Renal pathology 3 Flashcards Preview

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Flashcards in Renal pathology 3 Deck (50):
1

What are the two types of nephritis that we must distinguish between?

Glomerulonephritis
Pyelonephritis

2

What is glomerulonephritis?

Non infective inflammation of the kidney often caused by autoimmune conditions

3

What does glomerulonephritis cause?

Glomerular tufts with secondary tubulointerstitial changes

4

Is glomerulonephritis diffuse or focal?

Diffuse (usually)

5

What is pyelonephritis?

Bacterial infection of renal pelvis, calycs, tubules and interstitium

6

Is pyelonephritis acute or chronic? Diffuse or focal?

Acute or chronic (chronic more common)
Usually patchy focal

7

What is the commonest cause of pyelonephritis? Name two other causes

E. coli

Step. faecalis
Pseudomonas

8

Which sex more commonly is affected by pyelonephritis?

Females

9

When does opportunistic pyelonephritis occur?

Immunocompromised patients (fungus, etc)

10

What is the pathogenesis of pyelonephritis?

Septicaemia (rare)
Post surgery
Ascending infection from distal UT

11

What is often present along with pyelonephritis?

Cystitis

12

What are the risk factors for pyelonephritis?

Female (length of urethra)
Post instrumentation
Pregnancy
Urinary tract obstruction
Duplex systems
Vesico-ureteric reflux
Diabetes

13

Cystitis and pyelonephritis is common in pregnant woman. T/F

True - hormonal & anatomic influence --> ureteric dilation & urinary stasis

14

What are the two main causes of urinary stricture?

Stones
Inflammatory disorders

15

What is the vesico-ureteric reflux?

Normal - Ureters enter bladder in oblique direction normally so orifice closed during contraction of bladder (i.e micturation)

Reflux - Perpendicular ureter entrance into bladder so contraction does not completely close orifices allowing reflux of urine

16

What are the causes of vesico-ureteric reflux?

Congenital
Acquired (post bladder surgery)

17

Which immune cell is the most numerous during an acute inflammatory reaction?

Neutrophil

18

How does chronic pyelonephritis present?

Vague symptoms
Often no preceding UTI (insidious onset)
Large urine volume
Hypertension
Uraemia

19

How does chronic pyelonephritis present on renal imaging?

Cortical scarring
Distortion of calyces
Shrunken in severe disease

20

Why might patients with chronic pyelonephritis produce large volumes of urine?

Damaged kidney cannot concentrate urine

21

Which immune cells are most numerous during a chronic inflammatory reaction?

Lymphocytes
Plasma cells

22

How does tubercular pyelonephrosis start?

Haematogenous spread from other source (lung)

23

How does tubercular pyelonephrosis present?

Vague symptoms
Loin pain
Dysuria
Weight loss
Fever

24

Which pathology is sterile pyuria associated with? What does it mean?

Pus in urine but negative culture (culture should be positive in later stage infection)

25

How is TB diagnosed?

PCR

26

What type of granulomas does TB produce?

Caseating

27

What type of histology stain can TB be seen on? Is this diagnostic?

Zeehl - Neilson (acid fast bacilli)
Yes but negative stain is not exclusion criteria

28

How does TB affect the kidneys?

Slow destruction of kidney +/- spread to ureter, bladder and other viscera

29

What kind of necrosis does TB cause?

Caseous ("cheese-like")

30

Which immune cells are often seen along with TB of the kidney?

Multi-nucleated giant cells

31

What are the most common organisms causing cystitis?

E.coli
Klebsiella
Proteus
Pseudomonas

32

Is cystitis acute or chronic?

Acute but necrotising if associated with outlet obstruction

33

What are ureteritis cystica and cystitis cystica respectively?

Multiple fluid filled cysts projecting into lumen of viscera

34

Ureteritis cystica and cystitis cystica are both neoplastic processes. T/F

False - they are reactive processes which can sometimes resemble tumours

35

How common is cystitis?

Common

36

Who usually gets necrotising cystitis?

Elderly males with prostatic bladder outflow obstruction

37

How does tubuerculosis cystitis occur?

Urinary spread of mycobacterium from the kidneys

38

What is schistosomiasis caused by?

S. haematobium (chronic urinary tract infection)

39

Schistomomiasis is common in the UK. T/F

False - common in tropical countries

40

What does schistosomiasis predispose to?

Urothelial malignancy (squamous cell)

41

Which sex is almost primarily affected by ureteric obstruction?

Males

42

What are the main causes of ureteric obstruction?

Stricture
Prostate pathology
Posterior urethral valves

43

What does prolonged bladder outflow obstruction cause?

Hypertrophy of detrusor -->
Diverticula formation

44

What is the cause of posterior urethral valve?

Congenital abnormality

45

What is hydronephrosis?

Dilation of pelvicalycael system with parenchymal atrophy

46

What is the cause of hydronephrosis?

Urinary tract obstruction
Prolonged reflux

47

What are the causes of unilateral and bilateral hydronephrosis respectively?

Unilateral
- calculi
- neoplasm
- pelvi-ureteric obstruction (surgery or congenital)
- strictures
Bilateral
- urethral obstruction
- neurogenic disturbance (paraplegic, etc)
- vesico-ureteric reflux
- bilateral ureteric obstruction (e.g cancer)

48

What are the effects of sudden complete urinary tract obstruction and gradual and partial, respectively?

Sudden & complete - urine production ceases, no dilation
Gradual & partial - dilation

49

What is a secondary complication of hydronephrosis?

Infection (pyonephrosis - pus in kidney)

50

What are the pathological effects on the kidney in severe hydronephrosis?

Cortical thinning
Atrophy
Fibrosis

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