Renal pathology

Question 1

Which one of the following would NOT be included as a feature of chronic renal failure (CRF)?
a. Pulmonary oedema
b. Pulmonary interstitial fibrosis
c. Encephalopathy
d. Peripheral neuropathy

Answer 1

Answer: b
Feature of CRF = (Pulmonary) Fibrinous pleuritic (inflammatory condition affecting the pleura).

• Pulmonary interstitial fibrosis = IDIOPATHIC pulmonary fibrosis.

Presentation of Chronic Renal Failure: slide 28 (lecture: renal pathology)

• Encephalopathy = overall brain dysfunction

Question 2

Chronic benign prostate enlargement (BPE) may result in chronic renal failure (CRF). Which one of the following statements regarding CRF is NOT correct?
a. By definition, a diagnosis of CRF requires that the patient has lost >/=75% of renal function.
b. In the patient under discussion (BPE) CRF would be the consequence of an obstructive uropathy.
c. CRF-related anaemia results in markedly elevated erythropoietin levels.
d. Salt and water retention may result in congestive cardiac failure.

Answer 2

Answer: c
Anaemia = LOW erythropoietin

(Refer to slide 27-28 - lecture Renal pathology)

Question 3

This patient (benign prostate enlargement - urinary obstruction) may be susceptible to the development of acute pyelonephritis. Which one of the following statements is NOT correct?
a. The infection in pyelonephritis may reach the kidney by haematogenous spread from another site.
b. The infection may reach the kidney by retrograde spread up the urinary tract.
c. Glomeruli are affected and show changes early in the disease.
d. An investigative cystoscopy may introduce organisms in the Genito-urinary tract.

Answer 3

Answer: c
Infection affects the renal interstitium and tubules - NOT the glomeruli.

(Slide 20-22 - Lecture Renal Pathology)
* Acute pyelonephritis = acute suppurative inflammation of tubules and interstitium due to pyogenic organisms.
* Presence of white cell casts indicates pyelonephritis.
Pathogenesis:
* Haematogenous spread
* Retrograde ureteric spread = most common route is ascending infection from lower urinary tract

Question 4

In terms of susceptibility to pyelonephritis, which one of the following statements is NOT correct?
a. Posterior urethral valves in infant boys may increase susceptibility.
b. Between puberty and middle age, females are more likely to develop pyelonephritis.
c. After middle age, males and females are equally at risk.
d. Diabetes mellitus may increase the risk of pyelonephritis.

Answer 4

Answer: c
Males become increasingly at risk after middle age - often due to benign prostate hyperplasia (BPH).

• (a) “begins early in life or with obstruction developing in adulthood” (slide 22 - renal pathology) - posterior urethral valves cause urinary obstruction in male infants - increasing the risk of urinary tract infections and pyelonephritis.
• (b) “often occurs in young women” (slide 21 - renal pathology) - young women are at higher risk due to a shorter urethra, pregnancy, and hormonal factors.
• (d) Diabetes impairs immune function and causes glycosuria which promotes bacterial growth + predisposes pts. to more severe infections - including pyelonephritis.