Flashcards in Renal Deck (115)
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
How does renal cell CA present grossly & microscopically?
gross: yellow mass
micro: clear cytoplasm
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
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
Define a Wilms tumor
malignant kidney tumor made of blastema (immature kidney mesenchyme), primitive glomeruli & tubules, & stromal cells
MC in 3yr old kids
How do Wilms tumors present?
large, unilateral flank mass w/ hematuria & HTN (due to renin secretion)
In syndromic cases, what mutation is present? differentiate the 2 diseases in which this mutation is present
WAGR syndrome=> Wilms tumor, Aniridia, Genital abnormalities, mental/motor Retardation
Beckwith-Wiedemann syndrome=> Wilms tumor, neonatal hypoglycemia, organomegaly (including tongue)
Define urothelial (transitional cell) CA
MC lower urinary tract cancer typically in bladder but can also arise from renal pelvis, ureter, or urethra
Give the major risks of urothelial CA
1) cigarette smoke;
azo dyes (hair dressers);
cyclophosphamide or phenacetin use
How does urothelial CA present & how is it treated?
older adults w/ painless hematuria
Rx only due to "field defect" from multifocal & high recurrence
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
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
Define adenocarcinoma of lower urinary tract
malignant proliferation of glands involving bladder
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)
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
What is the urine crystal in the MC kidney stone?
envelope or dumbbell shaped
What is the pH of the urine in Ammonium Mg+ phosphate kidney stone? what does the urine crystal look like?
Differentiate the different types of Calcium kidney stones based on pH
high pH => calcium phosphate
low pH => Calcium oxalate
What is the pH of the urine in a person producing uric acid stone? what does the stone look like?
Rhomboid or rosettes
What is the pH of the urine in a person producing cystine stone? what does the stone look like?
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),
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
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
Acute infectious hemorrhagic cystitis is caused by what?
adenovirus (nonenveloped, dsDNA)