Pathology: Renal and Urology 1

Question 1

What is pyelonephritis?

Answer 1

Infection of the renal pelvis, calyces, tubules and interstitium

Question 2

In which two ways can pyelonephritis present?

Answer 2

Acute or chronic

Question 3

Which type of distribution is associated with pyelonephritis?

Answer 3

Diffuse

Question 4

What is the most common organism responsible for causing pyelonephritis?

Answer 4

E. coli

(bacteria are most common)

Question 5

What are the risk factors for pyelonephritis?

Answer 5

Young females

Pregnancy (ureteric dilatation causing stasis)

Instrumentation from surgery

Obstruction (tumour, stricture, stones etc)

Diabetes

Vesico-ureteric reflux

Question 6

What is the vesico-ureteric reflux?

Answer 6

Distal ureters fail to enter the bladder obliquely meaning the perpendicular angle allows reflux of urine upon contraction of the bladder

Question 7

How does chronic pyelonephritis present?

Answer 7

Hypertension +/- uraemia

Large volumes of urine

Vague symptoms

Question 8

How does tuberculosis pyelonephritis occur?

Answer 8

Usually from haematogenous spread from the lungs

Question 9

Why does sterile pyuria occur with tuberculosis pyelonephritis?

Answer 9

Bacteria grows at a slower rate compared with other bacteria

This means pus will be present in the urine, but it appears sterile initially

Question 10

Besides sterile pyuria, which other symptoms or signs may be present in tuberculosis pyelonephritis?

Answer 10

Vague symptoms; weight loss, fever, loin pain, dysuria

Question 11

Which condition often occurs alogside pyelonephritis?

Answer 11

Cystitis

Question 12

What is cystitis?

Answer 12

Inflammation of the bladder

Question 13

Cystitis normally presents with acute inflammation, what can it progress to and under which circumstance?

Answer 13

Necrosis

Outflow obstruction

Question 14

For which reason does cystitis commonly occur alongside pyelonephritis?

Answer 14

Pyelonephritis often occurs as an ascending condition up the urinary tract

Question 15

What are the main causes of cystitis?

Answer 15

E. coli

Klebsiella

Proteus

Pseudomonas

Question 16

Cystitis cystica is associated with which histological appearence?

Answer 16

Many small fluid filled cysts projecting into the lumen

Question 17

What is the causative organism for schistosomiasis?

Answer 17

S. Haematobium

Question 18

Schistosomiasis can predispose to what?

Answer 18

Urothelial malignancy, particularly Squamous Carcinoma

Question 19

What are the main causes for urethral obstruction?

Answer 19

Stricture

Posterior urethral valves

Prostatic disease

Question 20

Prolonged bladder outlet obstruction can lead to what?

Answer 20

Hypertrophy of detrusor muscle and formation of diverticulum

Question 21

What are the main causes of hydronephrosis?

Answer 21

Urinary tract obstruction

Reflux

Question 22

Unilateral hydronephrosis has which main causes?

Answer 22

Calculi

Neoplasma

Strictures

Pelvic-ureteric constriction

Question 23

What are the main causes for bilateral hydronephrosis?

Answer 23

Urethral obstruction

Neurogenic disturbance

VUR

Bilateral ureteric obstruction (e.g. advanced carcinoma of cervix)

Question 24

Hydronephrosis commonly develops into which other condition due to the associated urinary stasis?

Answer 24

Pyelonephritis

Question 25

What changes does hydronephrosis cause to the renal system?

Answer 25

Dilatation of pelvicalyceal system with parenchymal atrophy

Question 26

If there is pelvicalyceal dilatation associated with hydronephrosis, what does this suggest about the condition?

Answer 26

It has taken a gradual path with a partial obstruction