Renal pathology 3

Question 1

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

Answer 1

Glomerulonephritis

Pyelonephritis

Question 2

What is glomerulonephritis?

Answer 2

Non infective inflammation of the kidney often caused by autoimmune conditions

Question 3

What does glomerulonephritis cause?

Answer 3

Glomerular tufts with secondary tubulointerstitial changes

Question 4

Is glomerulonephritis diffuse or focal?

Answer 4

Diffuse (usually)

Question 5

What is pyelonephritis?

Answer 5

Bacterial infection of renal pelvis, calycs, tubules and interstitium

Question 6

Is pyelonephritis acute or chronic? Diffuse or focal?

Answer 6

Acute or chronic (chronic more common)

Usually patchy focal

Question 7

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

Answer 7

E. coli

Step. faecalis
Pseudomonas

Question 8

Which sex more commonly is affected by pyelonephritis?

Answer 8

Females

Question 9

When does opportunistic pyelonephritis occur?

Answer 9

Immunocompromised patients (fungus, etc)

Question 10

What is the pathogenesis of pyelonephritis?

Answer 10

Septicaemia (rare)
Post surgery
Ascending infection from distal UT

Question 11

What is often present along with pyelonephritis?

Answer 11

Cystitis

Question 12

What are the risk factors for pyelonephritis?

Answer 12

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

Question 13

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

Answer 13

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

Question 14

What are the two main causes of urinary stricture?

Answer 14

Stones

Inflammatory disorders

Question 15

What is the vesico-ureteric reflux?

Answer 15

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

Question 16

What are the causes of vesico-ureteric reflux?

Answer 16

Congenital

Acquired (post bladder surgery)

Question 17

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

Answer 17

Neutrophil

Question 18

How does chronic pyelonephritis present?

Answer 18

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

Question 19

How does chronic pyelonephritis present on renal imaging?

Answer 19

Cortical scarring
Distortion of calyces
Shrunken in severe disease

Question 20

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

Answer 20

Damaged kidney cannot concentrate urine

Question 21

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

Answer 21

Lymphocytes

Plasma cells

Question 22

How does tubercular pyelonephrosis start?

Answer 22

Haematogenous spread from other source (lung)

Question 23

How does tubercular pyelonephrosis present?

Answer 23

Vague symptoms
Loin pain
Dysuria
Weight loss
Fever

Question 24

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

Answer 24

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

Question 25

How is TB diagnosed?

Answer 25

PCR

Question 26

What type of granulomas does TB produce?

Answer 26

Caseating

Question 27

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

Answer 27

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

Question 28

How does TB affect the kidneys?

Answer 28

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

Question 29

What kind of necrosis does TB cause?

Answer 29

Caseous ("cheese-like")

Question 30

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

Answer 30

Multi-nucleated giant cells

Question 31

What are the most common organisms causing cystitis?

Answer 31

E.coli Klebsiella Proteus Pseudomonas

Question 32

Is cystitis acute or chronic?

Answer 32

Acute but necrotising if associated with outlet obstruction

Question 33

What are ureteritis cystica and cystitis cystica respectively?

Answer 33

Multiple fluid filled cysts projecting into lumen of viscera

Question 34

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

Answer 34

False - they are reactive processes which can sometimes resemble tumours

Question 35

How common is cystitis?

Answer 35

Common

Question 36

Who usually gets necrotising cystitis?

Answer 36

Elderly males with prostatic bladder outflow obstruction

Question 37

How does tubuerculosis cystitis occur?

Answer 37

Urinary spread of mycobacterium from the kidneys

Question 38

What is schistosomiasis caused by?

Answer 38

S. haematobium (chronic urinary tract infection)

Question 39

Schistomomiasis is common in the UK. T/F

Answer 39

False - common in tropical countries

Question 40

What does schistosomiasis predispose to?

Answer 40

Urothelial malignancy (squamous cell)

Question 41

Which sex is almost primarily affected by ureteric obstruction?

Answer 41

Males

Question 42

What are the main causes of ureteric obstruction?

Answer 42

Stricture Prostate pathology Posterior urethral valves

Question 43

What does prolonged bladder outflow obstruction cause?

Answer 43

Hypertrophy of detrusor --> | Diverticula formation

Question 44

What is the cause of posterior urethral valve?

Answer 44

Congenital abnormality

Question 45

What is hydronephrosis?

Answer 45

Dilation of pelvicalycael system with parenchymal atrophy

Question 46

What is the cause of hydronephrosis?

Answer 46

Urinary tract obstruction | Prolonged reflux

Question 47

What are the causes of unilateral and bilateral hydronephrosis respectively?

Answer 47

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)

Question 48

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

Answer 48

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

Question 49

What is a secondary complication of hydronephrosis?

Answer 49

Infection (pyonephrosis - pus in kidney)

Question 50

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

Answer 50

Cortical thinning Atrophy Fibrosis