Kidney, Bladder and Prostate Pathology for Allied Health Sciences.pptx

Kidney, Bladder and Prostate Pathologies for Allied Health Sciences Prof. Nicholas Titiloye MBChB, FMCPath, FICS Dept of Pathology School of Medical Sciences The Kidney Relations of the Kidney  Renal Fat  Renal capsule  Adrenal Gland...

Kidney, Bladder and Prostate Pathologies for Allied Health Sciences Prof. Nicholas Titiloye MBChB, FMCPath, FICS Dept of Pathology School of Medical Sciences The Kidney Relations of the Kidney  Renal Fat  Renal capsule  Adrenal Glands  Renal artery  Renal Veins  Ureter KIDNEY Section of the Kidney  Capsule  Cortical surfaces  Renal Cortex  Renal Medulla  Pelvo calyceal system – Renal Calyces  Anatomic position of kidneys (T12-L3) Horse Shoe Kidney  Congenital defect  Kidneys joined together at the poles  The ureters pass through the kidneys in an abnormal course  There may be constriction to the ureters  The kidneys are in abnormal anatomical position Renal Cyst  Renal cysts may be congenital or acquired  They may be unitary or multiple  Multi cystic renal dysplasia could be seen  This is a sporadic abnormality in metanephric differentiation characterized histologically by the persistence of abnormal structures- cartilage, undifferentiated mesenchyme, immature collecting ductules and abnormal lobar organization  Dysplasia can be unilateral or bilateral ADULT POLYCYSTIC DISEASE.  Adult Polycystic Kidney disease are autosomal dominants in inheritance  Patient have enlarged multilobulated kidneys  They usually present with hypertension and haematuria  The counterpart of this disease in childhood is autosomal recessive Cystic Diseases of the kidney  Multiple renal dysplasia  Polycystic kidney disease  Medullary cystic disease  Acquired dialysis associated kidney cyst  Localised renal cysts  Renal cysts in hereditary malformation syndromes e.g tuberous sclerosis  Glomerulocystic diseases  Extraparenchymal renal cysts – pyelocalyceal cysts, hilar lymphangitic cysts RENAL CALCULI.  Renal stones may form at any level of the urinary tract.  Most arises from the kidney  Men affected more than women  Inborn errors of metabolism like gout, cystinuria, primary hyperoxaluria are predisposing factors  Stones may be Calcium stones, triple stones or struvite stones, uric acid stones and cystine stones  They cause obstruction to urine flow wherever they exist.  Hydroureter and hydronephrosis are consequences of these obstructions HYDROURETER. HYDRONEPHROSIS. KIDNEY IN ESSENTIAL HYPERTENSION.  Essential hypertension is one of the systemic diseases with gross morphology on the kidney.  The gross morphology is however seen in long standing, uncontrolled hypertension  The features seen on the kidney is benign nephrosclerosis  This is fine granularity of the cortical surface of the kidney  Histology associated with this is hyaline arteriolosclerosis of the vessels in the kidney Hyaline Arteriolosclerosis Kidneys in Malignant Hypertension  In certain conditions the blood pressure becomes elevated to uncontrolled limit with the potential of causing death to the patient  This is described as malignant hypertension  The kidneys are seen with haemorrhage to the cortical surfaces  This morphology is called flea-beaten appearance of the cortical surface of the kidneys  Histology associated with this is hyperplastic arteriolosclerosis also called onion skin apearance of the renal arterioles MALIGNANT HYPERTENSION. Hyperplastic Arteriolosclerosis ACUTE PYELONEPHRITIS.  Acute pyelonephritis is an acute inflammatory process of the kidneys  This is caused by numerous organisms most especially if the patient have a risk factor  Stagnation of urinary flow due to obstruction, urinary tract infections and immunosuppression are some of the risk factors  The kidneys are swollen and pus are seen at the cortical surfaces of the kidneys CHRONIC PYELONEPHRITIS.  Chronic inflammation is associated with healing by Fibrosis  Scarification is evidence of fibrosis in tissues  With continuous bouts of inflammation of the kidney and healing by fibrosis the kidney cortical surfaces have depressed irregular scars. END STAGE CGN.  Various conditions of the glomerulus which is the functional units of the kidneys are described as glomerulonephritidis  Most factors related to these conditions are auto-immune related  Auto-immune diseases present as a form of chronic inflammation  Features of acute glomerulonephritis are basically microscopic and ultra structural  The glomerular basement membrane, mesangium and blood vessels presents with variable features to enable diagnosis of glomerulonephritidis.  The kidneys in chronic glomerulonephritis presents with coarse granularity of the cortical surfaces Kidneys in shock  Acute tubular necrosis  Distinct cortico-medullary differentiation  Refer to shock lecture in General Pathology WILMS TUMOUR Wilms tumour  This is also known as nephroblastoma  It is a childhood malignant tumour of the kidney with peak age of 2 to 5 years with most tumours occuring before 10 years  There is improve management and cure rate of above 80%  Patient presents with enlarged deformed kidney, haematuria, pain, hypertension and intestinal obstruction  Histologically it is a triphasic tumour with the blastemal, stromal and epithelial phases recapitulating different stages of nephrogenesis RENAL CELL CA. Renal cell Carcinoma  Renal cell carcinoma accounts for 85% renal cancers in adult  It occurs in older patients between 6 th and 7th decades  Male :Female = 2:1  Initially called hypernephroma  Risk factors include cigarette smoking, obesity, hypertension, unopposed oestrogen therapy, exposure to asbestos, petroleum products and heavy mentals  May be sporadic or associated with autosomal dominant familial cancer syndromes  Histologically may be clear cell, papillary carcinoma, chromophobe renal carcinoma and collecting duct carcinoma  Most patients present with haematuria, vertebral pain and palpable mass  It is one of the tumours with numerous paraneoplastic syndromes which include polycythaemia, hypercalcaemia, hypertension, hepatic dysfunction, feminization or masculinization, Cushing syndrome, eosinophilia, leukemoid reactions and amyloidosis  Prognosis depends on early detection  Treatment is nephrectomy Urinary Bladder  The bladder may become enlarged in response to obstruction  Common causes of obstruction include posterior urethral valves, urethral stricture, prostatic hyperplasia and renal stones  Sometimes with infection the bladder wall may become thickened  One of the causes of chronic cystitis is schistosomiasis which is also associated with risk of cancer  Cancer of the bladder is of squamous cell variant (strongly associated with schistosomiasis) or transitional cell carcinoma PROSTATIC HYPERTROPHY. Prostate  The prostate undergo hyperplasia/hypertrophy as one continues to grow old  Since the location of the prostate is the neck of the bladder, it has the tendency to cause obstruction to the flow of the urine  This cause severe discomfort to the patient  This is usually relieved by prostatectomy  Methods of prostatectomy which is image assisted is preferable to open surgery  In cases the prostate may undergo malignancy – Prostatic Carcinoma  Prostatic carcinoma is the male cancer with the highest percentage of occurrence, but they are thought to be slow growing tumours THANK YOU