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Kidney Pathology
Dr. Sultana
158
Science
Post-Graduate
10/25/2011

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Term
Urinary system pathology
Definition
Developmental disorder
UTI (Urinary Tract Infection)
Stone
Tumor
Term
Major Developmental disorders
Definition
may be and evident at birth or during infancy
Term
minor Developmental disorders
Definition
asymptomatic
Term
minor Developmental disorders examples
Definition
polycystic kidney disease, hydronephrosis, kidney tumor
Term
CONGENITAL RENAL ANOMALIES:

Agenesis
Definition
– Bilateral renal agenesis (Potter syndrome)
Term
CONGENITAL RENAL ANOMALIES:

Ectopia
Definition
(stay in the pelvis or presacral area)
Term
CONGENITAL RENAL ANOMALIES:

Fusion
Definition
Kidney does not separate
Term
CONGENITAL RENAL ANOMALIES:

Dysplasia
Definition
abnormal development
Term
CONGENITAL RENAL ANOMALIES:

Polycystic kidney disease
Definition
present of cysts of in kidney causing extreme enlargement
Term
Agenesis of one kidney frequency
Definition
occurs in 1 of 800 births and is usually asymptomatic.
Term
Agenesis of both kidneys (Potter syndrome) occurs
Definition
1 in 5000 births and is lethal
Term
Horse-shoe kidney. which occurs when the kidneys
Definition
fail to separate at the lower pole during development,
Term
Horse-shoe kidney causes
Definition
compression of the vena cava or aorta.
Term
Ectopic kidney is
Definition
Abnormal upward migration of the fetal kidneys results in positional anomalies.
Term
Ectopic kidneys are most often located
Definition
in the pelvis and are prone to infection or obstruction.
Term
Autosomal dominant polycystic kidney disease (ADPKD), caused
Definition
caused by an abnormality in one genes,
Term
Autosomal dominant polycystic kidney disease (ADPKD) occurs in
Definition
1 out of 1000 births
Term
Autosomal dominant polycystic kidney disease (ADPKD) enlarges
Definition
bilateral enlargement of the kidneys, which contain numerous fluid-filled cysts and weigh more than 1000 grams each.
Term
Autosomal dominant polycystic kidney disease (ADPKD) renal failure occurs during
Definition
adulthood
Term
Common kidney disease Autosomal dominant Polycystic kidney disease causes dialysis and transplants happen in
Definition
10% of patients
Term
Autosomal dominant Polycystic kidney disease Bilaterally enlarged kidneys are
Definition
>3,000g
Term
Autosomal dominant Polycystic kidney disease symptoms occur
Definition
in adult life
Term
Autosomal dominant Polycystic kidney disease causes renal failure in
Definition
5-10 years
Term
Autosomal recessive polycystic kidney disease (ARPKD) is
Definition
less common than ADPKD.
Term
In ARPKD, the kidneys contain
Definition
small cyst and are only slightly enlarged.
Term
Autosomal recessive polycystic kidney disease (ARPKD) Renal failure
Definition
during infancy
Term
Congenital Bladder Abnormality: Exstrophy is
Definition
The absence of a portion of the lower abdominal wall and the anterior wall of the bladder
Term
Exstrophy causes a
Definition
continuous leakage of urine
Term
Exstrophy causes a presistant or
Definition
recurrent local infection
Term
Exstrophy increasees the risk of
Definition
ascending urinary tract infection
Term
Exstrophy may progress into
Definition
adenocarcinoma or squamous cell carcinoma
Term
The upper urinary tract is composed of the
Definition
kidneys and ureters
Term
Infection in the upper urinary tract generally affects
Definition
the kidneys
Term
The lower urinary tract consists of the
Definition
bladder and the urethra
Term
Infection in the lower urinary tract can affect
Definition
the urethra or the bladder
Term
Infections of the urinary tract are the _________type of infection in the body.
Definition
second most common
Term
Urinary tract infections (UTIs) account for about _______ doctor visits each year.
Definition
8.3 million
Term
Polynephritis
Definition
pathology in the kidney, upper tract
Term
The classic (most common) cause of urethritis is infection with
Definition
Neisseria gonorrhoeae
Term
Urethritis non specific pathologies
Definition
Chlamydia : E. coli, or Mycoplasma.
Term
In males, urethritis typically complicates
Definition
prostatitis
Term
In females urethritis typically leads to
Definition
cystitis
Term
3 common characteristics of urethritis
Definition
Urinary frequency, dysuria, and urethral discharge
Term
dysuria
Definition
painful burning sensation during urination
Term
Reiter’s syndrome, in addition to urethritis, there is
Definition
arthritis and conjuctivitis
Term
UTIs are diagnosed clinically and confirmed by
Definition
urine analysis, which shows bacterial colonies in excess of 100,000.
Term
Cystitis is usually a complication
Definition
of urethritis,
Term
Cystitis may occur as a primary disease following
Definition
instrumentation(e.g.,catheterization, cystoscopy), urinary obstruction(e.g.,benign prostatic hyperplasia, or bladder irritation(e.g.,as a result of urolithiasis).
Term
Cystitis Patient presents with
Definition
urgency, dysuria, and hematuria; bacteria and leukocytes can be detected in the urine.
Term
Cystitis Patient Risk Factors (7 things)
Definition
advancement of age
the presence of bladder calculi
bladder outlet obstruction
diabetes mellitus
immuno-deficiency, previous instrumentation or catheterization, radiation therapy or chemotherapy.
the risk in females is increased because of the short urethra, especially during pregnancy.
prostatic hyperplasia.
Term
Causes of Cystitis is
Definition
Escherichia coli,
Proteus,
Pseudomonas, and
Enterobacter.
Term
Cystitis most frequent cause is
Definition
E Coli (80%) lower urinary tract
Term
Chronic Interstitial Cystitis is a
Definition
A disorder of unknown cause, typically affecting middle-aged women-
Term
Therapy for Chronic Interstitial Cystitis
Definition
refractory to all forms or therapy
Term
Common features for Chronic Interstitial Cystitis
Definition
Chronic inflammation and fibrosis are commonly observed within the muscularis.
Term
Chronic Interstitial Cystitis symptoms
Definition
are longstanding supra-pubic pain, frequency and urgency, with or without hematuria
Term
Urine cultures of Chronic Interstitial Cystitis
Definition
are negative
Term
Malakoplakia is an
Definition
An inflammatory disorder of unknown causes
Term
Malakoplakia features
Definition
macrophage containing mucosal plaques
Term
Malakoplakia affects mostly
Definition
women in their fifth to seventh decades of life
Term
Malakoplakia is associated with an infection in
Definition
urinary tract by E Coli
Term
Squamous Metaplasia is associated with
Definition
calculi and chronic cystitis
Term
Calculi is a
Definition
stone
Term
Squamous Metaplasia age group is
Definition
infancy to 8th decade of life
Term
Squamous Metaplasia is most common in
Definition
males (3:1)
Term
Squamous Metaplasia occurs most frequently in
Definition
the urinary bladder
Term
Squamous Metaplasia increases the risk of
Definition
bladder cancer
Term
Ureteritis is an
Definition
infection of the ureter
Term
Ureteritis may occur
Definition
as a result of vesicoureteral feflux
Term
Ureteritis may progress to
Definition
pyelonephritis
Term
The congenital defect predisposing to vesico- ureteral reflux is found in
Definition
2%--3% of patients and is an important cause of UTI in young girls and women.
Term
Vesicoureteral reflux is corrected by
Definition
surgery.
Term
Vesicoureteral reflux is
Definition
congenital condition which the valve in the bladder is defected and the urine refluxes back to the kidney
Term
Pyelonephritis is the term used for
Definition
bacterial infection of the kidneys, renal calices, and renal pelvis
Term
Pyelonephritis is caused by
Definition
gram negative uropathogens
Term
Pyelonephritis mnemonic
Definition
KEEPS.
1. Klebsiella
2. Escherichia coli
3. Enterobactor
4. Proteus
5. Serratia
Term
Pyelonephritis predisposing conditions
Definition
Urinary stones
Hydronephrosis
Cystitis
Prostatic hyperplasia
Tumors
Pregnancy
Vesico-ureteric reflux
External ureteric compression (e.g. fibrosis)
Term
Pyelonephritis is associated with
Definition
high grade fever, flank pain, hematuria
Term
hematuria
Definition
blood in urine
Term
Acute Pyelonephritis bacterial infection
Definition
E Coli (80%)
Term
Acute Pyelonephritis ascending
Definition
hematogenous
Term
Acute Pyelonephritis lower UTI
Definition
precedes renal infections
Term
Acute Pyelonephritis urine will have
Definition
leukocyte casts
Term
Acute Polynephritis may have
Definition
flank pain, hematmia, fever with chill, wbc cast
Term
what is the differential diagnosis for flank pain
Definition
kidney infection, cancer, stone,
Term
Healing recurrence will cause
Definition
chronic pyelonephritis
Term
Chronic polynephritis
Definition
fever, flack pain, dysuria, noctuna, young women, old men
Term
Costovertebral angle tenderness test (Murphy's Test) differentiates
Definition
acute polynephritis positive
Term
Chronic pyelonephritis caused by
Definition
recurrent infections
Term
Pathologically chronic pyelonephritis is characterized by
Definition
scarring of the kidney, deformities of the collecting system, heydronephrosis, and loss of the renal parenchyma
Term
Histopathology of chronic pyelonephritis is
Definition
the thyroidization, i.e., many dilated tubules with hyaline casts. Patchy presence of inflammatory cells.
Term
Urolithiasis is a
Definition
common disease; 5%--10% of the population is affected over the course of a lifetime.
Term
Urolithiasis affects more
Definition
men than women
Term
Some studies have shown that 50-70% of patients with a history of calcium urolithiasis will
Definition
will have another bout of urolithiasis within 10 years
Term
Renal – Primary stones are
Definition
calcium oxalate or phosphate, uric acid, magnesium ammonium phosphate and calcium phosphate, cystine
Term
Secondary stones are
Definition
Bladder
Term
account for 75% of urolithiasis.
Definition
Calcium oxalate and calcium phosphate stones
Term
Struvite stone (staghorn calculi) are
Definition
Requires cathederization, Magnesium....
Common Renal pelvis stone that forms ammonium magnesium phosphate stones that form in alkaline urine, such as occurs in patients with persistent UTIs.
Term
Struvite stones are found in
Definition
15% of patients with urolithiasis.
Term
calculus is the same as
Definition
stone
Term
Hydronephrosis
Definition
kidney swelling
Term
Complication of kidney stone
Definition
pain, infection, blood in urine, hydroneprosis, kidney failure
Term
Uric acid stones found in 9% of patient are typically seen in
Definition
association with gout.
Term
Uric acid stones caused
Definition
blood cancer followed by chemotherapeutic drugs
Term
50% cases they occur without hyperuricemia.
Definition
Uric acid stone
Term
Cystine stones found in
Definition
1% of patients with cystinosis
Term
Calcium stones are most common with a pH of
Definition
alkaline
Term
Stuvite is second most common stone with a pH of
Definition
Alkaline
Term
Uric acid is the third most common stone with a pH of
Definition
Acidic
Term
Cystine stone is least common with a pH of
Definition
acidic
Term
Complications of urolithiasis
Definition
1. Urinary colics
2. Hydroureter and hydronephrosis
3. Infection
Term
Acute Renal Colic presents
Definition
Severe flank pain
Radiation to groin to external gentalia
Vomitting and urinary symptoms
Blood in the urine
Term
Kidney stone pain will not present with
Definition
fever, (kidney infection will have fevers)
Term
Hydronephrosis commonly results from
Definition
an obstruction located at the junction of the ureter and renal pelvis (ureteropelvic junction).
Term
causes of hydronephrosis
Definition
structural abnormalities, stones in renal pelvis, compression from tumor
Term
Urinary bladder cancer is the
Definition
4th leading cause of death 15,000 deaths for every 70,000
Term
Kidney cancer is the
Definition
5th leading cause of death 13,000 deaths for every 60,000
Term
Wilms tumor (nephroblastoma) is
Definition
malignant tumor originating from the renal blastema. in children
Term
Wilms tumor (nephroblastoma) peak incidence is
Definition
in children between 1 and 3 years
Term
Following surgery combined with chemotherapy, the 5-year survival rate of Wilms Tumor
Definition
90%
Term
A palpable abdominal mass in an infant usually represents one of three conditions
Definition
1. Multicystic renal dysplasia
2. Wilms tumor
3. Neuroblastoma of the adrenal tumor
Term
Kidney cancer comes from the
Definition
renal tublule
Term
WIlms tumor is mostly
Definition
sporatic (90)% in abdomen of children
Term
Renal cell carcinoma is most common in
Definition
adults
Term
Neoplasm of renal cell carcinoma is between he ages of
Definition
50-70 years
Term
Renal cell carcinoma is
Definition
resistant to chemotherapy and is associated with a 5 year survival rate of 45%
Term
Renal cell carcinoma symptoms
Definition
will vary
Term
the classic triad in renal cell carcinoma is
Definition
hematuria, flank pain, and a mass found in only 10 % of cases
Term
Complications of renal cell carcinoma includes
Definition
hematogenous metastasis, following invasion of the renal veins
Term
Transitional cell carcinoma of the renal pelvis is
Definition
Small, well-differentiated tumors are associated with 5-year survival rate of 70%, but undifferentiated tumors are more malignant.
Term
Fifty percent of transitional cell carcinoma
Definition
are multifocal
Term
There are three most common type of urinary tract tumors.

In 90% of cases, they are transitional cell carcinoma; the remaining cases are squamous cell carcinoma or adenocarcinoma.
Definition
In 90% of cases, they are transitional cell carcinoma; the remaining cases are squamous cell carcinoma or adenocarcinoma.
Term
urinary tract tumors are usually found in
Definition
Typically, patients are men between the ages of 50 and 80 years
Term
Predisposing factors include cigarette smoking and exposure to aniline dyes.
Definition
tumor of the urinary bladder
Term
Clinical findings of tumor of urinary bladder are
Definition
dysuria, mass effect in the pelvic region at site of metastasis or
Term
Treatment of urinary bladder tumor is
Definition
surgical
Term
Treatment of urinary bladder tumor may include
Definition
adjuvant therapy with cytotoxic drugs and intravesical (BCG) immunotherapy.
Term
Prognosis of urinary bladder tumor is
Definition
dependant of on the histological grade
Term
for grade 1 of urinary bladder tumor is
Definition
survival up to 5 years by 90%
Term
Most common type in the United States
Definition
Transitional Cell Carcinoma
Term
Transitional cell carcinoma is most common in
Definition
Men are affected three- to fourfold as often as women
Term
an increased risk of bladder cancer was identified among
Definition
workers in the leather, rubber, paint, and organic chemical industries.
Term
doubling of the incidence of bladder carcinoma.
Definition
Smoking
Term
Squamous Cell Carcinoma is
Definition
distinctly uncommon in the Western World
Term
Squamous Cell Carcinoma is common where
Definition
schistosomiasis is endemic
Term
Tumors or the ureters and urethra
Definition
Transitional cell carcinoma in these locations are rare.
Obstruction is an early symptom
Term
Squamous cells cancer is predisposed to
Definition
parasitic infection, anaplasia
Term
Urinary outlet obstruction
Definition
tumor, prostate enlargement, pregnance, stone
Term
Urethral carnucle
Definition
mass usually 1-2 cm near urethra
Term
clear cell cancer
Definition
cytoplasm is clean in renal/kidney
Term
urethric casts
Definition
tests- show bladder or kidney infection
Term
Malakoplakia
Definition
E coli in the UTI, inflammation disorder, cause is known
Term
hydronephrosis
Definition
palpable kidney, slight pain, other complaints, unable to start or stop urinations
Term
dysuria
Definition
pain urinating
Term
anuria
Definition
absent urination (kidney failure sign)
Term
hematuria
Definition
blood in urine
Term
oliguria
Definition
low output of urine (<500 ml with good hydration)
Term
Nephrolysis
Definition
kidney stone, flank pain, no fever
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