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Questions and Answers
What is a prominent feature of nephritic syndrome?
What is a prominent feature of nephritic syndrome?
Which of the following conditions is associated with acute diffuse proliferative glomerulonephritis?
Which of the following conditions is associated with acute diffuse proliferative glomerulonephritis?
What is primarily responsible for increasing blood pressure in nephritic syndrome?
What is primarily responsible for increasing blood pressure in nephritic syndrome?
Which laboratory finding is typically elevated in nephritic syndrome?
Which laboratory finding is typically elevated in nephritic syndrome?
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What is the expected urine output in a patient with nephritic syndrome?
What is the expected urine output in a patient with nephritic syndrome?
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What complication is commonly associated with nephritic syndrome?
What complication is commonly associated with nephritic syndrome?
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In nephritic syndrome, which symptom is most indicative of kidney inflammation?
In nephritic syndrome, which symptom is most indicative of kidney inflammation?
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Which of the following best describes azotemia in nephritic syndrome?
Which of the following best describes azotemia in nephritic syndrome?
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What is a common site for metastasis of renal cell carcinoma?
What is a common site for metastasis of renal cell carcinoma?
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Which symptom is most commonly associated with local spread of renal cell carcinoma?
Which symptom is most commonly associated with local spread of renal cell carcinoma?
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What primary condition leads to left-sided varicocele in left renal cell carcinoma?
What primary condition leads to left-sided varicocele in left renal cell carcinoma?
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Which symptoms can result from paraneoplastic syndromes related to renal cell carcinoma?
Which symptoms can result from paraneoplastic syndromes related to renal cell carcinoma?
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What is the predominant age group for the occurrence of Wilms tumor?
What is the predominant age group for the occurrence of Wilms tumor?
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Which histological component is characterized by small, round primitive cells in Wilms tumor?
Which histological component is characterized by small, round primitive cells in Wilms tumor?
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What type of growth pattern is typically seen in Wilms tumor?
What type of growth pattern is typically seen in Wilms tumor?
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What is the most common symptom due to distant metastases associated with renal cell carcinoma?
What is the most common symptom due to distant metastases associated with renal cell carcinoma?
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What is the most common variant of renal cell carcinoma?
What is the most common variant of renal cell carcinoma?
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Which histological feature is characteristic of clear cell renal cell carcinoma?
Which histological feature is characteristic of clear cell renal cell carcinoma?
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Which type of renal cell carcinoma has the best prognosis?
Which type of renal cell carcinoma has the best prognosis?
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Which of the following is a risk factor for developing renal cell carcinoma?
Which of the following is a risk factor for developing renal cell carcinoma?
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What is a primary characteristic of papillary renal cell carcinoma?
What is a primary characteristic of papillary renal cell carcinoma?
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What histological arrangement is commonly seen in chromophobe renal cell carcinoma?
What histological arrangement is commonly seen in chromophobe renal cell carcinoma?
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Which type of renal cell carcinoma is typically multifocal and bilateral?
Which type of renal cell carcinoma is typically multifocal and bilateral?
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In clear cell renal cell carcinoma, what primarily accounts for the clear appearance of the cytoplasm?
In clear cell renal cell carcinoma, what primarily accounts for the clear appearance of the cytoplasm?
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Study Notes
Anatomy of the Kidney
- The nephron is the functional unit of the kidney, comprised of a renal corpuscle and a renal tubule.
- The renal corpuscle contains a glomerulus, a network of capillaries inside Bowman's capsule, and a mesangium, which supports the glomerulus.
Nephritic Syndrome
- A collection of signs and symptoms caused by kidney inflammation
- Characterized by:
- Hematuria
- Mild to moderate proteinuria
- Oliguria: Reduced urine output
- Uremia: Elevated blood urea and creatinine levels
- Azotemia: Increased nitrogen-rich waste in the blood
- Edema: Often in the face or legs
- Hypertension
Acute Diffuse Proliferative Glomerulonephritis
- Also known as post-streptococcal or acute glomerulonephritis
- Follows upper respiratory tract infections caused by nephritogenic strains of group A beta-hemolytic streptococci
- Immune complexes of antibodies against the bacteria deposit in the glomeruli, causing inflammation.
- Inflammation leads to endothelial cell proliferation, narrowing the capillary lumen, reducing blood flow and glomerular filtration rate (GFR).
- Decreased GFR contributes to oliguria and triggers renin/angiotensin release, leading to salt and water retention and edema.
### Renal Cell Carcinoma
- Commonly arises in the kidney cortex as a well-circumscribed solid mass, often extending into the renal pelvis and renal vein.
- Cut surface often has a variegated golden-yellow appearance due to hemorrhage, necrosis, and cyst formation.
- Microscopic picture:
- Clear Cell Type (80%): Large cells with clear cytoplasm arranged in solid masses, cords, or tubules.
- Chromophobe Cell Type (5%): Large cells with granular cytoplasm and distinct cell borders.
- Papillary Renal Cell Carcinoma (10-15%): Cells arranged in cysts with papillary formations.
Clear Cell Renal Cell Carcinoma
- Most common variant, accounting for 80% of cases.
- Cells contain abundant glycogen and lipids, accounting for the clear cytoplasm.
- Can exhibit various growth patterns including papillary, solid, glandular, and trabecular.
Papillary Renal Cell Carcinoma
- Makes up 10-15% of renal cell cancers.
- Can be sporadic or familial.
- Characterized by branching papillae with single layers of large cells with small amounts of cytoplasm and large nuclei.
- Often multifocal and bilateral, facilitating early diagnosis.
Chromophobe Renal Cell Carcinoma
- Accounts for 5% of renal cell cancers.
- Cells originate from cortical collecting ducts.
- Characterized by large cells with granular eosinophilic cytoplasm, a perinuclear halo, and prominent cell membranes.
- Shows a compact growth pattern and generally has a better prognosis than other variants.
Spread of Renal Cell Carcinoma
- Local Spread: Infiltrates the rest of the kidney, early invasion of the renal pelvis, late invasion of the capsule and perirenal fat.
- Lymphatic Spread: Primarily to the lumbar lymph nodes.
- Blood Spread: Early due to invasion of the renal vein (after renal pelvis invasion). Common metastatic sites include lungs (over 50%), bones (33%), liver, and brain.
- Left-sided varicocele can occur with left-sided renal cell carcinoma due to tumor spread.
### Clinical Presentation of Renal Cell Carcinoma
- Local spread:
- Painless hematuria
- Loin mass (palpable)
- Costovertebral pain (late symptom after infiltration of the capsule)
- Paraneoplastic Syndromes:
- Hypercalcemia, hypertension, polycythemia, Cushing syndrome, and other hormonal issues
- Distant metastases:
- Bone fracture, cough, convulsions, left varicocele
### Nephroblastoma (Wilms Tumor)
- A malignant embryonal tumor predominantly affecting young children, with the majority of cases occurring before the age of 10.
- Originates from nephrogenic blastema - primitive cells that resemble developing kidney tissue.
- Rapidly growing and infiltrates the capsule early.
- Gross Picture: Markedly enlarged kidney with a huge mass, often irregular and infiltrating the outer surface. Cut section usually appears homogenous, gray, and fleshy.
- Microscopic Picture: Comprised of three components:
- Blastema: Primitive cells with scanty cytoplasm.
- Mesenchymal Elements: Fibroblasts, smooth muscle, skeletal muscle, cartilage, or myxomatous tissue.
- Epithelial Component: Malignant epithelial cells forming abortive tubules or glomeruli.
### Spread of Wilms Tumor
- Local Spread: Rapidly destroys the remaining kidney tissue, early invasion of the capsule and perirenal fat, late invasion of the pelvis. Direct spread to surrounding intestines and adrenal glands.
- Lymphatic Spread: Lumbar lymph nodes (15%).
- Blood Spread: Lungs, liver, and brain.
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Description
This quiz covers key concepts related to the anatomy of the kidney, including the nephron's structure and function, as well as common kidney disorders like nephritic syndrome and acute glomerulonephritis. Test your understanding of renal physiology and the implications of kidney diseases.