Urinary pathology


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Urinary pathology

  1. 1. URINARY PATHOLOGY Mary E. Martin Biology 120
  2. 2. Wilm’s tumor <ul><li>Wilms' tumor is a rare kidney cancer that primarily affects children. Also known as nephroblastoma, it's the most common malignant tumor of the kidneys in children. The peak time of Wilms' tumor occurrence is around ages 3 to 4, and it occurs only rarely after age 6. </li></ul>
  3. 3. <ul><li>Wilms' tumor may also go undetected early on, because the tumors can grow large without causing pain. However, even when they're large, most of these tumors are found before they have a chance to spread (metastasize) to other parts of the body. Your child may appear healthy or may have: </li></ul><ul><li>Abdominal swelling </li></ul><ul><li>An abdominal mass you can feel </li></ul><ul><li>Fever </li></ul><ul><li>Blood in the urine </li></ul><ul><li>Reduced appetite </li></ul><ul><li>High blood pressure </li></ul><ul><li>Constipation </li></ul><ul><li>Stomach pain </li></ul><ul><li>Nausea </li></ul>
  4. 4. <ul><li>Although the exact cause remains unknown, it's believed that this cancer arises when your child is still developing in the womb and some of the cells that are supposed to form the kidneys fail to develop properly. Instead, they multiply in their primitive state, becoming a tumor that often becomes evident around the time a child is 3 or 4 years old. </li></ul>
  5. 5. <ul><li>Standard treatment for Wilms' tumor is surgery and chemotherapy. The stage of the tumor and appearance of the cancer cells under a microscope help determine whether your child also needs radiation therapy. At this point, your doctor may tell you the tumor appears to be either favorable or unfavorable (anaplastic) — the histology of the tissue. Children whose tumors have a favorable histology have better survival rates. However, many children with unfavorable histology also have good outcomes. </li></ul>
  6. 6. Polycystic kidneys PKD <ul><li>Polycystic kidney disease (PKD) is a disorder in which clusters of cysts develop primarily within your kidneys. Cysts are noncancerous round sacs containing water-like fluid. </li></ul>
  7. 7. <ul><li>The greatest risk for people with polycystic kidney disease is developing high blood pressure. Kidney failure is another common problem for people with polycystic kidney disease. </li></ul>
  8. 8. <ul><li>Polycystic kidney disease symptoms may include: </li></ul><ul><li>High blood pressure </li></ul><ul><li>Back or side pain related to enlarged kidneys </li></ul><ul><li>Headache </li></ul><ul><li>Increase in the size of your abdomen </li></ul><ul><li>Blood in your urine </li></ul><ul><li>Frequent urination </li></ul><ul><li>Kidney stones </li></ul><ul><li>Kidney failure </li></ul><ul><li>Urinary tract or kidney infections </li></ul>
  9. 9. <ul><li>A healthy kidney (left) eliminates waste from the blood and maintains the body's normal chemical balance. Fluid-filled sacs (right), called cysts, characterize polycystic kidney disease. </li></ul>
  10. 10. <ul><li>Abnormal genes cause polycystic kidney disease, and the genetic defects mean the disease runs in families. There are two types of polycystic kidney disease, caused by different genetic flaws: </li></ul>
  11. 11. Autosomal dominant polycystic kidney disease <ul><li>Autosomal dominant polycystic kidney disease (ADPKD). Signs and symptoms of ADPKD often develop between the ages of 30 and 40. In the past, this type was called adult polycystic kidney disease, but children can develop the disorder. Only one parent needs to have the disease in order for it to pass along to the children. If one parent has ADPKD, each child has a 50 percent chance of getting the disease. This form accounts for about 90 percent of cases of polycystic kidney disease. </li></ul>
  12. 12. Autosomal recessive polycystic kidney disease <ul><li>Autosomal recessive polycystic kidney disease (ARPKD). This type is far less common than ADPKD. The signs and symptoms often appear shortly after birth. Sometimes, symptoms don't appear until later in childhood or during adolescence. Both parents must have abnormal genes to pass on this form of the disease. If both parents carry the genes for this disorder, each child has a 25 percent chance of getting the disease. </li></ul>
  13. 13. <ul><li>There are numerous complications associated with polycystic kidney disease including: </li></ul><ul><li>High blood pressure </li></ul><ul><li>Loss of kidney function </li></ul><ul><li>Pregnancy complications </li></ul><ul><li>Growth of cysts in your liver </li></ul><ul><li>Development of an aneurysm in your brain </li></ul><ul><li>Heart valve abnormalities </li></ul><ul><li>Colon problems </li></ul><ul><li>Chronic pain </li></ul>
  14. 14. <ul><li>Several diagnostic methods are available to detect the size and number of cysts as well as to evaluate the amount of healthy kidney tissue. </li></ul><ul><li>Ultrasound examination </li></ul><ul><li>Computerized tomography (CT) scan </li></ul><ul><li>Magnetic resonance imaging (MRI) scan </li></ul><ul><li>Genetic testing </li></ul>
  15. 15. Nephrolithiasis <ul><li>Also known as kidney stones </li></ul>
  16. 16. <ul><li>Kidney stones (renal lithiasis) are small, hard deposits that form inside your kidneys. Kidney stones are made of mineral and acid salts. Kidney stones have many causes. In one common scenario, kidney stones form when the urine becomes concentrated, allowing minerals to crystallize and stick together. </li></ul>
  17. 17. <ul><li>A kidney stone may or may not cause signs and symptoms until it has moved into the ureter — the tube connecting the kidney and bladder. At that point, these signs and symptoms may occur: </li></ul><ul><li>Severe pain in the side and back, below the ribs </li></ul><ul><li>Pain that spreads to the lower abdomen and groin </li></ul><ul><li>Pain on urination </li></ul><ul><li>Pink, red or brown urine </li></ul><ul><li>Nausea and vomiting </li></ul><ul><li>Persistent urge to urinate </li></ul><ul><li>Fever and chills if an infection is present </li></ul>
  18. 18. <ul><li>Kidney stones often have no definite, single cause. A number of factors, often in combination, create the conditions in which susceptible people develop kidney stones </li></ul>
  19. 19. <ul><li>Most kidney stones contain crystals of more than one type. Types of kidney stones include: </li></ul><ul><li>Calcium stones </li></ul><ul><li>Struvite stones </li></ul><ul><li>Uric acid stones </li></ul><ul><li>Cystine stones </li></ul><ul><li>Other stones. Other, rarer types of kidney stones can occur </li></ul>
  20. 20. <ul><li>Kidney stones form in your kidneys. As stones move into your ureters — the thin tubes that allow urine to pass from your kidneys to your bladder — signs and symptoms can result. Signs and symptoms of kidney stones can include severe pain, nausea and vomiting. </li></ul>
  21. 21. <ul><li>If your doctor suspects you have a kidney stone, you may undergo tests and procedures to diagnose your condition, such as: </li></ul><ul><li>Blood tests </li></ul><ul><li>Urine tests </li></ul><ul><li>Imaging tests </li></ul><ul><li>Analysis of passed stones </li></ul>
  22. 22. <ul><li>Treatment for small stones with minimal symptoms Most kidney stones won't require invasive treatment. You may be able to pass a small stone by: </li></ul><ul><li>Drinking water </li></ul><ul><li>Pain relievers </li></ul>
  23. 23. <ul><li>Treatment for larger stones and those that cause symptoms Kidney stones that can't be treated with conservative measures — either because they're too large to pass on their own or because they cause bleeding, kidney damage or ongoing urinary tract infections — may require more invasive treatment. Procedures include: </li></ul><ul><li>Using sound waves to break up stones </li></ul><ul><li>Surgery to remove very large stones in the kidney </li></ul><ul><li>Using a scope to remove stones </li></ul><ul><li>Parathyroid gland surgery </li></ul>
  24. 24. Hydronephrosis <ul><li>Hydronephrosis is distension and dilation of the renal pelvis calyces , usually caused by obstruction of the free flow of urine from the kidney , leading to progressive atrophy of the kidney. In cases of hydroureteronephrosis , there is distention of both the ureter and the renal pelvis and calices. </li></ul>
  25. 25. <ul><li>There are numerous causes of hydronephrosis that are categorized based upon the location of the swelling and whether the cause is intrinsic (located within the urinary collecting system), extrinsic (outside of the collecting system) or if it due to an alteration in function. </li></ul>
  26. 26. <ul><li>There may or may not be direct symptoms of hydronephrosis depending upon the underlying cause. </li></ul>
  27. 27. <ul><li>Individuals with acute hydronephrosis, for example symptoms from renal colic due to a kidney stone begin with an acute onset of intense flank or back pain radiating to the groin, associated with nausea , vomiting , and sweating. Colicky pain comes and goes and its intensity may cause the person to writhe or roll around or pace in pain. There may be blood seen in the urine . </li></ul>
  28. 28. <ul><li>Chronic hydronephrosis develops over time and there may be no specific symptoms. Tumors in the pelvis or bladder obstruction may develop silently and the person may have symptoms of kidney failure . These are very non specific and may include weakness , malaise, nausea and vomiting . If electrolyte abnormalities occur because the kidneys are unable to regulate sodium, potassium, and calcium, there may be heart rhythm disturbances and muscle spasms . </li></ul>
  29. 29. <ul><li>The following laboratory tests may be ordered depending upon what potential diagnosis is being considered. </li></ul><ul><li>Urinalysis </li></ul><ul><li>Complete blood count </li></ul><ul><li>Electrolyte </li></ul><ul><li>BUN (blood urea nitrogen), creatinine and glomerular filtration rate </li></ul><ul><li>Imaging Studies </li></ul><ul><li>CT scan </li></ul><ul><li>Ultrasound </li></ul><ul><li>Intravenous pyelography </li></ul><ul><li>KUB X-rays </li></ul>Imaging Studies
  30. 30. <ul><li>If hydronephrosis remains untreated, the increased pressure within the kidney may decrease the ability of the kidney to filter blood, remove waste products, and make urine as well as regulate the electrolytes in the body. </li></ul>
  31. 31. <ul><li>Hydronephrosis can lead to kidney infections (pyelonephrosis), sepsis , and in some cases, complete kidney function loss or death. Kidney function will begin decreasing almost immediately with the onset of hydronephrosis but is reversible if the swelling resolves. Usually kidneys recover well even if there is an obstruction lasting up to 6 weeks. </li></ul>
  32. 32. calyx <ul><li>structural components of the mammalian kidney </li></ul><ul><li>Major calyx </li></ul><ul><li>Minor calyx </li></ul>
  33. 33. Structures of the Kidney <ul><li>1. Renal pyramid </li></ul><ul><li>2. Interlobar artery </li></ul><ul><li>3. Renal artery </li></ul><ul><li>4. Renal vein </li></ul><ul><li>5. Renal hylum </li></ul><ul><li>6. Renal pelvis </li></ul><ul><li>7. Ureter </li></ul><ul><li>8. Minor calyx </li></ul><ul><li>9. Renal capsule </li></ul><ul><li>10. Inferior extremity </li></ul><ul><li>11. Superior extremity </li></ul><ul><li>12. Interlobar vein </li></ul><ul><li>13. Nephron </li></ul><ul><li>14. Renal sinus </li></ul><ul><li>15. Major calyx </li></ul><ul><li>16. Renal papilla </li></ul><ul><li>17. Renal column </li></ul>
  34. 34. Major Calyx <ul><li>Two or three minor calyces converge to form a major calyx. The major calyx , in the kidney, surrounds the apex of the renal pyramids . Urine formed in the kidney passes through a renal papilla at the apex into a minor calyx then into major calyx before passing through the renal pelvis into the ureter . </li></ul>
  35. 35. <ul><li>Peristalsis of the smooth muscle originating in pace-maker cells originating in the walls of the calyces propels urine through the renal pelvis and ureters to the bladder . </li></ul>
  36. 36. Minor Calyx <ul><li>The minor calyx , in the kidney, surrounds the apex of the renal pyramids . Urine formed in the kidney passes through a papilla at the apex into the minor calyx then into the major calyx . </li></ul>