Renal Path (1/2 GU) Flashcards
(90 cards)
1
Q
Ratio of cortex to medulla
A
2:3
2
Q
What separates the renal calyces?
A
Columns of Bertin
3
Q
Define hydronephrosis
A
- Obstruction Resulting in:
- Dilatation of renal structures proximal to obstruction
- These can include: Calyces, Renal pelvis, Ureter
4
Q
External causes of obstructive Hydronephrosis
4
A
- Lymphadenopathy
- Retroperitoneal inflammation
- Retroperitoneal Fibrosis
- Endometriosis
5
Q
Most common intramural cause of Obstructive hydronephrosis
A
Transitional Cell Carcinoma
6
Q
Causes of Internal obstructive hydronephrosis
3
A
- Renal calculi (stones)
- Blood clots
- Renal colic
7
Q
Define stag horn calculus
A
- Single calculus occupies the entire calyceal system and renal pelvis
8
Q
Epidemiology of Stag Horn Calculus
A
Middle-aged to elderly females
9
Q
Cause of Stag Horn Calculus
A
Pyelonephritis caused by Proteus or E.Coli Infection
10
Q
Cause of Acute Pyelonephritis
A
Usually Ascending E.Coli infection
11
Q
Presentation of Pyelonephritis
2
A
Loin Pain
Fever
12
Q
Complications of acute pyelonephritis
A
Septicaemia –> Sepsis
Mycotic disease
13
Q
Treatment of acute pyelonephritis
A
Antibiotics
Remove Kidney
14
Q
Epidemiology of pyelonephritis
A
Young children
UTI usually treated before it gets to this stage
15
Q
Microscopic features of acute pyelonephritis
A
Neutrophil polymorphs
16
Q
Macroscopic features of acute pyelonephritis
A
Small studded abscesses throughout the renal parenchyma
17
Q
Aetiology of chronic pyelonephritis
A
Repeated infections caused by:
- Reflux
- Obstruction
18
Q
Diagnostic feature of chronic pyelonephritis
A
Polar scars (involve the calyx)
19
Q
Microscopic features of chronic pyelonephritis
A
Thyroidisation of tubules
Dilated tubules containing pink material- looks like thyroid follicles
20
Q
Macroscopic features of chronic pyelonephritis
A
- Polar scars
- Calyceal dilatation caused by hydronephrosis
- Reduction in renal parenchyma
21
Q
Inheritance of PKD
A
AD
22
Q
Epi PKD
A
- 3rd / 5th / 6thdecade
- FmHx PKD
23
Q
Presentation PKD
A
- CKD
- HTN
- Renal Mass
Extra-renal:
- Hepatic cysts
- Pancreatic cysts
- Berry aneurysms in circle of Willis
24
Q
Complications of PKD
A
- Cyst rupture : Pain + Bleeding
- 10% develop Cystic Clear Cell Carcinoma
- 20% berry aneurysm -SAH
25
Inheritance pattern of Infantile PKD
Autosomal Recessive
26
Epi Infantile PKD
Present at birth
27
Management of Infantile PKD
Dialysis from birth
28
Complication of duplex ureter
- Increased risk of stones and stricture resulting in hydronephrosis
29
Congenital/Inherited Renal diseases
5
```
PKD
Infantile PKD
Horseshoe Kidney
Duplex Ureter
Agenesis (1 Kidney)
```
30
What percentage of people have 1 kidney?
1%
31
Where are the kidneys located?
Retroperitoneal cavils
Upper pole at the 12th rib
32
Cause of Oligohydramnios
- Bilateral agenesis of Kidneys in fetus (Potter's syndrome)
| - Decreased volume of amniotic fluid caused by no fatal urine production
33
Define oligohydramnios
Reduced amniotic fluid
34
What chromosomes and genes are involved in PKD?
- 90% a-globin mutation on Chr 16 on PKD-1 gene
| - Minority on chr 4
35
Composition of stag horn stones
Magnesium Ammonium Phosphate
36
Most common renal stone composition
Calcium oxalate
37
Cause of White cell casts
Infection
38
Cause of Red cell casts
Glomerulonephritis: Nephritic syndrome
39
Cause of Hyaline casts
Glomerulonephritis: Nephrotic syndrome (Protein)
40
Name 3 benign Renal Tumours
Adenoma
Oncocytoma
Metanephric adenoma
41
Top 3 most common adult renal tumour
Clear cell carcinoma -90%
Papillary ca - 10%
Chromophobe ca - 5%
42
What % of all tumours are kidney tumours?
2%
43
Epi of renal tumours
M>F (2:1)
5th, 6th, 7th decades
44
RF renal tumours
5
1. Tuberous sclerosis
2. Von Hippel-Lindau (VHL)
3. Renal Transplant
4. Dialysis
5. Smoking
6. Cadmium exposure
7. HTN
45
What tumour is associated with Tuberous sclerosis?
Clear cell ca
46
What tumour is associated with Dialysis?
Papillary ca
47
Genetics associated with Clear cell ca
Majority: - Sporadic 3p del
Minority: - Familial: VHL
48
Genetics associated with Papillary Ca
- Trisomy 7 +/- 17
| - Mutations in MET proto-oncogene
49
Clinical Presentation renal tumour
Haematuria —> Most common
Renal mass
Flank pain
(Triad = poor prognosis)
50
Ix Renal mass
1. USS (Cystic vs solid)
2. CT
3. MRI
Intravenous urogram- not really used
51
Microscopic features of Clear cell carcinoma
- Sheets of clear cells
- Vacuolated (clear, lipid laden) cytoplasm
- Pyknotic (dark) nuclei
- Vascular
- May be cystic
52
Macroscopic Features of Papillary ca
Soft, friable tumour
| Multi-focal/ bilateral
53
Microscopic features of chromophobe ca
- Thick cell membrane (like vegetables)
| - Perinuclear halo
54
Microscopic features of collecting duct ca
Forms glands
Growth of dense CT and stroma
55
Microscopic features of sarcomatoid ca
Spindle
Mitotic features
Big nuclei
56
What is the name of the grading system fo renal tumours
Fuhrman Grading
57
How are renal tumours graded?
Based on size of nuclei
- Small = low grade
- Large = high grade
58
Which renal cell tumour is Grade 4?
Sarcomatoid
59
How are renal cell tumours staged?
pT1-4
60
Stage 1 renal ca
pT1a: confined to kidney, <4cm
pT1b: confined to kidney 4-7cm
61
Stage 2 renal ca
pT2: Confined to kidney, >7cm
62
Stage 3 renal ca
pT3: Involves renal Vein / Vena Cava
63
Stage 4 renal ca
pT4: Spread to adjacent organs
64
Rx Renal ca:
1. Surgery:
- Radical nephrectomy: mostly
- Partial nephrectomy: if tumour <4cm and peripheral
2. Chemo:
- Distant mets
3. Interferon:
- Distant mets
4. Radio-frequency ablation:
- Small tumour
- Patient unfit
65
Prognosis of Staged renal ca
pT1: 70%
pT2: 50%
pT3: 25%
pT4: 5%
66
Macroscopic features of TCC
Cauliflower tumour: Peduncualted
Yellow-brown
67
What type of tumour is a TCC
Papillary tumour
68
How to distinguish between RCC and TCC
RCC tumours enhance
69
Presentation of Nephroblastoma (Wilms tumour)
Abdo mass
Often bilateral (more likely in familial type)
70
Microscopic features of Nephroblastoma
```
Contains Foetal Tissue:
Triphasic pattern:
- Stroma
- Blastema (regenerating cells)
- Epithelial cells (forming poor glomerular and tubular structures)
```
71
Presentation of Nephrotic syndrome:
Proteinuria >3.5g/d
Oedema
Hypoalbuminaemia
Hypercholesterolaemia
72
Cause of Nephrotic syndrome in childhood
Minimal change disease
73
Cause of Nephrotic syndrome in adults
Membranous glomerulonephritis
Focal segmental glomerulonephritis
Secondary:
DM
SLE
Amyloidosis
74
Presentation of Nephritic syndrome
Haematuria
Oliguria
HTN
Acive urine sediment
- WBC casts
- RBC casts
- Hyaline (protein) casts
75
Causes of Nephritic Syndrome
- IgA nephropathy
- Post-Strep Glomerulonephritis
- Membranous glomerulonephritis
- Anti-GBM (Good-pastures)
76
Gold standard for diagnosing glomerulonephropathy
Renal biopsy under USS
77
When would you request an urgent report on a renal biopsy?
- Acute renal failure
| - Acute Transplant rejection
78
What do you send the renal biopsy for?
Light microscopy
Immunofluorescence (immune complex formation)
Electromicroscopy (Deposits in GBM and glomerular structure)
79
Where are most RCCs located?
Cortex
80
Macroscopic features of Clear cell carcinomas
- Yellow/ orange colour
| - Areas of cyst formation or haemorrhage
81
Macroscopic features of oncocytoma
- Mahogany colour
82
Inheritance of VHL
AD
83
Where are transitional cell carcinomas usually located?
- Attached to wall of renal pelcis
84
Rx Nephroblastoma/ Wilms’ Tumour
Surgery, shemo, radio
85
Survival rate of Nephroblastoma
90%
86
Epi of Nephroblastoma /Wilms’
- 98% in children <10
| - Mostly kids aged 2-4
87
Electron microscopic feature of minimal change nephropathy
Podocyte foot process fusion
88
Presentation of PKD
- Asymptomatic until 5th/ 6th decade
Then:
- Abdo masses
- Abdo and back pain
- Haematuria
- Renal insufficiency
89
What is shown on a renal biopsy in Post-strep glomerulonephritis?
- Endothelial and mesangial cell proliferation
- Fibrin deposits
- IgG deposits
- Complement C3 deposits
90
What vessels supply the renal medulla?
Vasa Recta
