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Renal Pathology (Cystitis (Causes (E. coli, Klebsiella, Proteus,…
Renal Pathology
Cystitis
Bladder infection
Causes
E. coli
Klebsiella
Proteus
Pseudomonas
Pathology
Acute inflammatory changes
Chronic necrosis
Associated with ureteritis & cystitis cystica
Can resemble tumours
Predisposes to malignancy
Tumours
Benign
Adenoma
Yellow, cortical nodule
Juxtaglomerular cell tumour
Produces renin leading to hypertension
Fibroma
White, medullary nodule
Angiomyolipoma
Malignant
Renal cell carcinoma
Arises from tubular epithelial cells
Most common
Presents in middle-old age
2x common in males
Presentation
Abdominal mass
Haematuria
Flank pain
Polycythaemia
Hypercalcaemia
Pathology
Well-circumscribed
Yellow
Renal vein extension
Haematogenous spread to lungs and bone
Nephroblastoma
Wilms' Tumour
Affects children
Urothelial carcinoma
Arises from pelvicalyceal system
Transitional cell carcinoma
Arises from transitional epithelium of bladder
Most often in trigonal area
Presents with haematuria
Associated with exposure to solvents etc.
Adenocarcinoma
Squamous carcinoma
Embryonal rhabdomyosarcoma
Nephritis
Glomerulonephritis
Autoimmune
Pathology
Glomerular tufts
Tubulointerstitial changes
Diffuse inflammation
Pyonephritis
Infective cause
E. coli
Strep. faecalis
Pseudomonas
Patchy distrubution
Risk factors
Female
Diabetic
Post-surgery
Cystitis
Pregnancy
UT obstruction
Chronic
Vague symptoms
Hypertension with uraemia & polyuria
Tuberculosis
Haematogenous spread from lungs
Presentation
Weight loss
Fever
Loin pain
Dysuria
Pathology
Focal caseous necrosis
Positive ZN stain
Granulomatous inflammation
Can spread to bladder via UT
Hydronephrosis
Dilatation of renal pelvis and calyces
Causes
Obstruction
Reflux
Unilateral
Calculi
Neoplasms
Stricture
Bilateral
Obstruction
Neurogenic
Cervical carcinoma
Pathology
Pelvicalyceal dilatation
Cortical atrophy
Fibrosis
Can lead to pyonephritis
Congenital abnormalities
Agenesis
Absence of one or both kidneys
Failure of ureteric bud to induce development of metanephric blastema
Unilateral
Asymptomatic
Bilateral
Potter's sequence
Fatal
Horseshoe kidney
Mechanical fusion of developing kidneys during metanephros
Can become trapped under inferior mesenteric artery
Usually fuses at inferior pole
2x common in males
Complications
Hydronephrosis
Renal stones
Infection
Malignancy
Hypolasia
Small but functional kidneys
Cystic disease
Child polycystic
Autosomal recessive
Results in terminal renal failure
Renal enlargement with medullary dilatation
Associated with congenital hepatic fibrosis
Adult polycystic
Massive bilateral enlargement
Autosomal dominant
Presents in middle age
Abdominal mass
Haematuria
Hypertension
Cysts often in liver, pancreas & lung
Associated with berry aneurysms
Cysts of tubular cell epithelium in cortex and medulla
Simple cyst
Usually does not impact on renal function
Multiple and large
Urinary tract obstruction
More common in males
Causes
Posterior urethral valves
Stricture
Prostatic disease
Bladder obstruction
Detrusor hypertrophy