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Clinical Pathology > Renal and Urological Pathology > Flashcards

Renal and Urological Pathology Flashcards

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1
Q

presentation of acute renal failure

A

unwell - malaise, fatigue, nausea, vomiting, arrhythmias
anuria/ oliguria
rapid rise in creatinine and urea

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2
Q

pre-renal causes of acute renal failure

A

reduced blood flow to kidney - severe dehydration, hypotension

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3
Q

renal causes of acute renal failure

A

damage to kidney

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4
Q

post-renal causes of acute renal failure

A

urinary tract obstruction - urinary tract tumours, pelvic tumours, calculi, prostatic enlargement

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5
Q

complications of acute renal failure

A 
cardiac failure - fluid overload 
arrhythmias - electrolyte imbalance 
GI bleeding 
Jaundice - hepatic vein congestion 
Infection - esp. lung and urinary tract
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6
Q

what is chronic kidney disease

A

permanently reduced GFR = reduced number of functional nephrons

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7
Q

causes of chronic kidney disease

A

adults - diabetes, glomerulonephritis, reflux nephropathy

chlidren - developmental abnormalities, glomerulonephritis, reflux nephropathy

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8
Q

presentation of chronic kidney disease

A

reduced urine output: excretion of water electrolytes > oedema and hypertension
reduced excretion of toxic metabolites
reduced epo production = anaemia and renal bone disease

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9
Q

renal manifestation of hypertension

A

damages renal vessels > wall thickening and reduced lumen size > reduced perfusion > ischaemia and activation of RAAS = ^HTN

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10
Q

renal manifestation of diabetes

A

damage due to hyperglycaemia
BM thickens
glomerulus produces excess extracellular matrix
small vessel damage causs ischaemia and tubular damage

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11
Q

renal manifestation of myeloma

A

excess Igs deposit in tubules which cause inflammation and fibrosis
renal tubule loss = irreversible decline in renal function

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12
Q

renal manifestation of vasculitis

A

inflammation in glomerular vessels can cause clotting and obliteration of capillary lumena and glomerulus destruction
inflammation of larger renal arterioles can cause tubule hypoxia
often part of systemic disease

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13
Q

renal manifestation of renal artery stenosis

A

due to atheroma or arterial dysplasia - ischaemic injury
activation of RAAS = HTN
loss of renal tissue = reduced function

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14
Q

nephrotic syndrome causes

A 
damage to glomerulus
adults: 
membranous nephropathy (idiopathic primary glomerular disorder) 
Focal segmental glomerulosclerosis 
minimal change disease 
diabetes, lupus nephritis, amyloid

children:
minimal change disease
focal segmental glomerulosclerosis

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15
Q

nephrotic syndrome presentation

A 
oedema
proteinuria >3g in 24hs 
hypoalbuminaemia 
\+/- hypertension 
\+/- hyperlipidaemia
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16
Q

acute nepritis presentation

A 
oedema 
haematuria 
proteinuria 
HTN 
acute renal failure
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17
Q

causes of acute nephritis

A 
adults:
post infective glomerulonephritis - after strep throat infection 
IgA nephropathy 
vasculitis 
SLE

children:
post-infective glomerulonephritis and IgA nephropathy
Henoch-Schonlein purpura
haemolytic uraemic syndrome

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18
Q

haematuria causes

A

IgA nephropathy
thin basement membrane disease
alport hereditary nephropathy - type IV collagen cause abnormal BM sometimes with eye and ear problems

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19
Q

what is pyelonephritis

A

infection via haematogenous spread

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20
Q

what is autosomal dominant polycystic kidney disease

A

bilateral cystic change > loss of functional renal parenchyma > chronic renal failure

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21
Q

clinical features of AD polycystic KD

A

HTN, polyuria, end stage renal disease between 40-60

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22
Q

pathenogenesis of AD polycystic KD

A

mutation of PKD1

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23
Q

what is autosomal dominant polycystic kidney disease

A

cystic disease of kidneys and liver in childhood

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24
Q

pathenogenesis of autosomal recessive polycystic KD

A

mutation of PKDH1

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25
most common kidney cancer
clear cell carcinoma
26
male or female renal Ca
males
27
risk factors for renal carcinoma
tobacco, obesity, HTN, oestrogens, acquired cystic kidney disease, asbestos
28
what is the most common several cancer syndrome observed in RCC
von hippel-lindau
29
what happens in V H-L sydrome
VHL gene required for breakdown of hypoxia inducible factor-1 oncogene causes cell growth and survival
30
presentation of RCC
haematuria, palpable abdominal mass, costovertebral pain incidental late presentation - systemic or mets
31
what are paraneoplastic syndromes
clinical syndromes that result from substances produced by tumours
32
paraneoplastic syndromes associated with RCC
Cushing's - ^ACTH hypercalcaemia - PTH related peptide polycythaemia - ^epo
33
morphology of clear cell renal carcinoma
well defined yellow tumours haemorrhagic areas may extend to perinephric fat tendency to invade renal vein
34
morphology of papillary renal cell carcinoma
more cystic | more likely to be multiple
35
overall 5 year survival or RCC
45% organ confined >70% distant mets = poor prognosis - chemo resitstant
36
most common bladder tumour
urothelial cell carcinoma
37
risk factors for urothelial cell carcinoma
``` age gender - male smoking arylamines cyclophosphamide radiotherapy ```
38
presentation of urothelial cell carcinomas
haematuria urinary frequency pain urinary tract obstruction
39
histological patterns in TCC
papilloma-papillary carcinoma invasive papillary carcinoma flat noninvasive carcinoma flat invasive carcinoma
40
causes of UT obstruction at pelvis
caliculi tumours uretopelvic stricture
41
causes of UT obstruction at intrinsic ureter
``` calculi tumours clots sloughed papilla inflammation ```
42
causes of UT obstruction at extrinsic ureter
pregnancy tumours retroperitoneal fibrosis
43
causes of UT obstruction at bladder
calculi tumour functional - neurogenic
44
causes of UT obstruction at urethra
posterior urethral valves | stricture, tumours
45
causes of UT obstruction at prostate
hyperplasia carcinoma prostatitis
46
sequelae of obstruction of UT
infection - cystitis, uretitis, pyelitis, ascending pyelonephritis acute/chronic kidney damage
47
complications from UT obstruction
hydronephrosis - result of chronic obstruction acute complete obstruction = reduction in glomerular filtration rate > acute renal failure
48
clinical features of UT obstruction
acute bilateral obstruction - pain, acute renal failure, anuria chronic unilateral obstruction - asymptomatic, cortical atrophy and reduced renal function
49
pathenogenesis of renal calculi
excess of substances which may precipitate out e.g. Ca change in urine constituents causing precipitation of substances poor urine output decreased citrate levels
50
classification of renal calculi
calcium stones - most common struvite stones - magnesium ammonium phosphate urate stones - uric acid cystine stones
51
why do calcium stones form
``` hypercalciuria due to hypercalcaemia excessive Ca absorption from gut inability to reabsorb tubular Ca idiopathic RF: gout, hyperoxaluria ```
52
why do struvite stones form
urease producing bacterial infection urease = urea > ammonia rise in urine pH precipitation of magnesium ammonium phosphate salts > staghorn calculus
53
gold standard test for renal calculi
non-contrast CT scan
54
sequelae of renal calculi
obstruction haematuria infection squamous metaplasia +/- squamous cell carcinoma
55
benign prostatic hyperplasia definition
enlargement of the prostate | overgrowth of the epithelium and fibromuscular tissue of the transition zone and periurethral area
56
BPH pathogenesis
arises from centrally situated glands 1. nodule formation 2. diffuse enlargement of the transition zone and periurethral tissue 3. enlargement of nodules
57
aetiology of BPH
impaired cell death
58
BPH lower uterine symptoms
``` urgency hesitancy diminished stream, size and force increased frequency incomplete bladder emptying nocturia ```
59
cancer of the prostate
adenocarcinoma
60
grading for prostatic cancer
gleason grade
61
risk factors of prostatic cancer
``` age race family history hormones levels environmental influences androgens inherited polymorphisms ```
62
when do the majority of germ cell tumours occur
young males | incidence accelerating rapidly following puberty and peaking close to 30 years of age
63
pre-existing medical conditions that are associated with the development of testicular germ cell tumours
``` prior TGCT in contralateral testicle cryptorchidism impaired spermatogenesis inguinal hernia hydrocele disorders of sex development prior testicular biopsy atopy testicular atrophy ```
64
age range of seminoma
most commonly 35-45 years old uncommon in men >50 rare in children
65
clinical presentation of seminoma
testicular enlargement with or without pain mets in 10% some have no symptoms
66
markers of seminona
elevated serum PLAP (40%) and hCG (10%)
67
macro seminoma
well demarcated cream coloured homogeneous corsely lobulated
68
teratoma age range
first and second decades of life
69
teratoma presentation
gradual testicular swelling with or without pain | almost always benign before puberty
70
markers of teratoma
pure teratoma = no markers
71
macro teratoma
well-demarcated, solid or multicystic
72
what is cryptorchidism
one or both testicles fail to descend and reach scrotum before birth most of the time has reached scrotum by 1 year
73
which side is cryptorchidism most frequent on
right
74
complications of cryptochidism
testicular atrophy infertility carcinoma - TGCT
75
skin flora
predominantly coag-neg staphylococci
76
lower GI tract flora
aerobic bacteria - enterobacteriaceae | gram positive coccus - enterococcus
77
what is cystitis
lower UTI
78
symptoms of cystitis
``` dysuria urinary frequency urgency supra-pubic pain/ tenderness polyuria, nocturia, haematuria ```
79
what is pyelonephritis
Upper UTI - kidney and/or renal pelvis
80
symptoms of pyelonephritis
symptoms of lower UTI loin/abdominal pain/ tenderness fever symptoms of systemic infection
81
what is asymptomatic bacteruria
significant bacteruria without symptoms of UTI
82
predisposing factors to UTI
``` female urinary stasis instrumentation sexual intercourse fistulae congenital abnormalities ```
83
what is a complicated UTI
underlying abnormality | presence of a foreign body
84
most common UTI causing organism
E.coli
85
causes of sterile pyuria
inhibition of bacterial growth hard to grow organisms urinary tract inflammation urethritis (sexually transmitted pathogens)
86
what is a catheter UTI
indwelling catheterisation results in bacteriuria | biofilm formation > colonisation
87
which other devices can also cause UTI
urostomies | nephrostomies
88
what can be seen on a urine dipstick
blood protein nitrite white blood cells - leucocyte esterase
89
non-antimicrobial management of UTIs
``` fluid intake anti-inflammatories device removal drainage if obstruction/ abscess recurrent UTIs - significant recurrent UTIs >3 episodes in 12 months cranberry juice ```
90
requirements for antibiotics in UTI
``` present in urine minimally toxic effective against likely organisms easily administered cheap ```
91
examples of antibiotics given in UTI
Nitrofurantoin Pivmecillinam Trimethoprim Fosfomycin
92
treatment of cystitis
females - 3 days antibiotics | males - 7 days
93
pyelonephritis treatment
empiric therapy - cefuroxime, ciprofloxacin piperacillin-tazobactam 7-14 days depending on antibiotic used
94
who should be treated with asymptomatic bacteruria
pregnant women infant - prevent pyelonephritis prior to urological procedures elderly
95
perinephric abscess
renal stones and/or diabetics obstruction of infected kidney gram neg bacilli
96
intrarenal abscess
haematogenous spread: unilateral, single, renal cortex s. aureus can be associated with classic acute pyelonephritis
97
what is prostatitis
inflammation of the prostate
98
symptoms of prostatitis
Lower UT symptoms fever tender prostate uropathogens - e. coli
99
laboratory tests of renal function
``` glomarular filtration rate eGFR creatinine clearance plasma creatinine plasma urea urine volume urine urea urine sodium urine protein urine glucose haematuria ```
100
definition of oliguria
<400mL/24hrs
101
anuria
<100mL/24hrs
102
polyuria
>3000mL/24hrs
103
normal urine output
750-2000mL/24hrs
104
plasma urea reference range
3-8mmol/L
105
factors influencing plasma urea concentration
GIT protein > liver amino acids Tissue protein > liver amino acids > plasma urea distribution volume > plasma urea Kidney reabsorption/ excretion kidney filtration
106
how is urea excreted
filtered at glomerulus 40% reabsorbed in health if more is absorbed then tubular flow is slow tubular flow is slow when there is hypoperfusion
107
causes of increased plasma urea
``` GI bleed trauma renal hypoperfusion acute renal impairment chronic renal disease post renal obstruction - calculus, tumour ```
108
normal range for plasma creatinine
50-140 umol/L
109
increase in conc as..
GFR increases
110
plasma creatinine in chronic renal disease
may increase to 1000umol/L
111
creatinine clearance in health
30-40% higher than GFR
112
creatinine clearance in chronic renal disease
tubular secretion increased
113
eGFR in stage 1 CKD
90+
114
eGFR stage 2 CKD
60-89
115
eGFR stage 3A CKD
45-59
116
eGFR stage 3B CKD
30-44
117
eGFR stage 4
15-29
118
eGFR stage 5
<15
119
pre-renal oliguria findings
GFR reduced ADH increased - conc urine/low vol renal hypoperfusion = renin increase Na reabsorption - urine Na low
120
Pre-renal failure causes
dehydration haemorrhage renal artery damage hypotension
121
renal oliguria findings
GFR reduced weak urine/ low volume renal renin secretion may be raised > HTN, nephrons unable to absorb sodium
122
renal oliguria findings
intrinsic damage - tubular necrosis - chronic infection - immunological damage - SLE - toxic damage - drugs, heavy metals, poisons
123
features of renal renal failure
anaemia haematuria proteinuria urine casts calcium/ phoshate bone disease

Clinical Pathology (8 decks)

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