Seminar 11 - Urosepsis Flashcards

Question

What causes luteal ovarian cysts

Answer 1

These occur when the corpus luteum has filled with fluid and failed to regress

Answer 2

These cells of mesangial origin are contractile, phagocytic and capable of proliferation, of laying down matrix and collagen, and of secreting several biologically active mediators

Answer 3

True where possible only the cyst or the ovary that the cyst is in will be removed leaving either both ovaries or one remaining ovary to preserve fertility

Answer 4

Type 1 | Though more common in adults

Answer 5

An extension of suppurative inflammation through the renal capsule into perinephric tissue

Answer 6

A proliferative process affecting endothelial cells.

Answer 7

Classed as pre-renal, renal (intrinsic) or post-renal

Answer 8

True | They can be both symptomatic and asymptomatic but most tend to asymptomatic

Answer 9

They can occur at any age but are most common in women of reproductive age Approx 4% of women will be admitted to hospital due to an ovarian cyst by age 65

Answer 10

Unusually receptive uroepithelial cells Colonization by ‘stick strains’ of E coli Behavioural factors Recurrent UTIs are mainly caused by reinfection by the same pathogen

Answer 11

Infections within 3 months of the original infection

Answer 12

Proximal convoluting tubule

Answer 13

Women | Significantly more common

Answer 14

More likely to occur in the presence of ureteral obstruction and in debilitated patients In patients receiving immunosuppressive therapy

Answer 15

Well defined nodules compressing urethra to slit

Answer 16

A biochemical abnormality referring to elevated blood urea nitrogen (BUN) and creatinine levels, and is related largely to a decreased GFR It is a consequence of many renal disorders (AKI, CKD), but it also arises from extra-renal disorders

Answer 17

Targeted therapy can be given in some carcinomas and can also be used in some to treat recurrence

Answer 18

Has there are occasional microvilli, mitochondria, golgi apparatus, interdigitating processes (at base of cell) and a basal lamina Smaller than PCT More obvious luminal margin as apical microvilli are sparse - no brush border

Answer 19

Sudden onset of acute severe pain +/- nausea and vomiting

Answer 20

Colonization of distal urethra & introitus (in the female) by coliform bacteria From urethra to bladder: organisms gain entrance during urethral catheterization or other instrumentation Or they can just spread up - more common in women There are then many conditions that predispose to the movement of microbes from bladder to kidneys - obstructions (particualrly lower UT), vesicoureteral reflux and intrarenal reflux

Answer 21

A non-proliferative process affecting podocytes

Answer 22

Circulating Ag-Ab complexes can become trapped within the glomeruli and cause glomerular injury Antigens which trigger formation of immune complexes can be endogenous (e.g., GN assoc. with SLE or in IgA nephropathy ) or exogenous (e.g., GN following infection).

Answer 23

Those whose condition does not respond rapidly to antibiotics

Answer 24

A family Hx of these tumours Hereditable mutations Nulliparity These tumours are also more frequent in women who have low parity

Answer 25

Proliferation of the cells within the glomeruli and an inflammatory leukocytic infiltrate severely injures the capillary walls This allows blood to pass into the urine and induces haemodynamic changes Leads to a overall reduction in GFR

Answer 26

Another infection with the same bacterial strain | Need to identify the cause of bacterial persistence in urinary tract e.g. stone, foreign body

Answer 27

Most are primary -75% | This is the auto-immune form

Answer 28

False | They will me slightly or massively enlarged

Answer 29

Renal cell carcinoma As a result they are resected when they are found to be safe They also affect the same demographics

Answer 30

Hyperplastic nodules composed of glands with infoldings of papillary epithelium

Answer 31

Begin treatment as soon as sepsis has been verified (NEWS2 of 5 or>5 in a patient with likely infection) by a senior clinician (ST3 or above) Start the Sepsis 6 aka BUFALO The critical care team may also adminisister corticosteroids, inotropes or vasopressors Reassess and frequently monitor.

Answer 32

How far it has spread outside the ovary and the extent of spread across the peritoneum The histological appearance of serous carcinoma will also influence its prognosis

Answer 33

True Post-infectious is the classic exogenous example nephritis of SLE is an example of endogenous.

Answer 34

The vast majority (>90%) are urothelial Squamous cell is associated with specific exposures - e.g. catheters

Answer 35

They are rare benign tumours seen in the ovary | They can contain mucinous, serous, endometroid or transitional ( Brenner) epithelium.

Answer 36

Serous tubal intraepithelial carcinoma Can be the precursor lesion fin both sporadic and familial cases (linked to BRACA mutations)

Answer 37

The continued glomerular filtration on top of the obstruction

Answer 38

Young women

Answer 39

Mainly made of epithelial cells that have abundant cytoplasms. This makes the cells resemble hypersecretory gestational endometrium

Answer 40

Overall caused a proliferative glomerular injury which includes: Acute proliferative - includes post-infectious (post-strep) and infection associated Crescentic (Rapidly Progressive) GN (RPGN) - includes anti-GBM antibody mediated, immune complex deposition and Pauci-immune crescentic GN

Answer 41

Pulmonary complications

Answer 42

Type 2 arise due to functional cysts being invaded by either ovarian endometriosis or type 1 endometriomas

Answer 43

They account for 40% of cancers of the ovary and is the most common malignant ovarian tumour

Answer 44

Meningococcal (Neisseria meningitidis) bacteraemic shock = Mortality of 10-20% Staphylococcal (s.aureus) toxic shock syndrome = mortality of 5% Streptococcal (group A) toxic shock syndrome - mortality of 50%

Answer 45

Age – often described as a disease of advancing age and age is one of the strongest risk factors Black ethnicity – Mortality is twice as high in the US Family Hx High dietary fat

Answer 46

True This is because they are related conditions Data on pyelonephritis is however limited

Answer 47

Fever, tachycardia, and hypotension are common | Also have signs related to the sight of infection e.g. urosepsis flank pain and dysuria

Answer 48

Caused by anti-GBM antibodies They cross react with the BM in the alveoli and affect the GBM in the kidney This leads to pulmonary haemorrhage associated with renal failure

Answer 49

Segmental glomerular necrosis and distinctive crescents (adjacent to glomerular segments uninvolved by inflammatory or proliferative change).

Answer 50

The collecting ducts | It increases their permeability to water - more is resorbed

Answer 51

Range from erythematous, slightly thickened bladder wall to large fungating tumours with areas of haemorrhage, necrosis and ulceration

Answer 52

Results from seeding of the kidneys by bacteria from distant foci during septicaemia or localized infections

Answer 53

The inflammatory response in sepsis causes widespread tissue injury. Multi-organ dysfunction may be partly caused by apoptosis of immune, epithelial, and endothelial cells and a shift to an anti-inflammatory phenotype, compounded by impaired organ perfusion due to hypotension, low cardiac output states, circulatory microthrombi, a disordered microcirculation, and tissue oedema

Answer 54

Shows deposits due to immune complex deposition. Regardless of type, EM may show ruptures in the GBM, a severe injury that allows leukocytes, plasma proteins to reach the urinary space, where they trigger crescent formation. In time, most crescents undergo organisation & foci of segmental necrosis resolve as segmental scars (type of segmental sclerosis). Restoration of normal glomerular architecture may be achieved with early aggressive therapy.

Answer 55

Both have a propensity to spread to the peritoneum and omentum and commonly cause ascites

Answer 56

It consists mostly of type IV collagen & several matrix proteins (incl. laminin, proteoglycans

Answer 57

Of the 70% of infected patients with positive microbiology: 47% of isolates were gram-positive (Staphylococcus aureus alone accounted for 20%) 62% were gram-negative (20% Pseudomonas species and 16% Escherichia coli) 19% were fungal

Answer 58

The combination of infiltration of leukocytes and swelling and proliferation of mesangial and/or endothelial cells

Answer 59

True | Due to prostatic hypertrophy & instrumentation

Answer 60

Adult women 1 in 5 experience a UTI at some point 30x more likely than men to develop UTI High rates in post-menopausal women

Answer 61

False | It is second after lung cancer

Answer 62

15-30% of endometroid ovarian carcinoma will be accompanied by carcinoma of the endometrium In these cases the endometroid ovarian carcinoma is a result of metastasis of the primary endometrial cancer

Answer 63

nephritic syndrome of haematuria, oedema, and hypertension indicates a glomerular aetiology

Answer 64

25 species known to date Includes: Staphylococcus aureus (S. aureus) Streptococcus pyogenes (S. pyogenes)

Answer 65

It is a chronic immune complex-mediated disease, primary form is an autoimmune disease caused mostly by antibodies to a renal autoantigen (PLA2R) This is a membrane protein at the basal surface of glomerular epithelial cells Also involves IgG4 deposition

Answer 66

gonadotrophins and other ovarian induction agents can cause cysts as they can cause ovarian hyperstimulation syndrome

Answer 67

Lactate is a marker of stress and may be a marker of a worse prognosis Raised serum lactate highlights the possibility of tissue hypoperfusion and may be present in many conditions

Answer 68

It's made of dense collagen fibres | Thin but strong

Answer 69

Furosemide

Answer 70

They arise in association with borderline tumours and endometriosis and are low grade. This group includes endometrioid, mucinous and low grade serous carcinomas

Answer 71

Derangement in glomerular capillary walls causes increased permeability to plasma proteins.

Answer 72

They become thickened with a double-contour” or “tram-track” appearance on silver or PAS stains This is caused by duplication of the BM (aka. splitting) usually as a result of new BM synthesis in response to subendothelial deposits of immune complexes

Answer 73

Diffuse thickening of the glomerular capillary wall due to accumulation of deposits containing immunoglobulin along the subepithelial side of the BM Epithelial cells of proximal tubules contain protein reabsorption droplets and there may be considerable mononuclear cell inflammation

Answer 74

Benign prostatic hypertrophy Tumours Calculi Neurogenic bladder dysfunction caused by diabetes or spinal cord injury

Answer 75

Observation and active surveillance are both options | Especially in older patients

Answer 76

Also called mature cystic teratomas They will contain elements from all three germ layers Most will be benign but 1-2% can undergo malignant transformation Can also become very large increasing the risk of ovarian

Answer 77

New infection by a different organism/strain

Answer 78

Urinary tract obstruction, either congenital or acquired Instrumentation of the urinary tract, most commonly catheterization Vesicoureteral reflux Pregnancy - 4-6% of pregnant women develop bacteriuria during pregnancy Pre-existing renal lesions, causing intrarenal scarring and obstruction Diabetes Immunosuppression & Immunodeficiency

Answer 79

1 = Immune system activation 2= Activation of endothelium and alteration in the coagulation system 3 = Inflammation and organ dysfunction 4 = These abnormalities may lead to lactic acidosis, cellular dysfunction, and multi-organ failure

Answer 80

Current thinking is that there is some immune dysfunction and elaboration of factors that damage visceral epithelial cells Ultrastructural changes point to a primary visceral epithelial cell injury This leads to the proteinuria

Answer 81

Type 1 - deposition of immune complexes containing IgG and complement Type 2 - dense deposit disease, in which activation of complement appears to be crucial.

Answer 82

Usually due to widespread metastasis and their effects on other organs causing ; Bowel obstruction Liver failure Respiratory tract blockage leading to infection causing sepsis or respiratory failure These patients have also been known to die from PE and infection - potentially due to chemotherapy or due to metastasis effecting the liver function and the lungs

Answer 83

Enlargement of prostate Prostatism Debilitation Subsequent instrumentation of the urinary tract

Answer 84

False | Polycystic ovaries are found in 20-30% of women of a reproductive age so not all have PCOS

Answer 85

Specific clinical settings such as a mismatched blood transfusion.

Answer 86

Caused by inadequate blood flow to the peripheral organs, hypotension and shock. Seen in cases of severe trauma, pancreatitis and ones listed earlier all lead to these blood supply issues

Answer 87

Pyelonephritis

Answer 88

They tend to have come from serous intraepithelial carcinoma. This group includes high grade serous carcinoma

Answer 89

Often larger than 2cm in diameter | If >2cm can be detected by palpations and USS

Answer 90

Lasts about 36 hours The main feature is the causative medical, surgical or obstetric event. Only clue that renal system is affected is a slight decrease in urine output and rise in blood urea nitrogen. Likely due to a transient decrease in blood flow and GFR

Answer 91

The normal ureteral insertion into the bladder is a one-way valve that prevents retrograde flow of urine when the intravesical pressure rises, as in micturition

Answer 92

The kidney can either be enlarged slightly or it can be enlarged massively. How enlarged it is will depend on the degree and the duration of the obstruction

Answer 93

They include; aberrations in PIK3CA, KRAS, ARID1A, PTEN and TP53 Most of the genetic aberrations that are seen in clear cell carcinoma are shared with endometrioid carcinoma just in different frequencies

Answer 94

Coarse, discrete, corticomedullary scars overlying dilated, blunted, or deformed calyces, and flattening of the papillae Involve predominantly tubules and interstitium Tubules show atrophy in some areas and hypertrophy or dilation in others Thyroidization -- Dilated tubules with flattened epithelium may be filled with casts resembling thyroid colloid Varying degrees of chronic interstitial inflammation and fibrosis around the calyceal epithelium Glomeruli may appear normal

Answer 95

Tumours most commonly present in pts in their 60s and 70s | Median age of diagnosis is 64

Answer 96

Composed of basement membrane beneath transitional epithelium/ urothelium. Most superficial layer of cells (“umbrella” cell layer) are very resistant to osmotic pressure and very distensible They have rounded tops when the tissue not stretched

Answer 97

The symptoms don't appear until late stages of the disease so women often present much later than in cervical or endometrial

Answer 98

Hyalin is an extracellular, amorphous material composed of plasma proteins It moves from the circulation into glomerular structures When extensive, these deposits may obliterate the capillary lumens of the glomerular tuft On light microscopy you see accumulation of material that is homogenous and eosinophili

Answer 99

These tumours collectively are rare with the benign and borderline forms being exceedingly rare and the clear cell carcinomas being uncommon

Answer 100

HUS - haemolytic uraemic syndrome | Also gastroenteritis can cause severe hypovolaemia and lead to an AKI

Answer 101

Treatment will depend on the patients health, whether they are post menopausal and how far the carcinoma has spread

Answer 102

True Incidence increases as age does Up to 40% of overs-70s will have them

Answer 103

The epithelial cells in the tubules are very sensitive to ischaemia and toxins Ischaemia causes structural and functional changes such as redistribution of membrane proteins This leads to abnormal ion transport and increased sodium in the distal tubules. The rise in Na causes vasoconstriction via tubuloglomerular feedback which initially lowers the GFR to maintain distal blood flow. The ischaemic tubular cells also release cytokines and adhesion molecules which recruit leukocytes to the area - contributes to injury Can also be caused by urine backflow and intratubular obstruction. You also get activation of the coagulation cascade and cell necrosis/apoptosis

Answer 104

True | Over 70% of new cases in the over-65s

Answer 105

Bacterial proteins that generate a powerful immune response by binding to Major Histocompatibility Complex class (MHC) II molecules on 1) antigen-presenting cells (APCs) and 2) T cell receptors on T cells They are extremely potent

Answer 106

IF shows granular deposits of antibodies and complement. Can be a complication of any of the immune complex nephritides, incl. post-strep GN, lupus nephritis, IgA nephropathy, and HSP

Answer 107

The vast majority of these tumours will be benign and borderline with a smaller proportion being malignant

Answer 108

Occurs in up to 80% of pts w/ tuberous sclerosis They also have a strong female predilection Overall prevalence of 0.2-0.6% so rare in general population

Answer 109

``` Age > 65 Immunocompromised Catheter Recent surgery Diabetes IV drug use ```

Answer 110

Seen in around 54% of patients. | Pulmonary oedema and hypoxia are common

Answer 111

It is secreted by the adrenal cortex Acts on the DCT and results in greater Na+ and water retention Therefore, increases BP.

Answer 112

infection of tubular epithelial cell nuclei, leading to nuclear enlargement and intranuclear inclusions visible by light microscopy

Answer 113

They are large and hypercellular Hypercellularity produced by proliferation of cells in mesangium and capillary endothelium + infiltrating leukocytes. Accentuated “lobular” appearance due to proliferating mesangial cells & increased mesangial matrix.

Answer 114

``` -RR and HR = tachypnoea and tachycardia Temp = high or low temp (+/- rigors) AVPU = Altered mental status O2 = low O2 sats BP = hypotension ```

Answer 115

``` Blood culture - before antibiotics Serum lactate Hourly urine output Urea and electrolytes Serum glucose Clotting screen Liver Function Tests C-reactive protein Serum procalcitonin (new) Blood gas ECG ```

Answer 116

The obstruction will either be a complete obstruction or an almost complete obstruction. The obstruction also tends to be high in the urinary tract

Answer 117

They account for approximately 10-15% of ovarian cancer

Answer 118

Lesions protruding into the lumen of the bladder

Answer 119

In patients receiving immunosuppressive therapy Also more common for certain viruses and fungi to be involved

Answer 120

KRAS proto-oncogene mutations are found in 85% of mucinous carcinomas and it is felt they are responsible for initiating the development of these tumours KRAS mutations are also seen in benign and borderline forms of these tumours

Answer 121

Should exclude vaginitis, cervicitis or pelvic tenderness (suggests PID) in pelvic examination

Answer 122

False This is where most cancers arise BPH in more common in the transitional zone

Answer 123

``` Vascular injury and bleeding Bowel, bladder or ureter damage Nerve damage Infection DVT Adhesion formation Ovarian remnant syndrome Anaesthetic complications ```

Answer 124

Yes It is possible to get malignant Brenner tumours and transitional cell carcinomas. The different is that malignant Brenner tumours are when are when there are benign Brenner nests mixed with malignant cells and transitional cell carcinoma is when >50% of the tumour is made of malignant transitional type epithelium

Answer 125

They are usually benign contained neoplastic epithelial cells that look like uroepithelium

Answer 126

Excessive activation of alternative complement pathway

Answer 127

They appear uncomfortable but not toxic Presence of toxic fever, chills, nausea and vomiting May appreciate signs of dehydration e.g. dry mucous membranes & tachycardia Clammy extremities & symptomatic orthostasis suggest poor vascular tone due to gram-negative bacteremia

Answer 128

Lactate is a marker of stress and may be a marker of a worse prognosis Raised serum lactate highlights the possibility of tissue hypoperfusion and may be present in many conditions

Answer 129

Made up of cells that are identical morphologically to high grade serous carcinoma. The cells in this lesion do not invade the underlying stroma

Answer 130

Have widespread infiltration or frank effacement of the underlying stroma and more complex growth patterns - distinguishes from low grade Tumour cells have nuclear atypia, including pleomorphism, atypical mitotic figures and multinucleation Sometimes of the tumours are so undifferentiated it may not be possible to recognise the serous feature

Answer 131

Tumours tend to be well-differentiated, but some cells may contain atypical nuclei Cells are generally rounded/ polygonal with large amounts of clear cytoplasm Vasculature is usually delicate and branching

Answer 132

For non-invasive cancers, transurethral resection is the treatment of choice with post-op intravesical chemotherapy +/- immunotherapy Invasive cancer will usually require radical cystectomy +/- pelvic lymph node dissection +/- systemic adjuvant chemotherapy

Answer 133

Breathlessness Nausea Diarrhoea Tiredness

Answer 134

diuretics (especially K+ sparing), metformin and anti-hypertensives They should be stopped in cases of AKI

Answer 135

Pathogen successfully enters and survives in body Innate immune system activated Amplification of cellular and humoural response (cytokines, interleukins, ROS, complement system activate immune cells)

Answer 136

Autoantibodies bind to the PLA2R membrane protein at the basal surface of glomerular epithelial cells This triggers complement activation and shedding of immune aggregates from cell surface Results in characteristic deposits of immune complexes along the subepithelial aspect of the BM. Complement activation injures the capillary wall and causes increased protein leakage.

Answer 137

Streptococcal infection Only certain group A b-haemolytic streptococcal strains are nephritogenic (>90% of cases due to types 12, 4 and 1).

Answer 138

Seen in 30% of over 50s and 90% of over 80s

Answer 139

GBM appears normal - no electron-dense material deposited Principal lesion is in the podocytes: uniform + diffuse effacement of foot processes - reduced to a rim of cytoplasm with loss of recognisable intervening slit diaphragms This change represents simplification of the epithelial cell architecture with flattening, retraction + swelling of foot processes PT cells are often laden with lipid & protein, reflecting tubular reabsorption of lipoproteins passing through diseased glomeruli

Answer 140

Recurrent episodes afflict in 1 in10 women at some time in their life

Answer 141

Fluid resuscitation is given with either colloids or crystalloids and vasopressors might be given

Answer 142

initiation, maintenance and recovery

Answer 143

Leads to vasoconstriction which in turn decreases GFR

Answer 144

When men reach the age of 60 and above

Answer 145

Takes 1 of 3 forms Amorphous electron-dense material on the endothelial or epithelial side of the BM or within the GBM itself. Increased synthesis of the protein components of the BM (e.g., diabetic glomerulosclerosis). Formation of additional layers of BM matrices – most often occupy subendothelial locations; range from poorly organised matrix to fully duplicated lamina densa (e.g., MPGN).

Answer 146

Get a sustained decrease in urine output (oliguria) of 40-400ml per day, salt and water overload, rising BUN, hyperkalaemia, metabolic acidosis and other symptoms of uraemia . Can recover from this with appropriate treatment

Answer 147

Ordinarily, organisms introduced into the bladder are cleared by continual voiding and by antibacterial mechanisms

Answer 148

Kidneys – RCC Ureters – Urothelial carcinoma Bladder – Urothelial carcinoma Prostate – Adenocarcinoma

Answer 149

May be more likely in those with sepsis or pre-existing cardiac disease

Answer 150

``` B - bloods U – urine output F – fluid resuscitation A – antibiotics L – lactate O – O2 judiciously ```

Answer 151

True | 66% are bilateral

Answer 152

Epithelial damage = ultrastructural hallmark of FSGS Circulating factors and genetically determined defects damage slit diaphragms of epithelial Causes hyalinosis + sclerosis from entrapment of plasma proteins in hyperpermeable foci + increased ECM deposition.

Answer 153

Seen in 35% of cases and can include heart failure, MI, arrhythmia Elderly with reduced cardiac reserve are high risk Hyperkalaemia can lead to arrhythmia and cardiac arrest

Answer 154

They appear as complex cysts on USS and have a ground glass appearance on internal echo

Answer 155

Eventual hypoperfusion due to hypovolaemia Impaired O2 delivery to cells due to peri-capillary oedema Additional contributing factors: disordered blood flow at capillary level and increased blood viscosity

Answer 156

Discrete subendothelial electron-dense deposits between duplicated (split) BMs IgG + C3 present in granular pattern along with early complement components (C1q & C4)

Answer 157

Diabetes Amyloidosis SLE

Answer 158

This is when the epithelial cells in borderline serous tumours grow in a delicate papillary pattern. This is thought to be the precursor lesion to low grade serous carcinoma

Answer 159

Invasion in basement membrane associated with papillary urothelial cancers or adjacent CIS – overlying CIS destroyed by malignant invasion

Answer 160

no Ig or complement deposits

Answer 161

Also account for 5-10% of primary renal tumours

Answer 162

Contributes to tubular injury This leads interstitial inflammation which directly decreases GFR It also leads to sloughing of cells > obstruction and reduced GFR

Answer 163

Ovarian endometriosis In some cases as the peak onset of endometrioid carcinoma is a decade earlier in endometriosis patients

Answer 164

Characteristically contains exfoliated tumour cells

Answer 165

Higher risk of endometrial hyperplasia and carcinoma This is due to increased levels of free serum estrone (type of female sex hormone)

Answer 166

``` The cysts are lined with columnar epithelium Concentric calcifications ( psammoma bodies) are features that are common in all types of serous tumours however they are not specific to neoplasia ```

Answer 167

The ovaries contain multiple cystic follicles which causes the ovaries to become enlarged

Answer 168

These cysts may form in the follicular phase due excessive FSH levels leading to a lack of ovulation or because of a lack of the LH surge

Answer 169

Ischaemic | Nephrotoxic

Answer 170

Cushing's Polycythaemia Hypercalcaemia Sex hormone disturbances

Answer 171

Watchful waiting Serial ultrasounds to ensure that the cyst is regressing by itself If the women is post menopausal they will have an ultrasound and a blood test every 4 months for a year

Answer 172

A morphological variant of FSGS | It has a poor prognosis

Answer 173

Pre-renal causes = reduced perfusion. Renal = disease of kidney itself causes ischaemic damage. Post = obstruction causes an increase in pressure which interferes with the pressure gradients and reduces filtration driving force.

Answer 174

It has a 10yr survival rate greater than 90%

Answer 175

Rupture Haemorrhage - can be severe and life threatening Torsion - a surgical emergency

Answer 176

Into high and low grade forms The difference between high and low grade is the degree of nuclear atypia The grades will correlate with patient survival.

Answer 177

Renal corpuscle + tubule This is the basic functional unit of the kidney

Answer 178

Originally thought it was mucinous carcinomas of the ovary but now believed to be the appendix

Answer 179

A rise in creatine >26 umol/L within 48hrs. A rise in creatine >1.5x of the baseline for that patient within 7 days. Urine output <0.5mL/kg/hr for more than 6 consecutive hours. 25% or greater fall in eGFR in children and young people within 7 days. Can also stage AKI based on the highest creatine reading or longest period of oliguria

Answer 180

They mainly occur in the middle section of adult life and are rarer before puberty and after menopause

Answer 181

True | 40% of these tumours are bilateral

Answer 182

Usually radical nephrectomy Nephron-sparing surgery may be possible for smaller masses - local ablation may be either cryoablation or radiofrequency ablation Pharmacological treatment or chemotherapy typically not beneficial except in metastatic disease

Answer 183

Can lead to significant urinary complications

Answer 184

Approximately 75%

Answer 185

They can occur on the ovaries surface therefore if unencapsulated they can spread to the peritoneum easily They can also originate from the fallopian tubes and from here they can also exfoliate into the peritoneum

Answer 186

Slowly progressive but unremitting course Some develop numerous crescents + clinical picture of RPGN. ~50% develop chronic renal failure within 10 years.

Answer 187

little/no deposition of immune reactants

Answer 188

True | It is rare and metastatic spread from this is extremely uncommon

Answer 189

Renal causes may need referral for biopsy and specialist treatment of renal disease.

Answer 190

increasing age

Answer 191

True Sepsis is present in MANY hospitalisations that culminate in death In 2015, 23,135 people in the UK died from sepsis, where sepsis was an underlying or contributory cause of death

Answer 192

They are distinguished by the differentiation of their neoplastic epithelium

Answer 193

True It occurs once the carcinoma has extended through its capsule and seeded into the peritoneal cavity Fluid collection can be massive

Answer 194

The dilatation of the renal pelvis and calyces, that is associated with progressive atrophy of the kidney, due to the obstruction of the outflow of urine

Answer 195

The thick ascending limb lined by simple cuboidal epithelium The thin descending limb by simple squamous Permeability to water and ions and active transport of ions varies in the different parts of the Loop

Answer 196

women children older adults people who have a compromised immune system people who have existing wounds or injuries people who have invasive devices, such as catheters or breathing tubes

Answer 197

There will be mild dilatation of the calyces and pelvis and occasionally atrophy of the renal parenchyma will be seen

Answer 198

Ischaemia - hypovolaemia, microscopic polyangiitis, microangiopathies such as HUS or TTP Direct toxic injury, either from endogenous (myoglobin/haemoglobin/light chains) or exogenous sources (drugs or heavy metals)

Answer 199

those with shock related to sepsis, extensive burns or multiorgan failure the mortality can be above 50%.

Answer 200

It's a specialised visceral epithelium | It has interdigitating foot process, separated by 20-30nm wide filtration slits which are bridged by a thin diaphragm.

Answer 201

Local invasion to eminal vesicles, periprostatic tissues and base of the bladder Lymphatic spread through through the obturator nodes leading to the para-aortic nodes Also mets to the axial skeleton - osteoblastic lesions suggest a prostatic origin

Answer 202

Results from 1 or more of: Proliferation of mesangial or endothelial cells Infiltration of leukocytes (incl. neutrophils, monocytes, lymphocytes) or Formation of crescents

Answer 203

``` Presence of risk factors NEWS2 score of 5 or more Oliguria Poor cap refill / skin mottling Cyanosis Malaise Nausea/vomiting ``` Also have signs related to the sight of infection e.g. urosepsis flank pain and dysuria

Answer 204

Persistent hypotension requiring vasopressors to maintain mean arterial pressure of ≥65 mmHg Serum lactate >2 mmol/L (>18 mg/dL)

Answer 205

Neurological sequelae e.g. focal neurological deficits in patients with bacterial meningitis

Answer 206

Prognosis largely depends on stage at diagnosis, but 5-year survival is approx. 75%

Answer 207

The underlying cause | Need to diagnose and treat appropriately

Answer 208

Thought to arise from PCT so most commonly originate in and are confined to the cortex Most commonly solitary, well-circumscribed, unilateral, spherical mass which distorts the outline of the kidney Usually yellow-grey-white, commonly with areas of necrosis and foci of haemorrhage May show cystic changes Can bulge and fungate into calyces and pelvis, and have been known to extend into the renal vein up to the IVC

Answer 209

Pre-existing CKD Male Sex Age History of AKI Certain comorbidities – diabetes, CVD (heart failure), malignancy, chronic liver disease, complex surgery, connective tissue disease and autoimmune diseases Certain drugs can also increase risk – NSAIDs Some toxic substances too such as ethylene glycol, mercury vapour, heavy metal exposure

Answer 210

Frequent alterations increasing PI3K/AKT signalling ( PTEN, ARID1A, KRAS and PIK3CA mutations) DNA mismatch repair gene mutations TP53 mutations are also common in poorly differentiated carcinomas in both locations

Answer 211

IgM and C3 present in sclerotic areas and the mesangium. | Focal sclerosis has possible pronounced hyalinosis and thickening of afferent arterioles

Answer 212

Menstrual - tampons Skin wounds or surgical wounds Pneumonia Catheter infections

Answer 213

The obstruction causes high pressure in the renal pelvis which is then transmitted through the collecting ducts into the cortex which will result in renal atrophy

Answer 214

Tubular injury | Disruption of blood flow

Answer 215

Children ages 6-10 | Usually after an infection of pharynx or skin (impetigo)

Answer 216

Transitional Cell Tumours | They account for 10% of ovarian tumours

Answer 217

COVID patients will often have kidney involvement with 20-40% having AKI on admission (Europe and US figures) AKI in these patients is associated with a higher mortality

Answer 218

Leads to vasculitis | This results in nephritic syndrome

Answer 219

Only when podocyte effacement is associated with normal glomeruli by light microscopy that the diagnosis of MCD can be made.

Answer 220

The benign and borderline forms of this tumour are uncommon with the malignant form being more common

Answer 221

Patients most commonly present w/ painless haematuria, which may be associated w/ frequency, urgency and dysuria

Answer 222

Its size and appearance Whether it is symptomatic If the women is post menopausal - as this carries a higher risk that the cyst is cancerous

Answer 223

Consequence of endothelial or capillary wall injury | This is a typical end result of glomerular damage

Answer 224

If the intraluminal pressure has not been so high as to cause their atrophy, granulosa lining cells are present within them Outer theca cells may be conspicuous due to luteinisation If Luteinisation is pronounced there may be increased oestrogen production and endometrial abnormities

Answer 225

Urosepsis starts with the development of a UTI and typically occurs if a UTI is left untreated

Answer 226

It undergoes an initial increase in HR, but later hypoperfusion kicks in once heart is worn out

Answer 227

May appear as scattered malignant cells in otherwise normal urothelium or full thickness atypia May also see denuded basement membrane as malignant epithelium shed in urine

Answer 228

Usually polyomavirus Latent infection with polyomavirus is widespread in the general population and immunosuppression of the allograft recipient can lead to reactivation of latent infection and the development of nephropathy resulting in allograft failure in up to 5% of kidney transplant recipients

Answer 229

The 5yr survival of serous carcinoma that is confined to the ovary is 70% however once it has spread to the peritoneum this becomes 25%

Answer 230

High risk: Renal dysfunction Hypotension Medium risk: ARDS Myocardial dysfunction and failure Multiple organ failure Low risk: Hepatic encephalopathy DIC

Answer 231

Primarily children and YAs

Answer 232

Of the serous ovarian tumours 70% will be benign and borderline and 30% will be carcinomas

Answer 233

Follicular | If lutenisation occurs in the outer theca cells

Answer 234

Either those are neurogenic - due to spinal chord damage or diabetic nephropathy Or due to other functional abnormalities of the ureter or bladder

Answer 235

May be a manifestation of renal or systemic disease No single mechanism can explain all cases however, most cases have immunologically mediated glomerular injury

Answer 236

It is more common in ICU and elderly | This accounts for 50% of ICU AKI cases.

Answer 237

Have a central glomerulus surrounded by Bowman’s capsule | Both PCT and DCT have cuboidal epithelium but PCT has taller cells with microvillae so appear more pink on histology

Answer 238

They have been linked to the severe effects of bacterial infections, such as toxic shock syndrome The shock state that these antigens induce is ultimately caused by a massive T cell proliferation and cytokine release (or cytokine storm)

Answer 239

Acute proliferative - includes post-infectious (post-strep) and infection associated Crescentic (Rapidly Progressive) GN (RPGN) - includes anti-GBM antibody mediated, immune complex deposition and Pauci-immune crescentic GN

Answer 240

Posterior pituitary

Answer 241

Urosepsis and septic shock Kidney rupture resulting in peritonitis and death Irreversible kidney damage Fistula formation -renocolic, renocutanous and renoduodenal

Answer 242

``` Anaesthetic complications Bleeding Ureter, bladder or bowel damage Infection DVT Vaginal problems ```

Answer 243

urinary obstruction, flank pain, haematuria

Answer 244

Luteal | They normally resolve after the first trimester

Answer 245

It is transmitted through the collecting ducts into the cortex which will result in renal atrophy It will also compress the renal vasculature in the medulla which reduces the inner medullary blood flow These effects are reversible to begin with but eventually will progress to cause medullary functional disturbances

Answer 246

Characterised by diffuse effacement of foot processes podocytes, detectable only by electron microscopy, in glomeruli that appear normal by light microscopy Absence of immune deposits in glomerulus .

Answer 247

Latency period of around 1-4 weeks e.g. symptoms appear 1-4 weeks after the infection itself This is due to time required to produce antibodies and form immune complexes

Answer 248

The upper and lower poles of the kidney

Answer 249

False | Renal veins are anterior to renal arteries in hilum

Answer 250

The benign and borderline tumours are most common between the ages of 20-45 but the carcinomas tend to occur at older ages ( unless familial)

Answer 251

Acute tubular necrosis (ATN) should be suspected in any patient presenting after a period of hypotension secondary to cardiac arrest, haemorrhage, sepsis, drug overdose, or surgery.

Answer 252

They kidney can become a cystic structure with thin walls and can have a diameter up to 15-20cm. There will also be severe parenchymal atrophy The pyramids will be totally obliterated and the cortex will be thinned

Answer 253

Electron-dense deposits between the BM and epithelial cells with effacement of podocyte foot processes BM material is laid down between these deposits forming irregular spikes protruding from GBM Spikes thicken into dome-like protrusions; eventually, close over the immune deposits + bury them within a markedly thickened, irregular membrane

Answer 254

A “colony count” performed using a calibrated loop, with 0.001 mL of the urine sample plated onto culture media & incubated Various tests can be performed to identify the causative organism

Answer 255

The tips or distal 2/3 of the pyramids have areas of gray-white to yellow necrosis Necrotic tissue shows characteristic ischemic coagulative necrosis, with preservation of outlines of tubules on microscopic examination

Answer 256

Makes it permeable to water and small solutes The slit diaphragm -> acts assize-selective distal diffusion barrier to filtered proteins.

Answer 257

Pain – usually a unilateral pain that if felt low in the abdomen. It can either be intermitted or constant and it can also be either sharp or dull Menstrual Changes – menstrual cycles can become irregular and abnormal vaginal bleeding can occur Women may present with a feeling of fullness/pressure/ heaviness in the abdomen Abdominal bloating may occur

Answer 258

It is probably the result of both the fluid retention and renin release from the ischaemic kidneys

Answer 259

Contributes to tubular injury This causes tubular back leak which reduced urine output It also leads to sloughing of cells > obstruction > decreased output

Answer 260

A tuft of capillaries in the nephron

Answer 261

Inflammation affecting the tubules

Answer 262

True | More likely to be bilateral and lower in tract

Answer 263

The underlying cause of AKI in sepsis is not completely understood. It is likely multi-factorial and includes hemodynamic changes within the kidney, endothelial dysfunction, infiltration of inflammatory cells, intraglomerular thrombosis, and obstruction of tubules with necrotic cells and debris. Arterial vasodilation with an associated decrease in SVR is a hallmark of sepsis, and until recently, it was believed that sepsis-induced AKI was mainly due to hypoperfusion of kidneys. However, recent studies have shown that RBF is typically normal or increased in these cases.

Answer 264

management of fluid balance, hyperkalaemia and acidosis. Mainly want to restore renal blood flow - restore blood volume, remove obstructions. May also need to correct blood abnormalities (e.g., anaemia, uremic platelet dysfunction) with measures such as transfusions and administration of desmopressin. stop any nephrotoxic drugs (NSAIDs, ACEi etc), check dosages are suitable for renal impairment

Answer 265

Characteristically demonstrate glandular growth that is confluent - flows together This is not recognised as a form of ‘expansile’ invasion

Answer 266

Acute tubular necrosis | Responsible for 50% of cases in hospitalized patients

Answer 267

Presence of a catheter | 80% of nosocomial UTIs are related to urethral catheterization

Answer 268

True | Can either caused by something extrinsic causing compression or by an intrinsic lesion in the urinary tract

Answer 269

``` Infection Bleeding Cyst recurrence Infertility - if both ovaries have to be removed Thrombosis Damage to surrounding organs Anaesthetic complications ```

Answer 270

A proliferative lesion + red cells in urine.

Answer 271

Established by quantitative urine culture

Answer 272

Borderline serous tumours

Answer 273

Small finger-like protrusions which may be indistinguishable from papillary carcinomas at cytoscopy

Answer 274

The presence of crescents in most of the glomeruli

Answer 275

Massive proteinuria However, renal function remains good Often no HTN or haematuria Disease sometimes follows a respiratory infection or routine prophylactic immunisation Relatively benign condition

Answer 276

Urosepsis is just the development of sepsis from a UTI

Answer 277

Most are asymptomatic and found incidentally, but may present as fatal spontaneous retroperitoneal haemorrhage

Answer 278

Most ovarian cysts are functional cysts ( Follicular and Luteal) and other forms of cysts are much less common

Answer 279

The ribs offer some protection to the kidneys against penetrating trauma "floating” ribs 11 and 12 are posteriorly related to the kidneys However, if the ribs fracture the sharp displaced ends may bruise or lacerate the kidney.

Answer 280

E. coli | 70-95% of both upper and lower UTIs

Answer 281

Fever Tachycardia Flank pain/costovertebral angle tenderness Abdominal tenderness in suprapubic area Often indications of bladder & urethral irritation e.g. dysuria, frequency and urgency

Answer 282

It is a common condition effecting 6-10% of women of a reproductive age worldwide

Answer 283

False | Treatment with steroids, immunosuppressives, and antiplatelets have no proven benefit

Answer 284

It can be demonstrated by voiding cystourethrography, in which the bladder is filled with a radiopaque dye and images are taken during micturition

Answer 285

Cystoscopy is gold standard for papillary tumours CIS and invasive carcinomas may be more difficult to identify via cystoscopy – endoscopic resection may be an option here Urine cytology can be a useful diagnostic tool, w/ up to 90% sensitivity

Answer 286

Underlying malignant tumours – esp. carcinoma of lung & colon SLE Infections (chronic hep B, hep C, syphilis, schistosomiasis, malaria) Other autoimmune disorders e.g., thyroiditis. Drugs (penicillamine, captopril, gold, NSAIDs)

Answer 287

A dramatic response to corticosteroid therapy.

Answer 288

Anatomical variation in the renal system can be used to identify someone if their abnormality is known A solitary kidney might suggest agenesis or nephrectomy (pathology or donation). A bifid renal pelvis is seen in 1 in 10 people and a bifid ureter and unilateral duplicated ureter can be seen in 1:25

Answer 289

Acute pyelonephritis may be more serious and can lead to repeated septicemic episodes

Answer 290

Chronic immune complex disorders (SLE, HBV, HCV, cryoglobulinemia, endocarditis, infected ventriculo-atrial shunts, chronic visceral abscesses, HIB, schistosomiasis. Alpha1-antitrypsin deficiency Malignant diseases, esp. lymphoid tumours such as CLL which are commonly complicated by autoantibody development.

Answer 291

Activation of alterative complement pathway. | Essentially, patients have persistent C3 activation and hypo-complementaemia

Answer 292

sudden or insidious partial or complete unilateral or bilateral

Answer 293

Creates a hyperosmotic environment in the medulla

Answer 294

Identified by the NEWS score or SOFA/qSOFA criteria | SOFA = Sepsis-related Organ Failure Assessment

Answer 295

Often associated with systemic symptoms at presentation– fever, malaise, weight loss, weakness Classic features are haematuria, costovertebral pain and palpable mass All three are only seen in around 10%

Answer 296

Composed of roughly equal parts glands and fibromuscular stroma. Concretions are normal and appear with increasing age

Answer 297

Deposits made of immune complexes containing IgG and complement.

Answer 298

Collectively this group of tumours make up 20-25% of all ovarian tumours Primary ovarian mucinous carcinoma is uncommon and only accounts for 3% of all ovarian cancers - most are instead benign

Answer 299

Ninth most common cancer worldwide Incidence in the EU of around 20/ 100,000/ year

Answer 300

Acute and Chronic

Answer 301

Exogenous antigens | Most commonly from a strep infection

Answer 302

A layer of bright yellow tissue that contains luteinized granulosa cells will line the rim of these cysts It is common that they rupture which will then cause a peritoneal reaction They may have old haemorrhage and fibrosis within them which makes it difficult to differentiate them from endometriomas

Answer 303

Men | Male:female ratio is approx. 2:1

Answer 304

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to an infection Basically, it’s the body having a massive overreaction to infection

Answer 305

Prostatic Intraepithelial Neoplasia (PIN) Can be a significant predictor of the development of prostatic cancer, but this exact process has yet to be determined

Answer 306

``` Acute renal failure Oliguria Mild-mod proteinuria ± oedema HTN Active urinary sediment (RBCs, red cell + granular casts) ```

Answer 307

A high frequency of TP53 mutations are seen in high grade serous carcinomas. These tumours also lack either KRAS or BRAF mutations. It is also common to see genomic imbalances in these tumours which may include amplifications of a number of oncogenes and deletions of tumour suppressor genes

Answer 308

RRT comes with the risk of catheter insertion, procedural hypotension, bleeding (raised by use of anticoagulants) and many more

Answer 309

True | Will usually have metastasized widely throughout the abdomen and causes rapid clinical deterioration

Answer 310

large surface area, presence of active transport systems for ions and acids, high metabolism rate, high O2 consumption and the capability to resorb and concentrate toxins all vital for their usual function of resorption but make them vulnerable

Answer 311

False | Most resolve themselves within a few months

Answer 312

Scrotal hematoma, hydrocele, masses or tenderness Meatal discharge Prostatic tenderness Inguinal adenopathy

Answer 313

Deep seated infections Necrotising fasciitis Surgical operation sites Puerperal sepsis

Answer 314

Minimal change disease

Answer 315

1 = Primary (idiopathic) 2 = Cases associated with other conditions e.g., HIV infection, heroin addiction, sickle cell, morbid obesity. 3= Secondary event reflecting scarring of previous active necrotising lesions (IgA nephropathy). 4 = Part of adaptive response to loss of renal tissue (congenital or acquired) or in advanced stages of other renal disorders. 5 = Uncommon inherited forms of nephrotic syndrome due to mutations in proteins found in slit diaphragm

Answer 316

Incompetence of vesicoureteral valve allows reflux of bladder urine into ureters This allows bacteria to ascend the ureter into the renal pelvis

Answer 317

They are <15 mm discrete lesions arising from tubular epithelium Histologically similar to low-grade RCC

Answer 318

First they seed into the peritoneum after breaking through their capsule The serosa of the peritoneum becomes seeded with 0.1-0.5cm tumour nodules that do not, in most cases, invade deeply into the underlying parenchyma After the peritoneum has been affected by the tumour ascites discussed will form Metastasis will also travel to the regional lymph nodes, lungs, liver, Gi tract and elsewhere Half of ovarian carcinomas will also spread to the other ovary.

Answer 319

Tobacco smoking – Associated w/ 50-80% of bladder cancers in men Workplace exposure – Aryl amines in rubber and dye industries, aromatic hydrocarbons in mining Pelvic radiation and chemotherapy, particularly in relation to prostate cancer

Answer 320

An increased no. of glomeruli will be involved, The sclerosis spreads within each glomerulus until there is total (global) sclerosis of glomeruli, with pronounced tubular atrophy + interstitial fibrosis

Answer 321

It is divided into pyramids (8-18/kidney) with apices pointing toward the hilum (papillae), ending on minor calyces Each pyramid contains ~50,000 nephrons running axially towards the apex of each pyramid - looks striped The stripes are called medullary rays and are composed of collecting ducts and straight segments of proximal and distal tubules

Answer 322

True | They are not processed by the immune system as normal antigens are

Answer 323

Obstruction increases risk of urinary tract infection and stone formation If an obstruction is not fixed it will almost always result in permanent renal atrophy which is given the name hydronephrosis An interstitial inflammatory reaction can also be caused by an obstruction which will eventually lead to interstitial fibrosis

Answer 324

May lead to acute renal failure and then death

Answer 325

A thin layer of fenestrated endothelium A GBM The visceral epithelium (podocytes) The entire glomerular tuft supported by mesangium.

Answer 326

If it is large, symptomatic, persistent or there is concerns it either may become or already is cancerous

Answer 327

To evaluate the patient for renal dysfunction - Patients with acute kidney injury due to sepsis have a worse prognosis than those with non-septic acute kidney injury. Determines whether the patient would benefit from haemofiltration or intermittent haemodialysis

Answer 328

Nuclei may be hyperchromatic with prominent nucleoli | Cells will be dyscohesive with architectural disruption

Answer 329

Correct the volume depletion and/or increase renal perfusion by circulatory or cardiac support Treat hypovolaemia if present with fluid bolus (renal perfusion will improve as volume is replaced)

Answer 330

33% will develop infections, mostly pulmonary and urinary. | Infectious complications may have mortality of 11-72%.

Answer 331

Most ovarian cysts are benign and will resolve spontaneously resulting in a very good prognosis and no requirement for surgical intervention 70-80% of functional cysts resolve spontaneously However, if they malignantly transform (only occurs in certain types) the prognosis is poor as ovarian cancer presents late

Answer 332

Papillary necrosis – usually bilateral Pyonephrosis Perinephric abscess

Answer 333

Anti GBM antibody mediated - 1/5 Immune complex deposition - 1/4 Pauci-immune crescentic GN - the rest

Answer 334

Transient oliguria (small output) is common - due to hypotension Rarely, anuria occurs AKI relatively common

Answer 335

highly permeable to water and small solutes - due to fenestrations impermeable to proteins of the size of albumin or larger

Answer 336

In 98% of clear cell carcinomas, there is loss of sequencing in the area of chromosome 3 which encodes the VHL gene (acts as tumour suppressor) VHL protein is part of a ubiquitin ligase targeting HIF-1, a transcription factor which promotes expression of genes that trigger angiogenesis and cell growth VHL gene becomes inactive which leads to high levels of HIF-1 This causes inappropriate expression of angiogenic and oncogenic genes which leads to tumour formation

Answer 337

True | Even if it is a large carcinoma they tend to behave in a benign way

Answer 338

Type 1 are primary endometriomas. | They are small and develop from surface endometrial implants

Answer 339

Retraction and collapse of the entire glomerular tuft with or without additional FSGS lesions Proliferation + hypertrophy of glomerular visceral epithelial cells is another characteristic

Answer 340

False - ish It can be useful where there is high clinical suspicion but has limited use as a screening tool as sensitivity and specificity are suboptimal

Answer 341

FSGS has a higher incidence of haematuria, reduced GFR, and HTN Proteinuria is more often non-selective in FSGS FSGS has a poor response to corticosteroid therapy; There is progression to CKD in FSGS with at least 50% developing ESRD in 10yrs.

Answer 342

``` Renal cell carcinoma Rare ones: Papillary carcinomas Chromophobe renal carcinomas Collecting duct carcinomas ```

Answer 343

may need catheterisation, nephrostomy or urological intervention

Answer 344

Characterised by deposition of extracellular collagenous matrix. May be confined to mesangial areas, involve the capillary loops, or both. May also result in obliteration of some or all of the capillary lumens in affected glomeruli.

Answer 345

Degeneration & focal disruption of podocytes with foot process effacement

Answer 346

Pyogenic exotoxin B (SpeB) = principal antigenic determinant in most cases of post-strep GN. Elevated antibody titres against 1 or more strep antigens is seen in majority of patients. Serum complement levels are low - reflects activation of complement system + consumption of its components

Answer 347

Fluid overload - monitor fluid levels Correction of acidosis with sodium bicarbonate can generate CO2 so ventilation may be required Also comes with Na+ and a volume load which can precipitate fluid overload in vulnerable patients Risks of RRT

Answer 348

True | They can form borderline tumours with nuclear atypia

Answer 349

The first features that are seen are simple dilatation of the pelvis and calyces. There often is also significant interstitial inflammation even if no infection is present

Answer 350

The cause is unknown but may either arise due to invagination of the surface epithelium of the ovary followed by serous metaplasia or because of implantation of detached fallopian tube epithelium at areas where the ovaries surface has been disrupted by ovulation

Answer 351

Females have a shorter urethra They lack the antibacterial properties in prostatic fluid Hormonal changes affect bacterial adherence to the mucosa Urethral trauma during sexual intercourse

Answer 352

Normally bacteria are cleared from the bladder due to voiding and antibacterial mechanisms. If there is obstruction however incomplete bladder emptying occurs and residual urine is left where bacteria can multiply leading to infection which can effect the kidney - pyelonephritis The pyelonephritis can then progress onto a pyonephrosis Perirenal abscesses can then subsequently form

Answer 353

With time they detach from the basement membrane and form casts which cause luminal obstruction, increased pressure within the tubules and a further decrease in GFR

Answer 354

Patients will die from renal failure within weeks to months

Answer 355

Lungs: 64% Abdomen: 20% Bloodstream: 15% Renal or genitourinary tract: 14%

Answer 356

Both sclerotic and non-Sclerotic areas show diffuse effacement of foot processes (resembling MCD) May also be focal detachment of epithelial cells & denudation of the underlying GBM

Answer 357

It is not often used in the management but can be used adjuvantly in early stage cancer or palliatively

Answer 358

Fluid resuscitation is important if blood pressure is unstable or if the patient is very old

Answer 359

Catheterisation Routine pelvic examinations - an increased risk of a UTI for 7 weeks post procedure Renal transplantation - High susceptibility in the first 2 months following transplantation

Answer 360

Considered a pattern of immune-mediated injury rather than a specific disease

Answer 361

Bacteria may persist in the urine or there may be recurrence of infection with new serologic types of E. coli or other organisms This infection can either disappear or may persist, sometimes for years

Answer 362

Serous, mucinous and endometroid carcinomas Within each of these three groups it is also possible to get benign and borderline tumours

Answer 363

Most patients present with low-grade, non-invasive bladder cancers These have a high risk of recurrence but low risk for disease progression and death Once invasion has occurred, overall survival drops to around 50% Up to a quarter of high risk patients will develop urothelial carcinoma of the prostate, which has >40% mortality rate

Answer 364

A cusp of simple squamous where the capillaries of the glomerulus invaginate into

Answer 365

Sepsis can cause blood clots leading to limb ischaemia and amputation's

Answer 366

They atrophy | Loss of size/charge specific barrier

Answer 367

The seminal vesicles, periprostatic tissues and base of the bladder

Answer 368

If this occurs most patients will only survive for a few months to a few years

Answer 369

Not necessarily | Creatine will lag 24hrs behind the clinical response so give it time to drop

Answer 370

Historical ‘diffluent’ or ‘septic’ spleen i- however this s a debatable gross entity so not used 'Shock lung’ and ‘acute tubular necrosis’ are difficult to diagnose on gross examination alone

Answer 371

Prostate enlargement along with delayed presentation

Answer 372

Will be of non-haemorrhagic origin Persistent thrombocytopenia is associated with an increased risk of mortality. Lymphocytopenia is increasingly recognised as a useful sign in a patient with sepsis.

Answer 373

Triggering factors include vesicoureteral reflux and immunosuppression

Answer 374

E.colii S. saprophyticus Proteus species, Klebsiella species, Enterococcus faecalis, other Enterobacteriaceae and Yeast Candida - usually albicans Mycobacterial & fungal organisms induce caseating & non-caseating granulomatous inflammation

Answer 375

True They can be hard to accurately identify Gross identification is only around 65% accurate with a 20% false positive rate

Answer 376

Most women will have chemotherapy as well as surgery Chemotherapy is used both neoadjuvatly and adjuvantly and is used for recurrence Most people will have 6 cycles lasting 3 weeks each Radiotherapy

Answer 377

VHL gene | Acts as a tumour supressor

Answer 378

Defined by a lack of detectable anti-GBM antibodies or immune complexes by IF & EM Most patients have circulating ANCAs - c-ANCA or p-ANCA staining pattern (thought to be related to vasculitis or polyangiitis)

Answer 379

True | Has an almost 100% 5-year survival rate in the US, but the treatment may cause significant morbidity

Answer 380

Congenital abnormalities

Answer 381

Straight portion of proximal tubule and ascending limb are very vulnerable Proximal tubules most commonly affected by necrosis

Answer 382

True | This due to the fact that ovarian cancer tends to present in advanced stages

Answer 383

Oliguria Fluid retention Azotaemia - increased creatine and BUN

Answer 384

It increases mortality and can lead to multi-organ effects.

Answer 385

Metastatic mucinous adenocarcinoma Especially if they are bilateral as this is less common in the primary ovarian type

Answer 386

The infection is termed pyonephrosis when there is a suppurative exudate that is unable to drain so has filled the renal pelvis, calyces and ureters Occurs due to superimposed infection on top of urinary tract obstruction

Answer 387

Men | Male:female ratio is around 3:1

Answer 388

The exact pathogenesis is unknown Thought to be a combination of inherited genetic factors, exposure to external carcinogens, and mutations within the androgen receptor gene

Answer 389

Deposits made of unknown material

Answer 390

``` Shows alterations in GBM Accumulation of mesangial matrix Proliferation of glomerular cells Leukocytic infiltration Deposits in mesangial regions and glomerular capillary walls. Crescents are present in many cases ```

Answer 391

Most often due to a congenital absence or shortening of the intravesical portion of the ureter, such that the ureter is not compressed during micturition It can be acquired from the infection itself or from persistent bladder atony caused by spinal cord injury

Answer 392

True Focal and segmental lesions may involve only a minority of the glomeruli and therefore if a biopsy specimen doesn't contain enough glomeruli, it can be missed

Answer 393

Through the bloodstream (hematogenous infection) - less common From the lower urinary tract (ascending infection) - more common

Answer 394

There are no specific morbid anatomical features of ‘septicaemia’ The interpretation of pre-mortem, let alone post-mortem, blood cultures is not easy There are no standard histopathological features that reliably point to ‘septicaemia’ There is no agreed case definition of ‘septicaemia’. It is more logical to consider ‘sepsis’: its local origins, systemic consequences and degrees of severity

Answer 395

True | Spontaneous in 80% of cases

Answer 396

Bacterial infections of the lower urinary tract that are asymptomatic

Answer 397

Yes | If detected and treated promptly

Answer 398

there is a lack of reliable sepsis incidence and prevalence data due to the absence of a consistent definition for sepsis and differences in coding practices amongst professionals and organisations and different countries.

Answer 399

Radiotherapy can be given via external-beam or brachytherapy (a small radioactive source is implanted into the prostate) Androgen deprivation therapy is increasingly being used at many grades Radical prostatectomy +/- pelvic lymph node dissection is the first line treatment for high-risk disease, almost always in combination with radiotherapy

Answer 400

False | It is also seen in other protein-uric states such as membranous nephropathy and diabetic nephropathy

Answer 401

False Unfortunately they tend not to occur until later stages of disease meaning women don’t present until later stages of the disease

Answer 402

Surgery Chemo Radiotherapy Targeted therapy

Answer 403

They occur in endometriosis due to ectopic growth of endometrial tissue

Answer 404

Menstrual abnormalities Decreased fertility Chronic anovulation Polycystic ovaries Hyperandrogenism.

Answer 405

One outcome is that cells are repaired and function returns. May see very mild renal impairment for some time after but most will recover with time. However, those surviving severe AKI often have a worse health related QoL (worse with age and renal function). May be left with impaired kidney function, CKD or requiring dialysis.

Answer 406

Glomeruli may appear normal except for a variety of ischemic changes, including periglomerular fibrosis, fibrous obliteration and secondary changes related to hypertension

Answer 407

Intrinsic tissue antigens, e.g., NCI domain of type IV collagen, PLA2R antigen, mesangial antigens, others. Extrinsic antigens, including DNA/nucleosomes/other nuclear proteins, bacterial products, large aggregated proteins, and immunoglobulins themselves

Answer 408

Causative agents vary significantly with region, hospital size, season and type of unit

Answer 409

It is idiopathic but it has been associated with some drug toxicities (pamidronate) and it is the most characteristic lesion of HIV-associated nephropathy

Answer 410

They appear ill and may have hypotension Also have the fever, chills, flank pain/costovertebral angle tenderness that follow the symptoms of UTI May also find prostate enlargement in older males with pyelonephritis Combined with findings of pyuria and bacteriuria

Answer 411

Vesicoureteral reflux also affords a mechanism to propel infected bladder urine up to the renal pelvis and deep into the renal parenchyma through open ducts at the tips of the papillae

Answer 412

Increases susceptibility to infection Causes neurogenic bladder dysfunction Undergo more frequent instrumentation

Answer 413

Minor, uncomplicated ones resolve on their own w/o the help of antibiotics A more severe bladder infection left untreated can spread to kidneys and cause permanent damage

Answer 414

Production and collection of glomerular filtrate.

Answer 415

Classic presentation of acute post-streptococcal GN | RPGN

Answer 416

Increase in urine output (up to 3L per day) as the damaged tubules lose a lot of water, sodium and K+ via the urine. For some reason patients become vulnerable to infection in this stage . With time, tubular function restored, and urine concentration returns to normal. BUN and creatine return to normal

Answer 417

They usually appear complex | They have a variety of appearances due to the different tissue types that can arise within them

Answer 418

Usually implies that there was bacteraemia associated with one or more organ failures Often used by pathologists as the final process causing death

Answer 419

The mesangium | A meshwork that mesangial cells are embedded in

Answer 420

Well-circumscribed epithelial lesion made up of eosinophilic cells thought to arise from DCT

Answer 421

You can get anti-GBM antibodies which bind to intrinsic antigens homogenously distributed along the entire length of the GBM Causes a diffuse linear pattern of staining for the antibodies by IF techniques Causes <5% of cases of human GN but is the cause of severe necrotising crescentic glomerular damage + clinical syndrome of RPGN

Answer 422

If they are predominantly solid the clear cells will be arranged in sheets or tubules

Answer 423

Tobacco smoking – smokers have 2x incidence of RCC Obesity HTN Pre-existing renal disease, particularly CKD and some cystic disease A strong family history of renal cancer – some autosomal dominant syndromes, particularly VHL (Von Hippel-Lindau Syndrome)

Answer 424

In most cases, microbiology is used to diagnose

Answer 425

Granular deposits of IgG and C3 (sometimes IgM) in the mesangium and along the GBM

Answer 426

Creates acid-base and water balance | Absorption of water, Na+ and bicarbonate, excretion of K+ and H+

Answer 427

Functional ovarian cysts

Answer 428

Focal Segmental Glomerulosclerosis (FSGS)

Answer 429

Thought to be a manifestation of small-vessel vasculitis or polyangiitis, which is limited to the glomerular and (possibly) peritubular capillaries.

Answer 430

Renal corpuscle Proximal convoluted tubule Loop of Henle Distal convoluted tubule

Answer 431

Vasodilation + increased capillary permeability result in low circulating volume Hypovolaemia is compounded by reduced LV contractility This results in hypotension

Answer 432

Transrectal biopsy is needed to confirm diagnosis

Answer 433

Abdominal pain and distension - most common symptoms Pelvic pressure Vaginal bleeding Urinary and GI tract symptoms due to compression or invasion by the tumour - urinary symptoms can include frequency and dysuria Feeling full quickly Progressive weakness, weight loss and cachexia can also occur

Answer 434

They proliferate | Releases angiotensin II, chemokines, attract inflammatory cells

Answer 435

Localised disease is often asymptomatic May be found on digital rectal exam - abnormal nodules felt Urinary obstruction - may present in more advanced disease Elevated PSA

Answer 436

Genitourinary tract

Answer 437

Neoplasm comprised of vessels, fat and smooth muscle

Answer 438

A more complex condition that is a complication if UTIs | It can affect the bladder (cystitis), the kidneys and their collecting systems (pyelonephritis), or both

Answer 439

A hysterectomy, salpingo-oophorectomy and omentectomy can all be carried out together If the women is premenopausal and the carcinoma is confined to one ovary or both then the aim will be to only remove the effected ovaries and leave the uterus in place so they can still carry a pregnancy

Answer 440

granular deposits

Answer 441

They contain thick, gelatinous, dark, aged blood products and are therefore referred to as chocolate cysts

Answer 442

The glomerulus and Bowman's capsule

Answer 443

Overall causes non-proliferative glomerular injury which includes ``` Primary glomerular injuries such as: Membranous nephropathy Minimal change disease Focal Segmental Glomerulosclerosis (FSGS) Membrano-proliferative GN (MPGN) IgA nephropathy ``` Also the cause in cases secondary to systemic diseases such as diabetes and SLE

Answer 444

Patchy interstitial suppurative inflammation Intratubular aggregates of neutrophils Neutrophilic tubulitis Tubular injury

Answer 445

Seen in those with total or almost complete obstruction - particularly when it is high in the urinary tract Suppurative exudate is unable to drain and fills the renal pelvis, calyces and ureter with pus

Answer 446

Reabsorption of water, proteins, amino acids, carbohydrates & glucose

Answer 447

Those with cancer or underlying immunosuppression

Answer 448

Sepsis caused by UTI | This can possibly lead to death

Answer 449

Immune complexes in glomerular and activation of both classical + alternative complement pathways Indicative of an immune complex pathogenesis.

Answer 450

People over 65 years old are particularly susceptible

Answer 451

Can be difficult to identify Typically solid, white-grey lesion with gritty appearance Poorly defined Lesions may be easier to feel than see – will be gritty and firm compared to spongey feeling of normal prostatic tissue

Answer 452

Dense Deposit Disease

Answer 453

Specific patterns are associated with each subtype - ischaemic and toxic Tubular injury can have specific appearance in certain types of poisoning such as mercuric chloride or ethylene glycol

Answer 454

Most cases are managed with a combination of chemotherapy and surgery Surgery is the main treatment

Answer 455

Electrolyte and fluid imbalances

Answer 456

Calcium chloride or gluconate for cardio protection Insulin to trigger K+ uptake Salbutamol again for K+ shift Definitive is K+ removal by treating the underlying cause, if not quick may require renal replacement

Answer 457

Cluster of diseases characterised histologically by diffuse proliferation of glomerular cells and associated with influx of leukocytes Typically caused by immune complexes

Answer 458

Occurs in up to 18% of hospital patients and around 50% of ICU patients. Post-op AKI develops in around 1% of general surgery cases. Around 21% of solitary kidney recipients will develop AKI within 6 months. A study in Wales found the incidence to be 577 per 100,000 population.

Answer 459

Can either be a mass that project from the ovarian surface OR they can be a multicystic lesion where papillary epithelium is contained within fibrous walled cysts ( the latter being termed intracystic)

Answer 460

neurological symptoms such as lethargy, reversal of the sleep-wake cycle, cognitive and memory issues nausea, vomiting and anorexia

Answer 461

survival rates drop to as low as 30%

Answer 462

``` Blood culture - before antibiotics Serum lactate Hourly urine output Urea and electrolytes Serum glucose Clotting screen Liver Function Tests C-reactive protein Serum procalcitonin (new) Blood gas ECG ```

Answer 463

Can lead to infection and a raised PSA | May not correctly identify malignancy due to small tissue samples

Answer 464

Nephritic syndrome w/ haematuria ± nephrotic syndrome w/ proteinuria Overlaps with that of MPGN

Answer 465

Due to decreased perfusion or volume depletion Hypovolaemia – haemorrhage, diarrhoea and vomiting, burns and pancreatitis Decreased cardiac output - shock, MI, heart failure Systemic vasodilation - sepsis, drugs Renal vasoconstriction - NSAID, ACEi, ARB, hepatorenal syndrome

Answer 466

Each medullary pyramid + its associated cortical tissue

Answer 467

less than 100ml of urine per day

Answer 468

These occur either because the follicle has failed to rupture allowing ovulation or because the follicle has ruptured and then sealed immediately

Answer 469

Most are done laparoscopically but of the cyst is particularly large or there is chance that it is cancerous it will be removed via a laparotomy

Answer 470

Minimal change disease Membranous nephropathy FSGS.

Answer 471

Cortical tubular atrophy with marked diffuse interstitial fibrosis. Following this you will see progressive blunting of the apices of the pyramids which ultimately results in the pyramids becoming cupped

Answer 472

Seen in 20% of over 50s and 70% of over 70s

Answer 473

When in renal pelvis, may be confined to the calyces or may begin to invade renal parenchyma

Answer 474

It will almost always be a high grade serous carcinoma with TP53 mutations. It is rare however to find BRACA 1 and 2 mutations in sporadic high grade serous carcinoma

Answer 475

A rapid decline in GFR, raised serum creatine and/or decreased urine output

Answer 476

Generally caused by bacterial infection Associated with urinary tract infection The infection can reach the kidney via hematogenous spread or through ureters in association with vesicoureteral reflux

Answer 477

Ovarian carcinoma

Answer 478

Primary Care: Co-trimoxazole 960 mg bd or Co-amoxiclav 625mg tds (7 days) Secondary Care: Amoxicillin IV 1g tds + Gentamicin IV (Total IV/PO 7 days) If penicillin allergic: Co-trimoxazole IV 960mg bd + Gentamicin IV Step down for all patients: Co-trimoxazole PO 960mg bd or as per sensitives

Answer 479

Upper retroperitoneal area | Right lies slightly inferior (L1-L3) to left (T12-L2) due to the liver

Answer 480

Serous carcinoma

Answer 481

Membrane proteins redistributed from the basolateral to luminal surface of the tubular epithelial cells. Patchy necrosis throughout the tubules - seen at multiple sites along the tubule with large skip areas in between. Get a loss of brush border, flattening of the cells due to dilatation, detachment of cells and cast formation. May be associated with rupture of the basement membrane and occlusion of the tubular lumen by casts. May also see interstitial oedema and accumulations of leukocytes within dilate vasa recta

Answer 482

``` Congenital anomalies Urinary Calculi Benign Prostatic Hypertrophy Tumours Sloughed papillae or blood clots Pregnancy Uterine Prolapse and Cystocele Functional Disorders ```

Answer 483

Papillary urothelial neoplasm of low malignant potential

Answer 484

It can leak into the interstitium - due to disruption of the tight junctions between cells This causes oedema, increased pressure and further tubular damage This contributes to the overall decrease in GFR

Answer 485

Discrete, amorphous, electron-dense deposits on the epithelial side of the membrane, often having the appearance of “humps” - potentially Ag-Ab complexes at subepithelial cell surface This is characteristic Subendothelial deposits also commonly seen, typically early in disease course, and mesangial and intramembranous deposits may be present

Answer 486

``` Escherichia coli Enterococcus species Candida species and other fungi Enterobacter species Klebsiella species Proteus species Pseudomonas species Bacteroides species Staphylococcus species Salmonella species Mycobacterium tuberculosis ```

Answer 487

Intrinsic renal disease Glomerular causes: glomerulonephritis and ATN (prolonged hypoperfusion causing intrinsic damage) Interstitial causes: drug reactions, infections, infiltration from systemic diseases (e.g., sarcoidosis) Vascular causes: renal artery or vein obstruction, vasculitis, HUS, TTP, DIC, transplant rejection

Answer 488

Urinary symptoms – both storing and voiding

Answer 489

Infertility treatment Tamoxifen therapy Pregnancy – usually the cysts will form in the second trimester as this is when the HCG levels peak Maternal Gonadotrophins – these lead to foetal ovarian cysts Smoking Tubal ligation – this leads to functional cysts Endometriosis Severe pelvic infection – if it spreads to the ovaries it can result in cyst formation A previous ovarian cyst

Answer 490

Begin treatment as soon as sepsis has been verified (NEWS2 of 5 or>5 in a patient with likely infection) by a senior clinician (ST3 or above) Start the Sepsis 6 aka BUFALO

Answer 491

daily urine volume of less than 400mL

Answer 492

Mutations in KRAS, BRAF and EGFR2 oncogenes along with wild type TP53 genes are found

Answer 493

Depends on many factors like the type and resistance profile of infectious organism + the site and size of the infecting insult and the genetically determined or acquired properties of the host's immune system

Answer 494

Waste products normally excreted by the kidney but due to lack/loss of function they build up instead

Answer 495

Renal cell carcinoma | Makes up 80-90%

Answer 496

Orderly, cohesive cells w/ scattered nucleic changes and mitotic figures

Answer 497

caused by drugs, radiocontrast, heavy metals, poisoning etc.

Answer 498

Because the necrosis is patchy and the basement membrane is usually maintained in other segments. Therefore can be reversed if cause is removed/treated cause is removed/treated Depends on the capacity of the injured epithelial cells to proliferate and differentiate

Answer 499

GI complications such as nausea, vomiting and anorexia are very common (sign of uraemia). 1/3 of patients will have some form of GI bleed. Also get pancreatitis ( AKI causes increased amylase) and jaundice (hepatic congestion and sepsis).

Answer 500

If it is a dermoid cyst or endometrioma with malignant transformation it carries a poor prognosis and will likely be fatal due to the cancer If the cyst causes a haemorrhage this can also be fatal

Answer 501

An early effect is the loss of cell polarity due to redistribution of membrane proteins such as the sodium potassium pump

Answer 502

When an obstruction of the upper urinary tract is present e.g. due to stone disease

Answer 503

``` Pulmonary complications Older age Multiorgan failure Oliguria Hypotension Number of transfusions AKI occurring alone ```

Answer 504

Cells lining the urinary tract are exposed to carcinogens as they are concentrated and excreted in urine This leads to a field effect’ with high proportion of multifocal or synchronous tumours Tumours will develop following either a papillary or a CIS pattern

Answer 505

The aetiology is incompletely understood They do however have excessive androgen production (central feature) and dysregulation of enzymes involved in androgen biosynthesis

Answer 506

True This is due to the fact they sometimes occur alongside endometriosis or endometrioid ovarian carcinoma and look like clear cell carcinoma of the endometrium

Answer 507

True | There is a low risk of malignant transformation but they do increase the chances of malignancy in endometriosis

Answer 508

Seen in nephrotic syndrome The lipoproteins are resorbed by tubular epithelial cells and then shed along with injured tubular cells that have detached from the BM Appears in the urine either as free fat or oval fat bodies

Answer 509

False | Poor prognosis with >50% progressing to ESRD

Answer 510

Usually follows a benign course and symptoms disappear within a few days after the institution of appropriate antibiotic therapy

Answer 511

These are accumulations of cells composed of proliferating glomerular epithelial cells and infiltrating leukocytes The proliferation occurs following an immune/inflammatory injury involving the capillary walls. This causes plasma proteins to leak into the urinary space where exposure to procoagulants is thought to cause fibrin deposition and triggers the crescents to form

Answer 512

Pain Lymphoedema Potentially permanent nerve damage

Answer 513

Focal - involves only a fraction of the glomeruli in the kidney Diffuse - involving all of the glomeruli in the kidney Global - involving the entirety of individual glomeruli Segmental - affecting a part of each glomerulus Crescentic - presence of crescents Proliferative Non-proliferative - Usually refers to presence / absence of proliferation of mesangial cells Capillary loop - predominately affects capillary regions Mesangial - predominately affects mesangial regions

Answer 514

The low grade forms of this tumours will often progress slowly even once they have spread outwith the ovary meaning that these patients can survive for long periods

Answer 515

``` Regional lymph nodes Lungs Liver GI tract and elsewhere.... ```

Answer 516

Hypercellularity Basement membrane thickening Hyalinosis Sclerosis

Answer 517

The clinical association with respiratory infections & prophylactic immunisation. The response to corticosteroids ± other immunosuppressive therapy. The association with other atopic disorders (e.g., eczema, rhinitis) The increased prevalence of certain HLA halotypes in cases associated with atopy (suggesting genetic predisposition) Increased incidence of minimal change disease in patients with Hodgkin lymphoma, in whom defects in & cell-mediated immunity are well recognised However, the absence of immune deposits in glomerulus excludes immune complex-mediated injury

Answer 518

Catheters inoculate organisms into the bladder & promote colonization by providing a surface for bacterial adhesion and causing mucosal irritation

Answer 519

Characterised by linear deposits of IgG and (in many) C3 in the GBM The anti-GBM antibodies cross-react with pulmonary alveolar BMs in some patients This leads to pulmonary haemorrhage associated with renal failure (Goodpasture syndrome).

Answer 520

Adenocarcinoma | Almost always the case

Answer 521

High serum creatine Rise in blood urea nitrogen (BUN) Decreased urine output - in severe cases you get oliguria or anuria (gives worse prognosis)

Answer 522

Produce cystic masses These masses are larger than the ones produced by serous tumours. Mucinous tumours have been know to form cystic masses up to 25Kg in weight These tumours are multiloculated and are full of gelatinous fluid that is rich in glycoprotiens and is sticky

Answer 523

Glomeruli appear normal in early stages or show uniform, diffuse thickening of the glomerular capillary wall.

Answer 524

``` Arrange urgent assessment by a senior clinical decision-maker - CT3/ST3 or higher in the UK, or a trained nurse with prescribing rights in acute care If necessary (e.g. NEWS2 score of 7 or more) arrange an emergency assessment by a critical care specialist ```

Answer 525

Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Network (AKIN) classification RIFLE (risk, injury, failure, loss, end stage renal disease) system Also have pRIFLE which is the paeds version

Answer 526

A suppurative inflammation of kidneys caused by bacterial and sometimes viral (polyomavirus) infection

Answer 527

Bladder or uterine prolapse causing incomplete bladder emptying Loss of estrogen with attendant changes in vaginal flora - e.g. more gram-negative aerobes like E Coli Higher likelihood of concomitant medical illness e.g. diabetes

Answer 528

Can remain clinically silent for long periods of time even when it is caused by complete obstruction if it is unilateral as the unaffected kidney can maintain adequate renal function If the obstruction is relived within the first few weeks of hydronephrosis forming then the kidney function can return to normal

Answer 529

A clinical syndrome assoc. with severe glomerular injury However, does not denote a specific aetiology. You get a relatively rapid + progressive loss of renal function - rapid decline in GFR (hrs-days) Associated with severe oliguria and signs of nephritic syndrome.

Answer 530

They are enlarged + pale | Often have petechial haemorrhages on cortical surface

Answer 531

It is postulated that bacteria themselves or the associated inflammation can promote reflux by affecting ureteral contractility, particularly in children

Answer 532

``` Posterior urethral valves Urethral strictures Severe vesicolurectal reflux Meatal stenosis Bladder neck obstruction - caused by ureteropelvic junction narrowing or obstruction ```

Answer 533

Bladder tumours Prostatic carcinoma Carcinoma of the cervix or uterus Contiguous malignant disease -retroperitoneal lymphoma

Answer 534

acute tubular injury

Answer 535

DIC is prominent | Haemorrhagic rash

Answer 536

bilateral obstruction or catastrophic damage

Answer 537

``` Has very highly specialised cells Cuboidal epithelium Brush border - gives fuzzy border Microvillous apical surface Mitochondria are abundant Larger than the DCT ```

Answer 538

True | This is concomitant w/ remission of proteinuria

Answer 539

If they are predominantly cystic the neoplastic cells will line the cystic spaces

Answer 540

Activated endothelium allows adhesion and migration of stimulated immune cells & becomes porous to large molecules such as proteins, resulting in tissue oedema

Answer 541

Many have a mesangial proliferative pattern of injury, in some, dense deposits can be seen permeating GBM Permeation of lamina dense of GBM by ribbon-like, homogenous, extremely electron-dense material of unknown composition. C3 in irregular granular or linear foci in BMs on either side of, but not within, dense deposits. Also seen in mesangium in circular aggregates (mesangial rings).

Answer 542

Will see suppuration – discrete focal abscesses or large wedge-like areas Can involve one or both kidneys Cortical surface shows grayish white areas of inflammation and abscess formation

Answer 543

Enlarged, hypercellular glomeruli Global, diffuse proliferation and leukocyte infiltration (i.e. involves all lobules of glomeruli). Also swelling, which coupled with proliferation and leukocyte infiltration obliterates capillary lumens. Crescents if severe

Answer 544

The elderly Pregnant Have pre-existing urinary tract structural abnormalities or obstruction

Answer 545

Infections or drugs associated with malignancies | Part of systemic disease (ANCA-associated vasculitis, SLE, Goodpasture’s, HSP).

Answer 546

Schistosomiasis | A history of chronic infection or irritation e.g. in frequent catheter use

Answer 547

collapsing glomerulopathy

Answer 548

In sclerotic segments you see collapse of capillary loops, increase in matrix & segmental deposition of plasma proteins along capillary wall (hyalinosis), which may occlude capillary lumens. Lipid droplets and foam cells are often present. However, the focal & segmental lesions may be missed on biopsy so may not be seen

Answer 549

It is also associated with obesity, premature atherosclerosis and type 2 diabetes

Answer 550

There is no specific macroscopic appearance for UTIs. However if UTI is due to chronic urinary tract obstruction, we can see the bladder become enlarged and hypertrophied and bladder wall thickened

Answer 551

Clear cell carcinoma | Makes up 70-80% of newly diagnosed cases

Answer 552

Non-proliferative lesion + protein in urine

Answer 553

Cognitive impairment Gynecomastia Metabolic disturbances Erectile dysfunction

Answer 554

Septic shock | Even those with more minor infection are at higher risk of AKI.

Answer 555

In situ lesions on the fallopian tube fimbriae - serous tubal intraepithelial carcinoma OR Serous inclusion cysts in the ovary

Answer 556

Uncomplicated

Answer 557

It appears as thickening of the capillary walls | Periodic acid-Schiff (PAS) stain is best.

Answer 558

True - ish | Histologically similar to low-grade RCC but most do not appear to progress - potentially some act as a precursor

Answer 559

If the carcinoma is bilateral it suggests that the carcinoma has spread outwith the genital tract

Answer 560

It is a subset of sepsis - indicates profound circulatory, cellular, and metabolic deterioration

Answer 561

DM, indwelling urinary catheters and antibiotic use

Answer 562

Develops on the surface of the ovary Can be serous or mucinous - filled with either watery or mucous material Can become very large and increase the risk of ovarian torsion

Answer 563

``` Sepsis Major surgery Cardiogenic shock Other hypovolaemia Drugs Hepatorenal syndrome Obstruction ``` In that order

Answer 564

Apoptosis more commonly seen in distal parts of the nephron

Answer 565

Reabsorption of water under the control of ADH.

Answer 566

Intrarenal vasoconstriction leads to reduced glomerular blood flow and reduced oxygen delivery to the functionally important tubules. The blood flow is the driving force behind renal filtration so if it reduces so does GFR. This is caused by a variety of pathways including activation of RAAS by decreased Na due to lower pressure and endothelial injury

Answer 567

Regular monitoring of fluid balance, K+, lactate if septic and creatine are important

Answer 568

more than 1000 CFU/mL of yeast from 2 cultures

Answer 569

``` Proteinuria >3.5g/day (mostly albumin) Hypoalbuminemia (<3g/dL) Generalised oedema (most common PC) Hyperlipidaemia + lipiduria Usually normal renal function ```

Answer 570

Fluid overload unresponsive to medical treatment Severe or prolonged acidosis Recurrent or persistent hyperkalaemia despite treatment Uraemia Pulmonary oedema

Answer 571

It is usually unaffected at the beginning but can fall later in the disease process This is because the initial changes in hydronephrosis are mainly tubular not vascular However, with time medullary functional disturbances occur due to reduced blood flow

Answer 572

``` low grade ( type 1 ) ovarian carcinomas The Brenner tumours are usually in stage one when they present ```

Answer 573

Alterations in the coagulation systems include an increase in pro-coagulant factors and reduced levels of circulating natural anticoagulants (which also carry anti-inflammatory and modulatory roles)

Answer 574

These have pronounced proliferation of fibrous stroma that lies under the columnar lining epithelium They tend to be small and multilocular with simple papillary processes that aren't as complicated and branching as those in normal cystadenoma

Answer 575

With segmental sclerosis that can progress to total glomerular sclerosis

Answer 576

Causes incomplete emptying and stasis of residual urine | This stasis allows bacteria in the bladder to multiply unhindered

Answer 577

May see signs of epithelial regeneration - flattened cells with hyperchromatic nuclei and mitotic figures With time no evidence of damage is seen

Answer 578

``` With treatment (removal of toxic cause) 95% will recover Nephrotoxic cases are likely to recover if the toxin has not damaged other organs. ```

Answer 579

Form glands with a specific, defined pattern Typically glands are smaller than benign glands without stroma/ epithelial infoldings/ outer basal cell layer Will correspond to a Gleeson grade

Answer 580

capillary endothelium - simple squamous which is fenestrated Capillary epithelium - made of podocytes (specialised visceral epithelium)

Answer 581

Presence of crescents in Most of the glomeruli | often show focal and segmental necrosis, and variably, endothelial proliferation, and mesangial proliferation

Answer 582

The peripheral zone

Answer 583

Seen in diabetes, sickle cell disease and those with urinary tract obstruction

Answer 584

Although in advanced stages clear cell carcinoma has a poor prognosis, when it is confined to the ovary its 5yr survival is around 90%

Answer 585

Dependent on the magnitude and duration of the AKI and the underlying cause

Answer 586

True May not have symptoms until they are over 10cm 15% of newly diagnosed cases will already have mets

Answer 587

Renal papillary adenomas Angiomyolipoma Oncocytoma

Answer 588

True | However, they are uncommon tumours

Seminar 11 - Urosepsis Flashcards

(643 cards)