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Patho Flashcards

1
Q

What are 5 causes of Chronic renal failure?

A

1) Diabetic nephropathy
2) Glomerulonephritis
3) Hypertension
4) Interstitial nephritis
5) Chronic urinary outflow tract obstruction
6) Pyelonephritis
7) Polycystic kidney disease
8) Other congenital kidney diseases / malformations
9) Tumours
10) Unknown

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2
Q

What are 6 systemic manifestations/complicates of end stage renal disease?

A

1) Fluid and electrolytes
– Dehydration and fluid overload
– Anaemia
– Hyperkalaemia
– Metabolic acidosis

2) Calcium, phosphate and bone
– Hyperphosphataemia
– Hypocalcaemia (but later may have hypercalcaemia)
– Secondary hyperparathyroidism
– Renal osteodystrophy

3) Haematologic
– Anaemia
– Bleeding diathesis

4) Cardiopulmonary
– Hypertension
– Heart failure
– Cardiomyopathy
– Pulmonary oedema
– Uraemic pericarditis

5) Gastrointestinal
– Nausea and vomiting
– Bleeding
– Oesophagitis, gastritis, colitis

6) Neuromuscular
– Myopathy
– Peripheral neuropathy
– Encephalopathy

7) Skin
– Dermatitis
– Pruritus (itch)
– Sallow colour

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3
Q

What are 3 treatment options for chronic renal failure?

A

1) Haemodialysis
– Involves removal of solutes across a semi-permeable membrane within a dialysis
machine, from blood circulated through an extra-corporeal circuit

2) Peritoneal dialysis
– Involves removal of solutes across the peritoneal membrane into peritoneal dialysate
fluid.

3) Renal transplant
- need to be on immunosuppressive therapy for life

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4
Q

In chronic renal failure, both kidneys are (small, contracted/large and hypertrophic). The histological features include: (3).

A

Small and contracted kidneys (bilateral)

1) Widespread glomerulosclerosis
2) Tubular atrophy
3) Interstitial fibrosis

  • Urine volume may be normal(ish) initially, or may even have polyuria as tubules cannot concentrate glomerular filtrate.
  • Terminal oliguria when no functioning nephrons left.
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5
Q

In acute renal failure, there is:
i) Oliguria/anuria: ____________________

ii) Azotaemia: ________________________

A

Oligo/Anuria: marked ↓ in/absence of urine production

Azotaemia: Progressive/rapid ↑serum creatinine

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6
Q

What are 3 pre-renal causes of ARF?

A
  1. Hypotension
  2. Haemorrhage
  3. Severe dehydration
  4. Shock
  5. Heart disease
  6. Liver failure
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7
Q

What are 3 renal causes of ARF?

A
  1. Glomerulonephritis
  2. Acute tubular necrosis (due to drugs, toxins, pigment, etc)
  3. Acute interstitial nephritis
  4. Haemolytic uraemic syndrome
  5. Vasculitis
  6. Severe infections (eg. pyelonephritis, bilateral)
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8
Q

What are 2 post-renal causes of ARF?

A

1) Acute urinary tract outlet obstruction (eg. due to blood clots, stones, tumour, etc)

2) Acute atonia, hypotonia of the bladder to the nerve damage (neurogenic bladder)

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9
Q

What are 4 Ix for renal failure?

A

1) Blood tests:
- urea, creatinine, electrolytes

2) Urine tests:
- Protein, Hb, Myoglobin, RBC, WBC

3) Imaging:
- IVU, US KUB, CT urogram, CT/MRI, etc.

4) Kidney biopsy

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10
Q

What are 3 examples of renal disease?

A

1) Glomerular disease
2) Tubulo-interstitial disease
3) Vascular disease

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11
Q

What are 5 clinical presentations of glomerular disease?

A

1) Nephrotic syndrome
2) Nephritic syndrome
3) Microscopic hematuria
4) Proteinuria
5) ARF
6) CRF

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12
Q

What is nephrotic syndrome?

A

A leaky glomerular filter

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13
Q

What are 5 clinical manifestations of nephrotic syndrome?

A

1) Heavy proteinuria
2) Hypoalbuminemia
3) Anasarca
- generalised edema due to ↓serum oncotic P
4) Lipiduria
5) Hyperlipidemia (bi-product of hepatic albumin synthesis)
6) Polyuria with frothy urine (due to large amounts of protein in urine)

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14
Q

What are 2 complications of nephrotic syndrome?

A

1) Infection
2) Thromboembolism (loss of anticoagulants)

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15
Q

Why is the age of the px important in the differential diagnosis of nephrotic syndrome?

A

Causes of nephrotic syndrome in children and adults often differ

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16
Q

Px with nephrotic syndrome may be classified as steroid-sensitive or steroid-resistant. Childhood nephrotic syndrome is almost always _________________.

A

Childhood almost always steroid-sensitive

only if the child does not respond to treatment, will a renal biopsy be performed.

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17
Q

What is nephritic syndrome?

A

Glomeruli are damaged - some are unable to filter; others leaky

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18
Q

What are 5 clinical manifestations of nephritic syndrome?

A

1) Oliguria
2) Azotaemia
3) Oedema (usually not as prominent as in nephrotics)
4) Hypertension ← fluid retention
5) Gross hematuria
6) Proteinuria - mild to moderate, sometimes in nephrotic range

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19
Q

What are 3 complications of nephritic syndrome?

A

1) Hypertensive encephalopathy
- seizures
- strokes

2) Fluid overload
- CHF
- acute pulmonary edema

3) Acute kidney impairment
- uraemia
- HyperK+, HyperPO4
- HypoCa2+

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20
Q

What is glomerulonephritis?

A

“Inflammation of the glomeruli”
- diseases characterized by increased glomerular cellularity caused by proliferation of indigenous cells and/or leucocyte infiltration.

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21
Q

What are 3 antibody-mediated mechanisms for glomerular injury?

A

1) In situ formation of immune complexes
- against native antigen eg. Anti-GBM disease (Goodpasture’s Disease).
- against planted antigen that localises in glomerulus eg. HBV.

2) Circulating immune complexes
- antigen in excess of antibody leads to circulating immune complexes that get lodged in the glomeruli eg. Lupus nephritis.

3) Antineutrophil Cytoplasmic Antibodies (ANCA)
- antibodies bind to the neutrophils in glomeruli
→ release toxic granules and substances in the glomeruli
→ glomerular damage.

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22
Q

What are 2 Ix for mechanisms of glomerular injury?

A

1) IF
- Allows determination of what types of antibody and complement involved

2) EM
- Allows more precise localisation of immune complexes
– Allows identification of ultrastructural pathology eg. GBM abnormalities

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23
Q

What are 3 microscopy methods used in a renal biopsy?

A

1) LM: formalin
2) IF: Fresh
3) EM: Glutaraldehyde

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24
Q

What are 4 causes of nephrotic syndrome?

A

Common:
1. Minimal change disease
2. Idiopathic focal segmental glomerulosclerosis (FSGS)
3. Membranous glomerulonephritis.

Uncommon:
1. Membranoproliferative glomerulonephritis.
2. IgA nephropathy

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25
True or false: Minimal Change Disease is the most common cause of childhood nephrotic syndrome. It has a very good prognosis as it is curable with steroids.
True
26
What is the etiology and pathogenesis of Minimal Change Disease?
Unknown
27
In Minimal Change Disease: Proteinuria: (±) LM: __________ IF: ________________ EM:_______________
In Minimal Change Disease: Proteinuria: Selective LM: no abnormality IF: no deposits EM: fusion of foot processes and occasionally detachment from basement membrane
28
Focal Segmental Glomerulosclerosis causes (nephritic/nephrotic) syndrome and is steroid (sensistive/resistant).
FSG: Nephrotic Steroid Resistant
29
What is the etiology and pathogenesis of Focal Segmental Glomerulosclerosis?
Idiopathic and 2° causes - podocyte injury w loss of podocytes
30
In Focal Segmental Glomerulosclerosis: Proteinuria: (±) LM: __________ IF: ________________ EM:_______________
In Focal Segmental Glomerulosclerosis: Proteinuria: + LM: segmental sclerosis of glomeruli IF: sclerotic lesions stain w IgM and C3 EM: loss of podocytes
31
True or false: Focal segmental glomerulosclerosis, though steroid resistant, can be treated and often do not progress to chronic renal failure.
False, many progress to chronic renal failure
32
What is the most common cause of nephrotic syndrome in children?
MCD
33
What is the most common cause of nephrotic syndrome in adults?
Membranous Glomerulopathy
34
In Membranous glomerulopathy: Proteinuria: (±) LM: __________ IF: ________________
In Membranous glomerulopathy: Proteinuria: + LM: basement membrane thickening IF: IgG and C3 on the epi-membranous side of basement membrane (“spikes” or “string of pearl appearance”).
35
What are 3 causes of nephritic syndrome?
Usually glomerulonephritis: 1. IgA nephropathy 2. Post-infectious glomerulonephritis 3. Lupus nephritis 4. Membranoproliferative glomerulonephritis
36
What is the most common cause of glomerulonephritis?
IgA nephropathy
37
What are 2 microscopic features of IgA nephropathy?
1) Microscopic proteinuria w hematuria 2) Mesangial proliferation with mesangial deposits of immune complexes containing IgA
38
What is post-infectious glomerulonephritis?
Glomerulonephritis follows infection by nephritogenic strains of streptococci, classically streptococcal pharyngitis.
39
In Post-infectious Glomerulonephritis: (Nephrotic/Nephritic) LM: __________ IF: ________________ EM: ________________
In Post-infectious Glomerulonephritis: Nephritic LM: diffuse proliferative changes IF: Granular IgG and C3 EM: sub-epithelial humps of large electron-dense deposits
40
What is Lupus Nephritis?
2° SLE - any clinical/histological pattern - aggressive forms a/w proliferative changes, present w nephritic syndrome and may have crescents - membranous variant present w nephrotic syndrome
41
What is seen on an IF of lupus nephritis?
"Full house" pattern IgG, IgA, IgM, C1q, C3
42
In Membranoproliferative Glomerulonephritis: (Nephrotic/nephritic) LM: ______________ a/w: ________________
In Membranoproliferative Glomerulonephritis: BOTH Nephrotic/nephritic LM: proliferative changes involving mesangium + thickening of basement membrane a/w: ↓serum C3
43
In which condition is Crescentic glomerulonephritis seen?
1) Post-infectious glomerulonephritis (most commonly rapidly progressive) 2) Goodpasture's 3) Other RPGN (eg. ANCA related)
44
Rapidly Progressive Glomerulonephritis requires _________________, otherwise all progress to ______________.
Requires immunosuppressive treatment, otherwise all progress to renal failure
45
How is RPGN classified?
IF staining pattern: 1) IF+ - immune complex proliferative GN, but if linear pattern, due to anti-GBM disease. 2) IF- (pauci-immune) - due to systemic vasculitis. (ANCA-related)
46
What is Goodpasture's syndrome?
Anti-glomerular basement membrane disease - antigen is part of D-chain of Type IV collagen
47
What organs are most commonly affected in Goodpasture's syndrome?
Kidney and Lungs (both have basement membrane with similar type 4 collagen)
48
In Goodpasture's syndrome: LM: ________________ IF: _________________
In Goodpasture's syndrome: LM: Crescentic glomerulonephritis IF: linear immunofluoresence for IgG
49
What is amyloidosis?
Extracellular accumulation of fibrillary proteins which show positive staining with the Congo red stain, with apple green birefringence under polarised light examination. In the kidney, usually occurs in patients with either: – Plasma cell dyscrasia (AL amyloid) – Chronic inflammatory diseases or neoplasms (AA amyloid)
50
What is the most likely diagnosis for a renal biopsy that shows: 1) Amorphous material in glomerulus, arteriole and interstitium 2) Congo Red positive 3) Apple green birefringence under polarised light
Amyloidosis
51
True or false: Acute mild hypertension can commonly cause hypertensive nephrosclerosis.
False. Only common in px with long standing, poorly controlled HTN
52
In hypertensive nephrosclerosis, Proteinuria: (±) Arterioles show _____________ Arteries show ______________
In hypertensive nephrosclerosis, Proteinuria: low grade till 2° FSGS Arterioles show hyalinosis ± muscular thickening Arteries show arteriosclerosis
53
What are 2 histological findings in a renal biopsy of a px with malignant hypertension?
1) Fibrinoid necrosis of arterioles and glomeruli 2) Mucoid intimal thickening of arteries
54
What is the commonest cause of ESRD in SG?
Diabetic nephropathy
55
What is the pathogenesis of diabetic nephropathy
Hyperglycemia leads to the non-enzymatic glycosylation of collagen and other glomerular matrix and GBM proteins. Also occurs in blood vessels in the kidney.
56
What are 7 histological findings in diabetic nephropathy?
Glomeruli: 1) GBM thickening (EM) 2) Mesangial widening (↑matrix and cells → Kimmelstiel-Wilson nodules) 3) Hyalinosis lesions (protein insudation) 4) Microaneurysms of glomerular capillary loops. 5) Eventually, glomerular sclerosis. Tubules: 6) Thickened tubular basement membranes 7) Tubular atrophy Interstitium 8) Interstitial fibrosis Vessels: 9) Arteriolar hyalinosis 10) Arteriosclerosis
57
Diabetic nephropathy predisposes a patient to ___________
Pyelonephritis
58
What are 4 congenital malformations of the kidney?
Size/number: 1) Renal Agenesis - bilateral → die - unilateral → opp. kidney hypertrophy (compensate) 2) Renal hypoplasia - small, ↓lobules and calyces - oligomeganephronia (hypertrophic glomeruli) - Primitive glomeruli and tubules in dense fibrous or fatty interstitium Position/shape: 3) Displacement of kidneys - within pelvis → kinking of ureters →obstruction + UTI 4) Horseshoe kidney - fusion of lower/upper poles - complication → renal calculi
59
What are 3 types of cystic kidney diseases?
1) Cystic renal dysplasia 2) Polycystic kidney disease (AD/AR) 3) Medullary cystic disease 4) Acquired cystic disease 5) Localised/simple renal cysts 6) Misc.
60
What is the pathogenesis of cystic renal dysplasia?
abnormal metanephric differentiation, with persistence of primitive / abnormal structures.
61
Cystic renal dysplasia is often: (uni/bilateral) a/w___________
Both uni and bilateral a/w other abnormalities (eg. ureteric atresia, agenesis)
62
What is the gross finding of cystic renal dysplasia?
Enlarges, irregular kidneys that are multicystic
63
What are 3 microscopic features of cystic renal dysplasia?
1) Lobar disorganisation 2) Multiple cysts lined by flattened epithelium 3) Presence of primitive / immature structures: - Islands of undifferentiated mesenchymal cells. - Islands of cartilage tissue. - Primitive ductal structures.
64
In polycystic kidney disease, AD affects (adults/children) AR affects (adults/children)
AD: Adults AR: Children
65
AD Polycystic kidney disease usually ends in ___________ due to mutations in ______________ genes.
Ends in renal failure due to loss of parenchyma over time with multiple cysts (in mid to late adulthood) Due to mutations in PKD1 and 2 (code for Polycystin-1 and 2 proteins)
66
What is 1 primary and 3 secondary causes of urolithiasis?
Primary: - Supersaturation of urine w crystalline material (most commonly calcium salts) Secondary: 1) UTI - Crystalline material encrust on a necrotic focus 2) Indwelling catheter or foreign body in the bladder 3) Vitamin A deficiency producing squamous metaplasia of upper urinary tract mucosa. 4) Low urinary pH predisposes to formation of uric acid stones
67
What are 3 types of renal calculi?
1) #1 Calcium (eg. calcium oxalate) 2) Triple stones (15%) (Magnesium ammonium phosphate) - follow infections 3) Urate stones (5-10%) - px w gout and leukemia 4) Cysteine stones (1-2%) - a/w genetic defect in renal transport/amino acids
68
What is the pathogenesis of "Triple stones" (Magnesium ammonium phosphate)?
A/w infections bt urea splitting bacteria (eg. PROTEUS) Urea converted to ammonia → alkaline urine → precipitation of Magnesium ammonium phosphate salts → massive stones (staghorn calculi)
69
What type of calculi are staghorn calculi?
Magnesium ammonium phosphate stones (usually due to proteus infection)
70
What is the most common cause of calcium oxalate stones?
Idiopathic - also a/w hypercalcaemia due to hyperparathyroidism, diffuse bone disease, vitamin D intoxication, sarcoidosis, milk-alkali syndrome, renal tubular acidosis of Cushing’s syndrome
71
What are 2 mechanisms/ pathogenesis of idiopathic hypercalciuria?
1) Absorptive hypercalciuria: hyperabsorption of calcium from the intestine, with prompt increased renal output without hypercalcaemia. 2) Renal hypercalciuria due to intrinsic impairment in renal tubular reabsorption of calcium
72
What are 4 sequelae/effect of renal calculi?
1) Urinary stasis → necrosis or renal failure (depending where) 2) Ulceration 3) Bleeding 4) Infection 5) Pain 6) Fistula formation
73
What are 4 disorders of the renal tubules/interstitium?
1) Acute tubular necrosis 2) Acute interstitial nephritis 3) Acute pyelonephritis 4) Chronic pyelonephritis 5) Xanthogranulomatous pyelonephritis 6) Tuberculosis 7) Sarcoidosis 8) Neoplastic infiltrates (leukemias, myeloma, etc.)
74
What is the most common cause of ARF?
Acute tubular necrosis
75
Acute tubular necrosis is (reversible/irreversible) in most cases and (not) associated with necrosis of glomeruli or adjacent renal cortical tissue.
Acute tubular necrosis is reversible in most cases if the cause is corrected, as the damaged / dead tubular epithelial cells can be replaced by regenerating residual viable cells. And NOT a/w necrosis of glomeruli or adjacent renal cortical tissue (unlike zonal infarction of the kidney or renal cortical necrosis).
76
What are the 3 phases of acute tubular necrosis?
1. Oliguric phase: Renal failure, oliguria 2. Polyuric phase: Polyuria, tubular cells regenerating 3. Recovery phase: Renal function recovering
77
What are 6 causes of acute tubular necrosis?
Ischaemic causes: (hypotension/hypovolemia and reduced renal perfusion) 1) Shock 2) Hemorrhage 3) Major surgery 4) Severe burns 5) Dehydration Toxic causes: 1) Endogenous products 2) Drugs 3) Heavy metals 4) Organic solvents 5) Others (eg. venom)
78
What are 2 histological features of acute tubular necrosis?
1) The tubular epithelial cells show varying degrees of: – Swelling – Vacuolation – Flattening – Sloughing – Loss of PAS-positive brush border – Necrosis 2) There may also be tubular dilation and interstitial oedema
79
What are 3 causes of acute interstitial nephritis?
1) #1 Drugs 2) Toxins 3) Metabolites 4) Autoimmune 5) Non-renal infections 6) Idiopathic
80
In px with acute interstitial nephritis, px present with ___________ urinalysis show ______________
Acute interstitial nephritis: present with variable degrees of renal impairment and often ARF Urinalysis show RBC, WBC, eosinophils, mild proteinuria
81
What is the pathogenesis of drug-induced acute interstitial nephritis?
Usually allergic or T-cell mediated HS rxn to antibiotics, diuretics, NSAIDs
82
What are 3 common presentations of drug-induced acute interstitial nephritis?
1) Fever 2) Rash 3) Hematuria 4) Proteinuria 5) Eosinophilia 6) Renal impairment/failure
83
What is acute pyelonephritis?
Infection of the kidney (usually due to bacterial infection)
84
What are 2 ways bacteria can reach and infect the kidney, causing acute pyelonephritis?
1) Ascending/Retrograde spread from bladder - more common - predisposing factors: a) Lower UT obstruction b) Vesicoureteric reflux c) DM d) pregnancy 2) Hematogenous spread - less common
85
What are 4 clinical features of acute pyelonephritis?
1) Chills, fever 2) Flank tenderness and pain 3) Dysuria 4) Frequency of micturition 5) Often >100,000 / ml bacteria in urine 6) Pyuria (may have pus casts)
86
What are 3 complications of acute pyelonephritis?
1) ARF 2) Septicemia 3) Pyonephrosis 4) Perinephric abscess
87
What are 2 causes of chronic pyelonephritis?
1) Vesico-ureteric reflux - Reflux of urine from bladder, up the ureter, to the kidney – Predisposes to recurrent kidney inflammation and progressive scarring (usually more prominent at the renal poles) – Usually begins in childhood 2) Obstruction - Predisposes to recurrent kidney infection and progressive scarring
88
What are 2 gross and 2 histological findings in chronic pyelonephritis?
Gross: 1) Cortical depression 2) "flea-bitten" appearance Micro: 1) Thyroidisation 2) Tubular atrophy 3) Pericapsular fibrosis
89
Xanthogranulomatous pyelonephritis mimics _________.
Renal cell carcinoma
90
What is the most common causative organism of xanthogranulomatous pyelonephritis?
Proteus
91
Xanthogranulomatous pyelonephritis: Gross features (1) Microscopic (2)
Gross: Enlarged kidney, replaced by yellow nodules with firm, grayish white tissue. Micro: Foam cells, giant cells, lymphocytes, plasma cells
92
What is hydronephrosis?
Dilatation of renal pelvis and calyces with progressive enlargement of the kidney with parenchymal atrophy due to obstruction of urine outflow
93
What are 2 gross and 3 microscopic features of hydronephrosis?
Gross: 1) Enlarged kidney 2) Renal cortex thinned and atrophic Micro: 1) Dilated tubules and bowman's spaces 2) Flattened tubular epithelium 3) Tubular atrophy w fibrosis 4) Disappearance of glomeruli
94
What is pyonephrosis?
Infected hydronephrosis with frank pus in the dilated calyces and pelvis.
95
What is pyoureter?
Hydroureter infected and contains pus.
96
What are 4 causes of obstruction in the urinary system?
Congenital Anomalies: 1) Urethral valves/strictures 2) Bladder neck obstruction 3) Uretero-pelvic junction narrowing or obstruction Acquired Obstruction: 4) Benign prostatic hypertrophy 5) Calculi 6) Tumours – carcinoma of prostate, bladder tumours, carcinoma of cervix or uterus 7) Inflammation of prostate, ureter, urethra 8) Sloughed papillae or blood clots Functional disorder: 9) Neurogenic (spinal cord damage) 10) Functional obstruction along urinary tract.
97
What are 3 malignant tumours of the kidney?
1) Renal cell carcinoma (85%) 2) Urothelial carcinoma 3) Nephroblastoma (Wilms tumour) in children
98
What is a benign tumour of the kidney?
Angiomyolipoma
99
Where do renal cell carcinomas arise from?
Tubular epithelium
100
Clear cell RCC may be sporadic (most common) or a/w _______________________
von Hippel Lindau (VHL) syndrome (Associated with chromosome 3p deletions and mutations of the VHL gene).
101
What are 2 clinical features of Renal Cell Carcinoma?
1) Painless haematuria. 2) Mass in flank. 3) Fever due to necrosis.
102
What are 2 types of renal cell carcinoma?
1) Clear cell RCC. 2) Papillary RCC. 3) Chromophobe RCC
103
What are 3 gross features of clear cell RCC?
1) Solitary, unilateral, with a circumscribed appearance. 2) Yellowish cut surfaces with foci of necrosis and haemorrhage. 3) Invasion of renal vein not uncommon. 4) Tendency to metastasize widely; metastasis may be late.
104
What are 2 microscopic features of clear cell RCC?
1) Polygonal cells with clear cytoplasm. 2) Delicate branching vasculature. 3) Invasion of renal vein and its branches may be seen.
105
True or false: Urothelial carcinoma may be non-invasive or invasive and only involves areas lined by urothelium. It may be multifocal and grossly and microscopically identical to urothelial carcinoma of bladder.
True May be non-invasive papillary urothelial carcinoma or invasive urothelial carcinoma. Involves the areas of the kidney lined by urothelium i.e. pelvi-calyceal system. May be multifocal, and also associated with urothelial carcinoma of the ureter and bladder. Grossly and microscopically identical to urothelial carcinoma of the bladder.
106
What is Wilms tumour?
Nephroblastoma Paediatric tumor usually diagnosed between ages of 2 and 5 years. - a/w congenital malformations – WAGR syndrome, Denys-Drash Syndrome and Beckwith-Wiedemann syndrome.
107
What are 2 clinical feature of Wilms tumour?
1) Large abdominal mass. 2) Fever due to necrosis and hemorrhage
108
What is the treatment of choice for Wilms tumour?
Combination nephrectomy and chemotherapy - good prognosis even for tumors that have spread beyond the kidney
109
What is a gross features of Wilms tumour?
Well circumscribed grayish white, soft mass. - Begins in renal cortex and replaces entire kidney
110
What are 3 microscopic features of Wilms tumour?
1) Sheets of small blue cells (blastemal component) 2) Abortive tubular and glomeruloid structures (epithelial component) 3) Spindle-shaped cells (stromal component). 4) Heterologous elements such as striated/smooth muscle and cartilage may be found
111
Where do Wilms tumours usually spread to?
1) Lungs 2) Liver 3) Brain 4) Lymph nodes - both hematogenous and lymphatic spread
112
What is the most common mesenchymal tumour of the kidney?
Angiomyolipoma
113
What is a angiomyolipoma?
Benign mesenchymal tumour composed of a combination of adipose cells, myoid spindle cells and blood vessels, in varying proportions.
114
Can angiomyolipoma be accurately diagnosed on CT?
Yes, because of its fat content
115
What is the gross appearance of angiomyolipoma?
Unencapsulated. Variegated cut surfaces, with yellow (fatty) areas
116
What is a microscopic finding of angiomyolipoma?
Mixture of myoid spindle and epithelioid cells, adipocytes and blood vessels, often thick-walled. The myoid cells show immunostaining for HMB-45.
117
What are 2 risk factors for bladder carcinomas?
Non-occupational: 1) Cigarette smoke 2) Schistosomiasis 3) Cyclophosphamide 4) Phenacetin Occupational 1) 2-Napthylamine 2) 4-aminobiphenyl 3) Benzidine
118
What are 3 malignant tumours affecting the bladder?
1) Papillary urothelial carcinoma (non-invasive) 2) Invasive urothelial carcinoma 3) Squamous cell carcinoma 4) Adenocarcinoma 5) Other types are rare
119
What are 2 benign tumours of the bladder?
1) Papilloma 2) Inverted papilloma 3) Nephrogenic adenoma

Renal System (8 decks)

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