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Year 2: Clinical Pathology > Renal and Urogenital Pathology > Flashcards

Renal and Urogenital Pathology Flashcards

(90 cards)

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1
Q

Types of Renal Pathology (3)

A

Glomerular, tubular and vascular

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2
Q

What is Radiology used to diagnose in renal pathology (4)

A

Obstructions
Malignancies
Size
Other abnormalities

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3
Q

Types of Renal Biopsy investigations (3)

A

electronmicroscope
immunofluorescence
light microscope

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4
Q

Pathogenesis of most renal pathologies

A

Damage to basal membrane OR epithelial cells OR podocyte cells = disturbances in filtration

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5
Q

Types of Renal Vascular damage (3)

A

Thrombotic microangiopathy (thrombi and endothelial damage)
Vasculitis (inflame)
Renal stenosis - diabetes, hypertension and antheroma

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6
Q

Glomerular damage

A

vascular and basal membrane damage

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7
Q

Immunological Glomerular damage causes (3)

A

Circulating immune complexes = SLE or IgA
Circulating antigens deposit in glomerulus
Antibodies against the Basal membrane (autoimmune)

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8
Q

Immunological response in Glomerulus stimulates? that causes damge (4)

A

complement activation
Neutrophil activation
Reactive O2 species
Clotting factors

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9
Q

Non-immunological Glomerular damage? (3) + examples

A

Enodthelial injury eg. Vasculitis
Altered Basal Membrane eg. hyperglyceamia or inherited disease
Abnormal protein deposition eg. Amyloid

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10
Q

3 types of tubular damage? + examples

A

Ischemic - eg. hypotension
Drug induced eg. Antibiotic, NSAIDs or ACEi
Toxic eg. crystal deposits (gout)

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11
Q

Nephritic VS Nephrotic syndrome - cause

A 
Nephritic = acute nephritis or inflammation
Nephrotic = Due to glomerulus damage
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12
Q

Nephritic Vs Nephrotic - signs and symptoms

A

Nephritic = Haematuria +++ (macroscopic)
Also: proteinuria, hypertension and low urine volume

Nephrotic = Proteinuria +++ (frothy urine)
Also: Hypoalbuminaemia –> oedema, hypertension

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13
Q

Diseases that cause Nephrotic syndrome (3)

A

Membranous nephropathy - thicken Basal membrane
Focal Segmental glomerulosclerosis (FSGS) - hereditary, Heroine and HIV
Minimal Change - in children due to steroids

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14
Q

Disease that cause Nephritis (Nephritic syndrome) = 4

A

Prior infection - strep OR Ecoli (haemolytic-ureamic syndrome in kids),

IgA Nephropathy - autoimmune in young adults

Vasculitis - fever, purpuric rash, myalgia (Henoch-schonein purura in children)

Lupus - autoimmune

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15
Q

Acute (7) VS Chronic renal Failure (5) - presentation

A

Acute = rapid onset, anuria, raised creatinine and urea, malaise, fatigue, N&V and arrhythmias

Chronic = same as above + oedema, hypertension, anemia and bone disease

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16
Q

Acute (pre, renal and post = 7) Vs Chronic renal failure (3) - Causes

A

Acute:
Pre = ischemia
Renal = infection and malignancy = tubular damage
Post (obstructive) = UTI, enlarge prostate, pelvic tumour, stones

Chronic: diabetes, glomerulanephritis, reflux nephropathy

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17
Q

Acute Renal Failure complications (4)

A

Fluid/ Cardiac overload = pulmonary oedema
GI bleeds
Jaundice (hepatovenous congestion)
Infections = lung and urinary

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18
Q

Nephritis Vs Pyelonephritis

A

Nephritis = (Infection and toxins) BUT mainly autoimmune

Pyelonephritis = ascending UTIs reaching the renal Pelvis (more common in women)

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19
Q

Vasculitis - effect on kidneys + other symptoms

A

Inflammation in glomeruli vessels = thrombosis and obliteration of lumen

Rash, weight loss, fever, myaglia

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20
Q

Renal Artery stenosis - Cause + effect on kidneys. Presentation + why?

A

Atheroma and arterial dysplasia = ischemic injury and loss of function

Hypertension = due to hypoperfusion of the kidneys stimulating the angiotensin system

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21
Q

Diabetes - affect on kidneys? –> end stage renal failure (most common cause)

A

Hyperglycemia = Thickening of BM and glomerular damage

Small vessel damage = ischemia and tubular damage

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22
Q

Hypertension = affect on kidneys?

A

Damage vessel walls = thickening and occlusion = ischemia

Hypoperfusion to kidneys = angiotensin and worsens hypertension

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23
Q

Malignancy = type of tumour + affect on kidneys?

A

Plasma cell

Ig G deposits = inflammation and fibrosis = irreversible decline in function

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24
Q

Obstructive uropathy two types

A

Intrinsic = in the urethral lumen - stones, inflammation and infection, malignancy, clots

Extrinsic = outside the ureter (compression) - strictures, tumours, pregnancy

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25
Bladder causes of obstructive uropathy
vesicoureteral reflux (valvular issues) = back flow of urine and infections Tumours Stones Neurological = stasis and infection
26
Complications of Obstructive uropathy (5) - depend on SITE, DURATION and DEGREE
Bladder muscle hypertrophy Hyroureter - dilation of ureter (proximal) hydonephrosis - CHRONIC = dilated pelvis, calyces, cortical atrophy Acute renal failure - reduced glomerular filtration Chronic Renal failure - following hydonephrosis = loss of function
27
Causes of Urological Calculi or stones (urlithasis) (4)
Excess substances that precipitate eg. calcium Change in urine constitutes eg. pH Poor urine output eg. supersaturation Decreased citrate levels
28
Calcium stones in 70% of patient - composition and causes
Calcium oxalate and Calcium Phosphate Hypercalcaemia - bone disease, PTH excess and sarcoidosis Excessive intestinal absorption + inability to reabsorb in tubules
29
Struvite stones in 15% of patients - composition and cause
Magnesium ammonium phosphate Urease producing bacteria = ammonia = rise in pH = precipitation and 'stag horn' caliculi on CT
30
Urate stones 5% of patients - composition and cause
uric acid Hyperuricaemia in patients with gout and leukaemia
31
Gold Standard diagnosis of Renal stones (>95% of cases)
Non-contrast CT (or USS in pregnancy)
32
Renal Cell Carcinoma risk factors - age, gender etc. (8)
``` age 60-80 Male (3:2) tobacco obesity hypertension oestrogens cystic kidney disease asbestos ```
33
Renal Cell carcinoma - two types - histological presentation
Clear cell (most common) = well defined, yellow tumour, small bland nuceali - invade fat and renal vein Papillary renal cell carcinoma = cystic/ mulitply. Foamy cuboidal cells with fibrovascular cores, macrophages and calcium
34
Presentation of RCC (renal cell carcinoma)
Haematuria, bollatile/ palpable kidneys, costovertibral pain Usually late presentation due Mets (25% of cases) Paraneoplasic syndrome = Cushings, hypercalcaemia, polyclythaemia (erythropoietin)
35
5 year survival for RCC - average, organ contained, invasive and distant mets
45% average 70% - confined 50% - invasive 8% - mets = poor response to chemo
36
Urothelial cell carcinoma - % of bladder cancers?
95% | Can present in the rest of system BUT most common in the bladder
37
Risk factors of UCC (urothelial cell carcinoma) (5)
``` older age M>F Smoking cyclophosphamide (chemo) Radiation ```
38
Presentation of UCC
Haematuria Urinary frequency pain on urination Urinary tract obstruction
39
UCC types (progression)
Papilloma-papillary carcinoma Invasive papillary carcinoma Flat non invasive Papillary carcinoma (CIN) - cells shed in the urine so analysis is necessary Flat invasive papillary carcinoma
40
``` 5 year survival for UCC Non invasive (Tis) Muscular invasion (T2) ```
95% - non invasive | 60% - muscular invasion
41
Solute concentration depends on:
Solute amount and solvent volume
42
Function of the kidneys
Excrete - urea and uric acid Regulate - acid balance and water Endocrine - renin and erythropoietin
43
3 reasons for kidney function tests
Detect damage Measure functional damage Distinguish between impairment and function
44
eGFR - what does it measure + involved? When is it used?
Estimated Glomerular filtration rate Clearance of DTPA Sex, age, creatinine levels and average surface ares (1.73m2) Only used in dialysis and kidney failure patients
45
Plasma Creatinine - normal range? Unhealthy level? What it signifies?
50-140umol/L 1000 umol/L in chronic renal disease Increases and eGFR decrease BUT is not a proportional to renal damage
46
Creatinine Clearance equation
urine creatinine mmol/L x urine volume (ml)/plasma creatinine (umol/L)
47
Normal creatinine clearance? Reasons for different levels?
100-130 ml/min Unreliable BUT increased due to secretion in tubules and decreases due to reaction to drugs
48
Plasma Urea normal range? measures?
5-8 mmol/L | unspecific measure of health
49
Reasons for changes in plasma urea? In health?
Intake of protein in GI tract and tissue proteins Affected by kidney re-absorption, excretion and distribution Kidney re-absorption is 40% BUT higher with slower tubular flow rate (hypoprofusion)
50
Increased Plasma Urea during?
GI bleeds - trauma | Reduced in Renal blood flow and extracellular fluid volume (hypoprofusion) in acute and chronic renal failure
51
Plasma Na normal references range
135-145 mmol/L
52
Urine Volume normal range? Different levels?
750-2000 ml/25 hours Oliguria <400 ml Anuria <100 ml Polyuria >3000 ml
53
Urine measures (5)
Urea Sodium Protein Glucose and Blood
54
ADH level in the blood?
Due to renin release stimulating ADH --> aldosterone High due to hypoprofusion of the kidneys
55
Which zone of the prostate due carcinomas usually reside?
Peripheral zone - easy to diagnose on digital rectal exam (DRE)
56
Which zone of the prostate is BPH usually reside in?
central and transitional zone - not easy to diagnose
57
BPH - benign prostatic hyperplasia? symptoms (5)? Risk?
``` Obstruction of the ureter = Weak Stream (size and length), Increased urgency and frequency Incomplete bladder emptying Nocturia Hesitancy ``` Increased age
58
Most common cancer of the prostate
Adenoma carcinoma
59
Risk factors for prostate cancer (6)
``` Age 40 - 50 African race Family history Diet Hormones Exposure to chemicals? ```
60
Staging and grading of prostate Cancer
``` Stage = TMN Grade = Gleason system ```
61
Treatments (4)
Surgery Radio Chemo Hormone therapy = anti-androgens --> regression of disease and can extend life by 15 years
62
PSA - what used for? what issues?
Prostate specific antigen Blood marker for prostate cancer - increased levels = increased chance BUT lots of false negatives and positives so NOT used in the UK
63
Testicular cancer Risks (5)
``` Family history European/ white descent Cryptorchidism Hormone imbalance Gonadal dysgenesis ```
64
Cryptorchidism - what this results in?
Failure for testes to descend >1 year after birth ECTOPIC testes = ab, inguinal or high scrotal. Bilateral or unilateral (more common on the right) Hormone imbalances and increased temp of ectopic testes
65
Hypogondalsim - what it causes?
reduced androgens = testicular atrophy
66
Primary hypogonadism due to? (7)
``` undescended testes Klinerfelter syndrome mumps trauma CF testicular torsion varicocele ```
67
Secondary hypogonadism due to ? (3)
Pituitary failure Drugs - steroids, opiods, chemo Obesity - adipose turn androgens in to oestrogens
68
Types of Testicular tumour (3)
Yolk sac Seminoma (germ cell) Paratesticular structures (eg. tunica vaginalis) Mesenchymal tumours
69
Yolk sac tumours - most common in? Presentation?
Children or mixed germ cell tumours in adults alpha fetoprotein elevated in blood and testes replaced with a gelatinous mass
70
Seminoma - age? presentation? blood markers?
35-45 years old testicular enlargement with or with out pain - RARE = inferitliy and gynecomastia PLAP and hCG
71
Inflammatory conditions of the testes (5 - long confusing words = just need to be able to recognize them)
``` Epididymoorchitis Granulomatous orchitis Sarcoidosis Malakoplakia sperm granulomas ```
72
Normal Flora of the Urogenital tract Kindeys and ureter Bladder urethra
STERILE = kindeys, ureter and bladder (usually) Urethra = perineal flora 1) skin = staph 2) lower GI = aerobic (enterobacteriaceae and gram negative coliforms) and Gram positive cocci
73
UTIs Complicated Vs uncomplicated
Complicated = due to underlying abnormality (structure or function) eg. insertion of foreign body (catheter) OR results in urinary stasis Uncomplicated = not due to any of the above
74
Cystitis Vs pyelonephritis
Cystitis = inflammation of the bladder = LUTI Pyelonephritis = inflammation of the ureter, renal pelvis and kidneys = UUTI
75
Symptoms of Cystitis
dysuria, urgency increase, frequency, nocturia, suprapubic pain, polyuria, haematuria
76
Symptoms of pyelonephrits
same as LUTI + loin and unilateral flank pain, fever, N&P, CRP and WBC elevated
77
Urethral syndrome - what is it? symptoms? ages?
Abacterial cystitis or frequent dysuria Same symptoms as UTI no infection Age 30 - 50
78
Signification Bacteriuria - (KASS criteria level)
Bacteria grown in urine culture above the KASS criteria count of 10^5 cfu/ml
79
Asymptomatic Bacteriuria
Significant levels of (one species) bacteria cultured but no symptoms
80
Sterile Pyuria
puss cells in urine BUT no bacteria cultured
81
Causes of UTIS - sex ratio (5)
``` Females 10:1 Urinary stasis - pregnancy, BHP, stones, strictures and neoplasm Instrumental Sexual intercourse fistulae congenital ```
82
Bacterial causes of UTIs (3)
Ecoli staphylococcus saprophyticus Enterococcus
83
Causes of Sterile Pyruia (4)
Inhibition of bacterial growth by AntiBs Fastidious - hard to grow organism UT inflammation - eg. by stones Urethritis eg. by STIs gonorrhea or chlamydia
84
Catheter UTI = two locations of bacteria? and why?
Bacteriuria - due to biofilm of colonization (distinguish from actual infection) Bacteraemia - on removal = discharge from site. AntiB prophylaxis used
85
Dipstick test for UTI - type of sample? result?
Clean catch midstream sample (can aspirate bladders of children) = no normal flora cultured NITRITE, blood, protein, WBC = cystitis BLOOD = pyelonephritis suspected
86
Urinary TB test
Acid fast bacilli - in 3 early morning urine samples
87
Microbial treatment of LUTI (4) - length of treatment?
nitrofurantoin pivemcillinan Trimethroprin fosfomycin ``` Females = 3 days Males = 7 days ```
88
Microbial treatment for Pyelonephritis (UUTI) (5) - same as LUTI and empiric? length?
Pivemicllinan, trimethroprin, fosfomycin Empiric = cefuroxime, ciprofloxacin 7 - 14 days
89
Treatment for symptomatic bacteriuria
Only in pregnant, infant or elderly with catheter
90
Non - microbial treatment of UTIs (4)
remove device anti- inflammatory Fluids drainage of abscesses

Year 2: Clinical Pathology (10 decks)

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