Dr. Perner 2024 Renal Lecture 2 - Haematuria/Nephritic (Student Copy) PDF

Disorders of the Urinary Tract associated with Haematuria / Nephritic Syndrome Lecture 2 Dr Y Perner Division of Anatomical Pathology University of the Witwatersrand  Haematuria Presence of blood in the urine macroscopic / microscopic inte...

Disorders of the Urinary Tract associated with Haematuria / Nephritic Syndrome Lecture 2 Dr Y Perner Division of Anatomical Pathology University of the Witwatersrand  Haematuria Presence of blood in the urine macroscopic / microscopic intermittent / persistent common clinical presentation in patients with disease of the urinary tract: kidney → urethra  Haematuria Presence of blood in the urine Not all that is red is haematuria Causes of red urine: Foods: beets, blackberries, rhubarb Meds: rifampacin, laxatives, pyridium Poisons: lead, mercury  Renal causes of Haematuria Renal parenchymal diseases – glomeruli / tubules Renal calculi within the renal pelvis Neoplasms of renal parenchyma / pelvis Trauma Red blood cells within the urine: normal / abnormal morphology  Other causes of haematuria Haematuria associated with diseases of: - ureter - urinary bladder - urethra - prostate red blood cells within the urine: normal morphology  Haematuria Haematuria associated with glomerular disorders: macroscopic / microscopic red blood cells within the urine are dysmorphic in appearance  Glomerular diseases associated with haematuria Patients with glomerular diseases – clinical features: Isolated proteinuria Nephrotic syndrome Macroscopic haematuria Microscopic haematuria Nephritic syndrome Mixed proteinuria and haematuria Acute renal failure Chronic renal failure Systemic hypertension  Glomerular diseases associated with haematuria Variety of glomerulonephritides result in haematuria (macroscopic / microscopic) with or without the nephritic syndrome Nephritic syndrome: acute onset haematuria oliguria ( F, >30 yrs age Develop at any site within the urinary tract, most common within the renal pelvis Present with renal colic; haematuria; obstructive uropathy Classified according to composition Urolithiasis 80% calcium oxalate, calcium phosphaste Struvite, uric acid, cysteine Struvite – repeated UTIs, proteus mirabilis, staghorn calculi Sometimes a very large calculus nearly fills the calyceal system, with extensions into calyces that give the appearance of a stag's (deer) horns. Hence, the name "staghorn calculus". Seen here is a horn-like stone extending into a dilated calyx, with nearly unrecognizable overlying renal cortex from severe hydronephrosis and pyelonephritis. Nephrectomy may be performed because the kidney is non-functional and serves only as a source for infection.  Renal causes of Haematuria Glomerular diseases Renal calculi within the renal pelvis Neoplasms of renal parenchyma Neoplasms of the renal pelvis  Renal neoplasia 1. Renal cell carcinoma: commonest primary tumour of the kidney typically presents late stage with: hematuria loin pain flank mass most common >50 yrs age (6th – 7th decades) M>F  RCC Aetiology: unclear tobacco smoking genetic predisposition Prognosis: - confined to kidney: 70% 5 yr survival - extended beyond kidney: 15-20% 5 yr survival Renal cell carcinoma that on sectioning is mainly cystic with extensive hemorrhage. Sometimes large simple renal cysts may develop hemorrhage and mimic this appearance. This is the classic histologic appearance of a renal cell carcinoma: the neoplastic cells have clear cytoplasm and are arranged in nests with intervening blood vessels. This microscopic appearance is why they are often called "clear cell carcinomas".  Renal neoplasia 2. Nephroblastoma: Wilm’s tumour commonest intra-abdominal tumour in children 90% survival with combination therapy https://librepathology.org/wiki/Wilms_tumour  Renal causes of Haematuria Glomerular diseases Renal calculi within the renal pelvis Neoplasms of renal parenchyma Neoplasms of the renal pelvis  Renal neoplasia Carcinoma of the renal pelvis: 5-15% of all tumours of the kidney arise from the urothelial lining of the renal pelvis present early due to haematuria and features of outflow obstruction aetiology: analgesic abuse thorotrast calculi TOBACCO  Carcinoma renal pelvis Macroscopy: identical to carcinomas bladder / ureter - papillary – flat (infiltrative) Microscopy: transitional cell carcinoma (TCC) squamous cell carcinoma (SCC) Prognosis: depends on grade + stage “Field effect”: multiple tumours of the urinary tract The cut surfaces of the kidney removed surgically here demonstrate normal cortex and medulla, but the calyces show focal papillary tumor masses of urothelial carcinoma.  Other renal causes for haematuria Tubulo-interstitial diseases Renal parenchymal infarcts Vascular diseases: isolated to the kidney part of systemic vasculitic process, with renal involvement