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Flashcards in Renal Deck (115)
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91

An enlargement of the pampiniform venous plexus in the scrotum is seen on exam due to cancer. What side is it on and why?

Left sided varicocele due to involvement of left renal vein by CA blocking drainage of left spermatic vein leading to varicocele

Right spermatic vein drains directly in to IVD

92

How does renal cell CA present grossly & microscopically?

gross: yellow mass

micro: clear cytoplasm

93

Renal cell CA Tumors can be hereditary or sporadic but all share what in common? describe the further pathogenesis

loss of VHL (3p) tumor suppressor gene leading to increased IGF-1 to promote growth & increased HIF transcription factor causing more VEGF & PDGF to be produced

94

Differentiate sporadic & hereditary renal cell CA

sporadic in adult male smokers w/ single tumor in upper pole of kidney

hereditary in younger adults often bilateral w/ FHx of VHL dz => increase risk of hemangioblastoma of cerebellum & renal cell CA

95

Define a Wilms tumor

malignant kidney tumor made of blastema (immature kidney mesenchyme), primitive glomeruli & tubules, & stromal cells

MC in 3yr old kids

96

How do Wilms tumors present?

large, unilateral flank mass w/ hematuria & HTN (due to renin secretion)

97

In syndromic cases, what mutation is present? differentiate the 2 diseases in which this mutation is present

WT1 mutation

WAGR syndrome=> Wilms tumor, Aniridia, Genital abnormalities, mental/motor Retardation

Beckwith-Wiedemann syndrome=> Wilms tumor, neonatal hypoglycemia, organomegaly (including tongue)

98

Define urothelial (transitional cell) CA

MC lower urinary tract cancer typically in bladder but can also arise from renal pelvis, ureter, or urethra

99

Give the major risks of urothelial CA

1) cigarette smoke;

naphthylamine (smoke);
azo dyes (hair dressers);
cyclophosphamide or phenacetin use

100

How does urothelial CA present & how is it treated?

older adults w/ painless hematuria

Rx only due to "field defect" from multifocal & high recurrence

101

Describe the 2 paths of urothelial CA pathways

Flat => starts high grade w/ EARLY p53 mutations & invades early

Papillary => starts low grade w/ papillary growth (finger-like projections) then progresses to high grade before invading => may have LATE p53 mutations

102

What must occur for squamous cell CA to be present? What are the MC risk assoc?

background of squamous metaplasia due to normal bladder not having squamous epithelium

chronic inflammation is MC risk factor =>
chronic cystitis in older woman;
Schistosoma hematobium infxn in young, Egyptian male;
long standing nephrolithiasis

103

Define adenocarcinoma of lower urinary tract

malignant proliferation of glands involving bladder

104

Describe how adenocarcinoma arises

urachal remnant => tumor develops at dome of bladder;
cystitis glandularis forming columnar metaplasia;
exstrophy (congenital failure to form caudal portion of anterior abdominal & bladder walls)

105

What is the glomerular filtration barrier composed of?

fenestrated capillary endothelium => size barrier;

fused basement membrane w/ heparan sulfate => negative charge barrier

epithelial layer consisting of podocyte foot processes

106

What is the urine crystal in the MC kidney stone?

envelope or dumbbell shaped

107

What is the pH of the urine in Ammonium Mg+ phosphate kidney stone? what does the urine crystal look like?

high pH

coffin lid

108

Differentiate the different types of Calcium kidney stones based on pH

high pH => calcium phosphate

low pH => Calcium oxalate

109

What is the pH of the urine in a person producing uric acid stone? what does the stone look like?

low pH

Rhomboid or rosettes

110

What is the pH of the urine in a person producing cystine stone? what does the stone look like?

low pH

Hexagonal

111

Define hydronephrosis. What are some of the causes of the pathology?

distention/dilation of renal pelvis & calyces causes by
UT obstruction (stones, BPH, cervical cancer, injury to ureter),
retroperitoneal fibrosis (post surg),
vesicoureteral reflux

112

Where does dilation take place in hydronephrosis? what does it ultimately lead to?

Dilation occurs proximal to site of pathology BUT only impairs renal fxn if bilateral or only one kidney

leads to compression atrophy of renal cortex & medulla

113

Define renal oncocytoma. How does it present?

benign epithelial cell tumor w/ large eosinophilic cells w/ abundant mitochondria w/o perinuclear clearing

Painless hematuria, flank pain, abdominal mass

Tx w/ nephrectomy

114

Acute infectious hemorrhagic cystitis is caused by what?

adenovirus (nonenveloped, dsDNA)

115

Describe the 3 stages of acute tubular necrosis

1) inciting event
2) Maintenance => oliguric lasting 1-3wks w/ risk of HYPERkalemia, metabolic acidosis
3) Recovery phase => polyuric, BUN & Cr fall w/ risk of HYPOkalemia