Urinary Tract obsturction

Question 1

Hydronephrosis

Answer 1

dilation of renal pelvis/calyces with progressive atrophy of kidney due to obstruction to urine outflow

Question 2

What does hydronephrosis of kidney show in kidney

Answer 2

• marked dilation of pelvis and calyces

- thinning of renal parenchyma

Question 3

Obstructive uropathy does what to the kidney

Answer 3

renal atrophy

hydronephrosis

Question 4

what type of obstruction is usually painful

Answer 4

acute obstruction

Question 5

what are clinical symptoms for bilateral complete obstruction

Answer 5

oliguria/ anuria

Question 6

what is obstructive uropathy

Answer 6

time course and degree of obstruction determines

• dilation
• degree of renal impairment
• ability to restore renal function following relief

Question 7

What is Urolithiasis

Answer 7

renal calculi

renal stone in kidney

Question 8

are urolithiasis usually bilateral or unilateral

Answer 8

unilateral

Question 9

where can urolithiasis occur

Answer 9

renal calyces
pelvis
bladder

Question 10

what is a characteristic of a urolithiasis

Answer 10

staghorn calculi ( large branching stone)

Question 11

what is colic

Answer 11

smaller stones passed into ureters

Question 12

What are 4 types of urolithiasis

Answer 12

calcium oxalate/phosphate
Struvite
uric acid
cystine

Question 13

Calcium oxalate/phosphate urolithiasis forms in what type of envirnment

Answer 13

acidic

Question 14

calcium oxalate crystals look like what

Answer 14

envelopes

-octahedron

Question 15

Magnesium ammonium phosphate stones ( struvite) are caused by what bacteria

Answer 15

urea-splitting bacteria

• proteus
• some staph

Question 16

What type of environment causes struvite urolithiasis

Answer 16

alkaline urine

Question 17

what does “ triple stone” struvite look like under microscope

Answer 17

coffin lids

Question 18

Uric acid crystals in urolithiasis occurs in what envirnment

Answer 18

acidic

Question 19

how does uric acid crystals show up on X-ray

Answer 19

radiolucent ( can’t see)

Question 20

how does calcium stones show up on X-ray

Answer 20

radiopaque ( can see)

Question 21

What environment does cystine stones show up in

Answer 21

-acidic

Question 22

What causes cystine stones

Answer 22

genetic defects in renal reabsorption of AA

Question 23

What are 3 types of kidney transplant rejection

Answer 23

hyperacute
acute: cellular and humoral
chronic

Question 24

How fast does hyperacute reaction occur

Answer 24

minutes to hours

Question 25

what occurs in hyperacute rejection

Answer 25

antigen-antibody rxn at level of vascular endothelium

Question 26

what is seen microscopically in hyperacute rejection

Answer 26

fibrin thrombi and WBC

Question 27

How long does it take for acute rejection to occur

Answer 27

days to weeks

Question 28

What happens in acute cellular rejection ( acute)

Answer 28

T-cell | Interstitial mononuclear cells infiltration, edema and parenchymal injury

Question 29

what happens in acute humoral rejection

Answer 29

rejection vasculitis, antibody mediated neutrophils, fibrin, thrombi DEPOSITION OF C4D

Question 30

when is C4d produced

Answer 30

during activation of antibody dependent classical pathway

Question 31

how do you treat both cellular and humoral rejection

Answer 31

cellular: increase immunosuppressive therapy humoral: B cell depleting agents

Question 32

Histo: what is seen in acute humoral rejection

Answer 32

thickened vessels fibroblasts foamy histocytes

Question 33

How long does chronic rejection occur

Answer 33

months to years

Question 34

What happens to the kidney in chronic rejection

Answer 34

hyalinization of glomeruli interstitial fibrosis tubular atrophy focal hemorrhage and swollen

Question 35

How can serum indicate chronic rejection

Answer 35

increase serum creatinine

Question 36

Name the benign renal tumors

Answer 36

1. renal papillary ademona 2. renal fibroma or hamartoma 3. angiomyolipoma 4. ancocytoma

Question 37

Name malignant renal tumors

Answer 37

1. renal cell carcinoma Clear, papillary, chormophobe, collecting duct 2. urothelial carcinoma 3. Wilms disease

Question 38

How does one find renal papillary adenoma

Answer 38

incidental

Question 39

renal papillary adenoma is associated with what

Answer 39

- long term hemodialysis - acquired cystic disease - lacks 3p alteration

Question 40

what is the size of renal papillary ademona

Answer 40

less than 0.5 cm

Question 41

What is the histo feature for renal papillary ademona

Answer 41

finger projections

Question 42

Renal fibroma can produce what? impacts?

Answer 42

prostaglandins | - regulate intra-renal blood pressure

Question 43

What are gross features of renal fibroma

Answer 43

well circumscribed gray-white firm nodule within pyramids

Question 44

what is the micro findings for renal fibroma

Answer 44

fibroblastic like cells collagenous tissue entrapped tubules at periphery

Question 45

What goes wrong in angiomyolipoma

Answer 45

neoplasm composed of - thick walled blood vessels - smooth muscles - fat includes spindle and epithelioid cells

Question 46

When is angiomyolipoma a tuberous sclerosis

Answer 46

angiomyolipoma: one large mass | tuberous sclerosis: multiple masses

Question 47

What chromosome is tuberous sclerosis found on

Answer 47

Ch9q ( TSC1) Ch16 (TSC2)

Question 48

Oncocytoma can coexist with what

Answer 48

renal cell carcinoma

Question 49

what does oncocytoma look like gross

Answer 49

golden mahogany, brown tumor

Question 50

micro: what does oncocytoma look like

Answer 50

pink | prominent nuclei

Question 51

renal cell carcinoma arise from what

Answer 51

renal tubular epithelium

Question 52

Von Hippel-Lindau is found in what syndrome

Answer 52

chromosome 3

Question 53

What are 3 classical features of renal cell carcinoma

Answer 53

costovertebral pain palpable mass hematuria

Question 54

genetically what happens in renal cell carcinoma clear type

Answer 54

loss of sequence of short arm of Ch3

Question 55

Name a renal cell carcinoma clear type

Answer 55

Von Hippel-Lindau disease

Question 56

What are clinical features of von Hippel-Lindau disease

Answer 56

hemangioblastoma cysts in pancreas, liver and kidney renal cell carcinoma

Question 57

number one mets for kidney

Answer 57

lungs

Question 58

Papillary carcinoma sporadic is associated with which genes

Answer 58

trisomies 7,16,17 | loss of Y in males

Question 59

Papillary carcinoma familial is associated with which genes

Answer 59

- trisomy 7 | - locus for MET

Question 60

What is seen histo for papillary carcinoma

Answer 60

finger like projections foamy histiocytes Somoma bodies - calcifications - black dots

Question 61

What are 3 histo features for chromophobe carcinoma

Answer 61

1. prominent cell membrane 2. pale eosiniophillic cytoplasm 3. halo around nucleus

Question 62

what stain is used for chromophobe RCC

Answer 62

hale's colloidal iron

Question 63

Collecting Duct (bellini Duct) carcinoma, has what type of cells and insterstital

Answer 63

Hobnail type cells | desmoplastic stroma - fibrosis

Question 64

What are hobnail type cells

Answer 64

nucleus protrudes out

Question 65

Who usually gets Xp11 translocation carcinoma

Answer 65

young patients

Question 66

what is seen in histo for Xp11 translocation carcinoma

Answer 66

clear cytoplasm | papillary architecture

Question 67

what is the treatment of choice for renal cell carcinoma

Answer 67

nephrectomy

Question 68

what are 3 clinical findings for urolethial carcinomas of renal pelvis

Answer 68

1. hematuria 2. hydronephrosis 3. flank pain

Question 69

what is histo for urolethial carcinomas

Answer 69

similar to bladder tumors | arise from urothelium of renal pelvis

Question 70

What is a primary tumor of childhood and 4th most common pediatric malignancy

Answer 70

Wilms tumor

Question 71

What are 3 syndromes of Wilm's tumor

Answer 71

1. WAGR syndrome 2. Denys-Drash syndrome 3. Bechwith-Wiedemann syndrome

Question 72

what is WAFR syndrome

Answer 72

aniridia genital anomalies mental retardation

Question 73

Wilms deletion is on what gene

Answer 73

WT1 gene

Question 74

Aniridia deletion is on what gene

Answer 74

PAX6 gene

Question 75

WT1 and PAX6 gene are located on what chromosome

Answer 75

11

Question 76

what is Denys-Drash syndrome

Answer 76

``` Gonadal dysgenesis ( male pseudohermaphroditism) early-onset nephropathy - diffuse mesangial sclerosis ```

Question 77

Denys-Drash syndrome is a defect in what gene

Answer 77

WT1

Question 78

Bechwith-Wiedemann syndrome clinical feature and chromosome

Answer 78

oragnomegaly | 11

Question 79

what is histo presentation for Wilms

Answer 79

Blastemal cells stromal cells epithelial type cells

Question 80

treatment for Wilms

Answer 80

surgery | chemotherapy