • Erectile Dysfunction
  • Change in Bladder Habit
  • Poor Stream
  • Bone Pain
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13
Q

Renal Parenchymal Tumours (2)

A
  • Renal Adenocarcinoma
  • Nephroblastoma Tumour of Childhood
    Known as Wilms’ tumour
  • Metastases
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14
Q

Renal Adenocarcinoma (RCC)

A

Most commonly clear cell cancer, incidental
findings

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15
Q

Risk Factors for RCC

A
  • Smoking
  • Obesity
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16
Q

Classic Triad of RCC

A
  • Haematuria (may produce iron deficient
    anaemia)
  • Loin Pain
  • Palpable Flank Mass
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17
Q

What are Paraneoplastic Syndromes?

A
  • Paraneoplastic syndromes are a group of
    rare disorders that are triggered by an
    abnormal immune system response to a
    cancerous tumour known as a “neoplasm”
  • They are thought to happen when cancer-
    fighting antibodies or WBCs (T-cells)
    mistakenly attack normal cells in the
    nervous system
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18
Q

What is Metastatic Disease/Metastasis?

A
  • It is when cancer cells break away from
    where they first formed (primary cancer)
  • Travel through the blood or lymph system
  • Form new tumours (metastatic tumours)
    in other parts of the body
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19
Q

How often does Paraneoplastic Syndromes occur in RCC?

A

<20%

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20
Q

How often does Metastasis occur in RCC?

A

15-20%

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21
Q

How common is RCC?

A
  • 8th most common cancer in UK
  • 95% of all upper urinary tract tumours
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22
Q

What is Von Hippel-Lindau Syndrome?

A

It is an inherited disorder characterised by the abnormal growth of both benign and cancerous tumours and cysts in many parts of the body

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23
Q

Risk Factors for developing RCC

A
  • Smoking (2x↑)
  • Obesity
  • Dialysis
  • Von Hippel-Lindau Syndrome
  • Familial Inheritance
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24
Q

Mortality of RCC

A
  • 8 in every 10 people live at least a year after
    diagnosis
  • 5 in 10 live at least 10 years
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25
What is Nephritic Syndrome?
* Nephritic syndrome is a condition involving haematuria, mild to moderate proteinuria (typically less than 3.5g/L/day), hypertension, oliguria and red cell casts in the urine * The patient usually has a more prominent creatinine elevation and hypertension as well which helps differentiate it from Nephrotic Syndrome
26
What is Iatrogenic Cushing's Syndrome?
It is usually related to prolonged and/or high-dose oral or parenteral steroid use
27
Iatrogenic Cushing's Syndrome Signs and Symptoms (4)
* Moon-Face * Odema * Purple Stretch Marks * Hair Thinning * Hypokalaemia * Hypernatraemia in blood (as cortisol can mimic effects of aldosterone) * Initial weight-loss * Then central weight gain
28
What is Intravesical BCG?
Chemotherapy injected directly into bladder
29
Why are people with Nephrotic Syndrome given corticosteroid?
In most children with nephrotic syndrome, this protein leak resolves with corticosteroid drugs (prednisone, prednisolone) reducing the risk of serious infection
30
What corticosteroids are prescribed for Nephrotic Syndrome?
* Prednisone * Prednisolone
31
What is the difference between Prednisone and Prednisolone?
Prednisone must be converted by liver enzymes to Prednisolone before it can work
32
Paraneoplastic Syndromes (5)
1) Polycythaemia: due to secretion of erythropoietin 2) Hypercalcaemia: due to secretion of PTH-related peptide 3) Hypertension: due to secretion of renin 4) Neuromyopathy 5) Feminising or masculinising syndromes
33
How is Diagnosis of RCC done? (5)
* Ultrasound * CT scan * MRI * Cystoscopy * Biopsy
34
Treatment of RCC
* Radiation Therapy * Radical Nephrectomy * Partial Nephrectomy * Radio Frequency Ablation or Cryotherapy * Embolisation
35
What is Embolisation?
Embolisation is a procedure to block the blood supply to the tumour, causing it to shrink
36
What is a Nephroblastoma/Wilms' Tumour? What is it caused by?
* A rare kidney cancer that primarily affects children * Caused by a Chromosome 11 abnormality * 80% Present before 5 years of age * Rarely seen after 10 years of age
37
What Symptoms does Nephroblastoma/ Wilms' Tumour present with? (7)
* Large Abdominal Mass * Abdominal Pain * Anaemia * Incidental Finding * Hypertension * Haematuria * Weight Loss
38
Investigations for Nephroblastoma/Wilms' Tumour (4)
* CT Scan * Ultrasound * MRI * Kidney Biopsy
39
What is the Treatment for Nephroblastoma/ Wilms' Tumour?
* Nephrectomy * Chemotherapy
40
What is the Prognosis of Nephroblastoma/ Wilms' Tumour?
* 80% Cured
41
What is another name for Ureteric (Urothelial) Cancer?
Transitional Cell Carcinoma (TCC)
42
Where does Urothelial Carcinoma arise from?
* Arise from the renal pelvis and resemble bladder cancer cells * Urothelium
43
What is the Prevalence of Ureteric (Urothelial) Carcinoma?
* Only <5% of all malignancies of upper urinary tract
44
What are Risk Factors for Ureteric (Urothelial) Carcinoma? (5)
* Smoking * Phenacetin Abuse * Being exposed to certain Dyes * Chemicals used in making leather goods, textiles, plastics, and rubber * Hereditary non-polyposis colorectal cancer
45
What Investigations are done for the Diagnosis of Ureteric (Urothelial) Carcinoma? (6)
* Ultrasound * CT Urogram * Retrograde pyelogram * Ureteroscopy * Biopsy * Washings for cytology lkan’s nephropathy
46
What Key Factor about Haematuria makes it a Red Flag for Malignancy?
Painless haematuria must be treated as urinary tract malignancy until proven otherwise
47
What is the percentage of recurrence of bladder cancer?
50-75%
48
Low Grade Bladder Cancer (T1): How often do they recur? How many progress to invasive tumours? Percentage mortality? Treatment?
* Unlikely to spread further * 70% recur * 10-20% progress to more invasive tumours * Mortality 1-15% * Rx: TURBT + Intravesical cytotoxics (MMC – 60% effective,for high Grade BCG)
49
Moderately Invasive Bladder Cancer (T2-T3): Spread? Treatment?
* Spread to muscle layers * Risk of cancer spreading further to rest of body * Rx= Radical cystectomy +/- radiotherapy, post op chemo or neo-adjuvant chemo
50
High Grade Invasive Bladder Cancer (T4): Spread? Treatment?
* Spread beyond bladder * Mets – pelvic structures, local LN, liver and lungs * Rx: Palliative chemo/radiotherapy * Aim is pain relief and controlling symptoms
51
Prevalence of Prostate Cancer? What type of cancer is it?
* It is the most common type of cancer in men * Prostate cancer is the second most common cause of cancer death in males in the UK (after lung cancer), accounting for 13% of all cancer deaths * 95% are adenocarcinomas
52
What is the PSA Test? Is it good?
* Prostate Specific Antigen Test * PSA is a protein (serine protease) produced by normal and cancerous prostate cells * Not very good as may things can give a postive PSA Tests e.g. injured prostate, benign prostatic hyperplasia, prostate cancer, vigorous exercise, UTI ..etc
53
What are some Risk Factors for Prostate Cancer? (6)
* >50 * Black * Genetics * Obesity or being overweight * Migrants moving from low risk to high risk areas acquire the local incidence rate * Incidence rates higher in more affluent men
54
Where do Prostate Cancers most commonly metastasise? (2)
* Bone * Lungs
55
What Signs and Symptoms can Prostate Cancer present with? (7)
* LUTS: nocturia, hesitancy, poor stream, terminal dribbling * Asymptomatic * Bone Pain * Anaemia * Weight Loss * General Malaise * Cachexia
56
What is Gleason Score/Grade?
It is the most common system doctors use to grade prostate cancer
57
Gleason Grading: Score 6 (Grade Group 1)
* The cells look similar to normal prostate cells * The cancer is likely to grow very slowly, if at all
58
Gleason Grading: Score 7 (or 3 + 4 = 7) (Grade Group 2)
* Most cells still look similar to normal prostate cells * The cancer is likely to grow slowly
59
Gleason Grading: Score 7 (or 4 + 3 = 7) (Grade Group 3)
* The cells look less like normal prostate cells * The cancer is likely to grow at a moderate rate
60
Gleason Grading: Score 8 (Grade Group 4)
* Some cells look abnormal * The cancer might grow quickly or at a moderate rate
61
Gleason Grading: Score 9/10 (Grade Group 5)
* The cells look very abnormal * The cancer is likely to grow quickly
62
Investigations to diagnose Prostate Cancer (4)
* PSA * Digital Rectal Examination (DRE) * MRI * Biopsy (Transrectal ultrasoundguided (TRUS) is being replaced by Trans Perineal (Tp) Prostate Biopsy)
63
How are Prostate MRIs Standardised
PI-RADS Scoring (Prostate Imaging-Reporting and Data System)
64
Complications of Transrectal Ultrasoundguided (TRUS) (4)
* Sepsis * Acute Urinary Retention * Haematuria * Bleeding per rectum and blood on ejaculation
65
Prevalence of Testicular Cancer
Commonest cancer in men between 15-35 yrs
66
Where do 95% of Testicular Cancers arise from?
Germ Cell
67
What does Testicular Cancer often present with? (8)
* Irregular, firm, fixed, no transillumination * Dragging sensation * Testicular/abdominal pain * Lymphadenopathy * Gynaecomastia (beta-hCG production) * Back Pain (mets) * Hepatomegaly (spread to liver) * Neurological Disease
68
Prevalence of Penile Cancer
Very Rare
69
What does Penile Cancer present with? (2)
* Presents with non tender swelling of the glans penis * Purulent and/or Bleeding from under the foreskin
70
Risk Factors for Penile Cancer (4)
* Phimosis (inability to retract the skin (foreskin or prepuce) covering the head (glans) of the penis) * HPV * Smoking * Low Immunity
71
What type of cancers are Penile Cancers usually?
Squamous Cell Carcinomas

Urinary System (15 decks)

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