CB570 - Module 9 Kidney, Bladder, and Testes Pathology

Functions of the Kidney

Regulate fluid and electrolytes in the body, remove waste products, produce hormones.

Glomerulus

Capillaries beds and functional units of the kidney, where the filtration happens.

Hormones Produced by the Kidneys (2)

1. Renin

2. Erythropoietin

Periodic Acid Shift Stain (PAS Stain)

Stains for the presence of sugar.

Bowman’s Capsule

The cup around the glomerulus, beginning of the urinary space.

Horseshoe Kidney

Associated with Turner’s syndrome. Typically asymptomatic.

Cystic Renal Dysplasia

Failure of the kidney to develop properly, disorganized and undifferentiated cells. Typically unilateral —> bilateral is not compatible with life.

Polycystic Kidney Disease

Autosomal dominant genetic disorder which causes cysts on the kidneys, liver, and ovaries. Presented with blood in the urine and increased nitrogen in the blood. Transplant and dialysis are necessary by midlife.

Nephrotic Syndrome

Protein lost to the blood due to glomerulus damage. Results in lack of protein, high blood lipid (liver compensation), and edema.

Nephritic Syndrome

Inflammatory response to the kidney, causing reducing glomerular filtration and urine. Symptoms include blood in the urine, lack of urine, and hypertension.

Factors Which Prevent Proteins from Crossing the Glomerulus (2)

1. Epithelial cell foot processes

2. Negative charge of the basement membrane

Minimal Change Nephrotic Syndrome

Most common cause of nephrotic syndrome in children.

Epithelial cells lose foot processes.

Types of Inflammatory Glomerulonephritis (3)

1. Anti-GBM antibody (basement membrane rxn)

2. Immune complex (post-infection)

3. Anti-neutrophil cytoplasmic antibody (binding PNM)

Membranous Glomerulopathy (Immune Complex Disease)

Most common cause of nephrotic syndrome in adults, immune complexes “gum up” the glomerulus.

HIV-Associated Nephropathy

Damage to the kidney associated with HIV, can be shown with a silver stain to show matrix proteins leaking into improper spaces.

Diabetic Glomerulopathy

Most common cause of end stage renal failure, related to hyperglycemia. Basement membrane thickens and foot processes are lost.

Results in protein loss.

Revealed with PAS stain for sugar.

Amyloid Nephropathy

Abnormal proteins in the blood gum up the kidney, such as excess antibody chains in lymphoma patients.

Negative for PAS stain.

Crescentic (Rapidly Progressive) Glomerulonephritis

Massive proliferation of parietal epithelial cells, Bm disrupted, foot processes lost, fibrin formation.

Benign Nephrosclerosis

Scars on the kidney formed during hypertension. Kidney atrophies due to reduced blood flow.

Most common cause of end stage kidney disease in the black adult demographic.

Renal Infarct

Caused by an embolism typically, areas of necrosis on the kidney.

Renal Cortical Necrosis

Can be caused by shock, lack of blood flow to the outer regions of the kidney.

Acute Tubular Necrosis (ATN)

Urine concentrating tubules are damaged or poisoned, can cause backleak and renal failure.

Pyelonephritis

Angle of urine expulsion must be acute, if it is flattened then UTIs can travel up the ureter via urine reflux and infect the kidney.

Can be acute of chronic.

Causes of Chronic Pyelonephritis (2)

1. Ureteral reflux

2. Obstruction

Nephrolithiasis

Kidney stones, can be made of calcium, infection material, or uric acid.

Hydronephrosis/Hydroureter

Dilation of the renal collecting ducts and ureter respectively, due to obstruction typically by kidney stones.

Wilms Tumor

Most common abdominal solid tumor in children, forms on the kidney.

Renal Cell Carcinoma

Accounts for 90% of kidney cancers.

Oliguria

Lack of urine

Transitional Cell Carcinoma of Ureter

Transitional cells are stretchy cells (for filling with urine), only appear in the bladder and ureter, so this cancer is specific to this tissue.

Congenital Exstrophy of Bladder

Lumen of the bladder is external due to lack of abdominal formation. Gene mutation is unknown.

Acute Hemorrhagic Cystitis

Bladder is damaged via inflammation. Risk factors include being female, pregnancy, or infection.

Causes painful urination.

Transitional Cell Carcinoma of Bladder

Tumor in the bladder. Standard of care is to induce inflammatory reaction via BCG infection (TB family member)

Bladder Carcinoma Staging

A (non-invasive)

C (invasive)

Cryptorchidism

Testes do not drop from the abdomen. Causes infertility and high risk of germ cell neoplasms in teens and 20s.

Leydig Cell Tumor

May present in a teen with cryptorchidism. Tumor fo the cells surrounding the germ cells in the testicle.

Embryonal Carcinoma

Type of testicular cancer where embryonic layers begin to form.

Intratubular Germ Cell Neoplasia (Carcinoma In Situ)

Early stage cancer of the testicles.

Seminoma

Malignant germ cell tumor in the testicle. Lance Armstrong had this.

Choriocarcinoma

Testicular tumor that secretes hCG, would cause a positive pregnancy test on a male.

Types of Scrotal Masses (Benign, 3)

1. Hydrocele (collection of fluid, hematocele is blood collection)

2. Varicocele (varicose veins, cause infertility)

3. Spermatocele (ductule collection of fluid)

Prostatitis

Prostate inflammation, typically from E. coli.

Nodular Prostatic Hyperplasia

Enlarged prostate typically seen in older males. May cause trouble with urination, frequent urination, or frequent pyelonephritis.

Prostatic Adenocarcinoma

Most common cancer in males.

Markers for Prostate Damage (2)

1. PSA

2. PAP

Not perfect because things like ejaculation can cause level spikes.

Prostatic Adenocarcinoma Staging

A or B (Localized to prostate, non-invasive)

C or D (metastasis and lymph node invasion)