Renal: Pathology Ii

Front 1

3 Morphological features in Wilm's tumor

Back 1

Primitive tubules (epithelium)
Blastema (immature cells)
Stroma

Front 2

Age of patients affected by Wilm's tumor

Back 2

1-3 y/o

Front 3

Wilm's cure rate

Back 3

High 80-90%

Front 4

Genes affected by Wilm's Tumor

Back 4

WT 1/ WT 2

Front 5

highest yield syndrome associated w/ Wilm's

Back 5

Beckwith Wiederman

Front 6

most common renal neoplasm in INFANCY

Back 6

Congenital mesoblastic Nephroma

Front 7

Congenital mesoblastic Nephroma morphological feature

Back 7

spindle cells that have varying immaturity

Front 8

< 0.5cm
> 0.5 cm

Back 8

papillary adenoma
papillary renal cell carcinoma

Front 9

Papillary Adenomas are located where?

Back 9

subcapsular in cortex

Front 10

Central stellate scare with mahogany brown appearance

Back 10

Renal Oncocytoma

Front 11

solitary tumor with a mixture of adipose, smooth m., and blood vessels?

Back 11

angiomyolipoma

Front 12

Most common malignant adult neoplasm?

Back 12

Renal Cell Carcinoma

Front 13

A 50 y/o pt presents with a history of flank pain, hematuria, and a unilateral palpable mass. He indicates he has a 50 pack/year smoking history. most likely diagnosis?

Back 13

Renal Cell Carcinoma

Front 14

Where does Renal Cell carcinoma commonly metastisize to? whats the best Tx?

Back 14

Lungs, bone, lymph nodes
Surgery....chemo is not effective

Front 15

Clear Cell RCC gene mutation?

Back 15

VHL (von Hippel Lindau) gene- a tumor suppressor gene

Front 16

Papillary RCC size?
gene mutation?
commonly known as what?

Back 16

> 0.5 cm (malignant)
c-met gene
"Dialysis kidney"

Front 17

Prognosis of Collecting Duct Carcinoma?

Back 17

50-66% die
worst prognosis of typical RCC subtypes.

this is b/c collecting system is involved which backs up the urine into the blood thus causing toxicities and all kinds of problems.

Front 18

African-American or Mediterranean decent, history of sickle cell disease, very rare....describes what?

Back 18

Renal Medullary Carcinoma

Front 19

glycogen rich tumor?

Back 19

Clear Cell RCC

Front 20

Renal Urothelial Cell carcinomas involve what tissue type?
risk factors associated?

Back 20

Transitional Cell epithelium (calyces, renal pelvis, ureters, bladder)

smoking, chemicals, chronic injury/irritation

Front 21

Common sequels with obstructive uropathy?

Back 21

you block urine, it sits around and brews up infection, and stones can also form. eventually you will lose renal function from hydronephrosis.

Front 22

dilated renal pelvis

Back 22

hydronephrosis

Front 23

Pt presents with pain, hematuria, and an altered urinary output...you know this is probably a _________.

Back 23

Urolithiasis

Front 24

Urolithiasis types of stones?

Back 24

Calcium
Struvite- magnesium, ammonium, phsophate
Uric Acid
Cystine

Front 25

tell the etiology of these stones:
1) Calcium
2) Struvite
3) Uric Acid
4) Cystine

Back 25

1) Most common 70% of time hypercalcemia/uria
2) bacterial infection (staghorn)
3) Gout
4) genetic defect in reabsortion of amino acids

Front 26

Layers of visceral bladder? (inside-->out)

Back 26

Mucosa
Lamina propria- incomplete slips of smooth m.
Muscularis propria- thick smooth m.
Adventitia

Front 27

1) Out pouching of bladder?
2) Anterior bladder wall and abdominal wall missing?

Back 27

1) diverticula
2) exstrophy

Front 28

whats the deal with a patent urachus?

Back 28

communicating duct from bladd to umbilicus which can set up lots of infection. typically requires surgical closing.

Front 29

What causes Cystitis?

Back 29

E.coli
Candida
SCHISTOSOMIASIS
chemicals can cause hemorrhagic cystitis.

Front 30

What is Malacoplakia?
Buzz cues associated??

Back 30

whitish, tanish, yellow plaques on the bladder wall

Michaelis- Gutmann bodies within lysosomes of macrophages.

Front 31

Why would Transitional epithelium replaced with the following epithelia:
1) columnar
2) squamous

Back 31

1) chemical environment protection
2) physical stressors protection

Front 32

Urothelial epithelium cancers are:
Benign
Premalignant (KNOW)
Malignant
(name the associated neoplasm within each class)

Back 32

Benign- urothelial papilloma

Premalignant- PUNLMP (Papillary urothelial neoplasm of low malignant potential) & Flat CIS (Flat carcinoma in situ)

Malignant- Papillary urothelial Carcinoma (TCC-Transitional Cell Carcinoma) & FLAT (associated w/CIS)

Front 33

Difference in PUNLMP and TCC histologically

Back 33

PUNLMP- mildly disorganized pattern w/ fibrovascular cores

TCC- less organized, big nuclei, mitotic figures.

Front 34

Squamous Cell carcinoma associated with?

Back 34

schistosomiasis

Front 35

Bladder CA risk factors?

Back 35

smoking
2- naphthylamine (aromatic compounds)

Extras:
Schistosoma
cyclophosphamides

Front 36

Patient presents with hematuria. Biopsy shows multiple tumors. Dr. Leonard gives this specimen a high grade and notes presence of CIS in surrounding mucosa. What does the pt have?

Back 36

Flat CA of uroepithelia associated with CIS

Front 37

Small tumors in uroepithelia can be treated how?

Back 37

TURBT- transurethralresection of bladder tumor

Front 38

which stones are not seen on standard X-ray imaging?

Back 38

Uric Acid stones

Front 39

Struvite stones associated with what urine pH?

Back 39

struvite is high pH, urine is low pH...salt precipitates.

Front 40

most common suprapubic mass palpable mass?

Back 40

urachal cysts. treat these soon b/c they can progress to an adenocarcinoma

Front 41

CIS, high grade TCC, multifocal and rapid recurrence tumors are treated how?

T4 grades that invade?

Back 41

immunotherapy/chemotherapy.

Cystectomy and/or systemic chemo

Front 42

Renal Cell Carcinoma that can invade into the renal vein and possibly the IVC?

Back 42

Clear Cell RCC

Front 43

being called to the morgue to do an autopsy, you notice you have an african-american corpse in front of you. you start the autopsy and notice an abnormally small kidney with a granular surface. under histological section, you notice hyaline thick capillaries. what did the former pt have?

Back 43

hypertensive nephrosclerosis or benign nephrosclerosis

Front 44

a 40 y/o male presents to you with headaches, retinal-vascular changes and progressive renal dysfxn. his BP is 195/125. Dx? and histo expectations?

Back 44

Malignant HTN

histo sections show fibrinoid necrosis of capillary walls that look like onion-skin lesions

Front 45

Pt presents w/ mild-moderate HTN. a bruit is heard over the L kidney. imaging shows narrowing of L renal artery. dx? and renin expectations? likely cause? other cause?

Back 45

Renal a. Stenosis
L renal vein renin increase
likely atherosclerotic
other cause may be fibromuscular dysplasia

Front 46

what does fibromuscular dysplasia look like? most common lesion site?

Back 46

String of beads due to increase in fibrosis of capillary wall

media fibroplasia (not intima not adventitia)

Front 47

Big deal with thrombic Microangiopathies?
How do i know if i got one?

Back 47

can cause ischemia

Schistocytes on CBC.
thrombocytopenia b/c clotting is going on, HTN and renal failure b/c kidneys are deprived of blood.

Front 48

causes of thrombic Microangiopathies?

morphology?

Back 48

infection, drugs, autoimmune dz, malignant htn, pregnancy

fibrinoid necrosis, collapsed vessels

Front 49

Hemolytic Uremic Syndrome
typical?

Back 49

kids
diarrhea positive
E.coli 0157:H7 (Shiga toxin)

Shiga toxin causes vascular damage in glomerulus.

Front 50

Hemolytic Uremic Syndrome
atypical?

Back 50

adults
diarrhea negative
inherited or acquired condition

some inherited conditions can cause thrombotic events to occur at level of kidney.

Front 51

A pt presents to you with a fever, acute renal failure. The patient has neurological deficits that you note. CBC shows microangiopathic hemolytic anemia and thrombocytopenia. Dx? due to???

Back 51

Thrombotic Thrombocytopenia Purpura (TTP)

ADAMTS13 gene mutation

Front 52

medullary interstitium is hypertonic and relatively hypoxic. This promotes what nephropathy?

Back 52

Sickle cell nephropathy pathogenesis

Front 53

Sickle cell nephropathy does what to the glomerulus? how do you treat it?

Back 53

occludes it causing hypoxia and papillar necrosis. FSGS may occur in some patients.
improve oxygenation via red cell exchange

Front 54

Sources of embolic kidney disease?

Result?

Back 54

cardiac mural thrombi, cardiac valvular vegetations, atherosclerotic plaques

renal infarct and wedge shaped infarcts