Pathology
Urinary Tract
Urinary tract pathology for MBBS and NEET-PG: nephritic and nephrotic syndromes, glomerulonephritis, acute and chronic renal failure, pyelonephritis, stones and renal tumours, mapped to NMC codes PA28.1 to PA28.16.
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Urinary Tract
Urinary tract pathology for MBBS and NEET-PG: nephritic and nephrotic syndromes, glomerulonephritis, acute and chronic renal failure, pyelonephritis, stones and renal tumours, mapped to NMC codes PA28.1 to PA28.16.
This chapter covers renal and urinary tract pathology. It includes the clinical syndromes, the glomerular diseases and glomerulonephritis, acute and chronic renal failure, tubulointerstitial and vascular diseases, cystic disease, stones and obstruction, and renal and bladder tumours.
High-yield: Urinary Tract
- Nephritic syndrome features haematuria, hypertension, oliguria and mild proteinuria; nephrotic syndrome features heavy proteinuria, hypoalbuminaemia, oedema and hyperlipidaemia.
- Post-streptococcal glomerulonephritis shows subepithelial humps on electron microscopy and a granular immunofluorescence pattern.
- Rapidly progressive glomerulonephritis shows crescents in Bowman space and leads to rapid loss of renal function.
- Minimal change disease is the commonest cause of nephrotic syndrome in children, with effacement of podocyte foot processes.
- Membranous nephropathy is a common cause of nephrotic syndrome in adults, with a spike-and-dome subepithelial pattern.
- IgA nephropathy (Berger disease) is the most common glomerulonephritis worldwide and shows mesangial IgA deposits.
- Diabetic nephropathy shows Kimmelstiel-Wilson nodules and is a leading cause of chronic kidney disease.
- Acute tubular necrosis is the commonest cause of acute kidney injury and follows ischaemia or nephrotoxins.
- Acute pyelonephritis shows neutrophils and microabscesses in the interstitium, usually from ascending gram-negative infection.
- Chronic pyelonephritis with reflux causes coarse cortical scarring over deformed calyces.
- Autosomal dominant polycystic kidney disease presents in adulthood with large cystic kidneys and is linked to berry aneurysms.
- Renal calculi are most often calcium oxalate and can cause obstruction and hydronephrosis.
- Renal cell carcinoma arises from the tubular epithelium, most often the clear cell type, and can invade the renal vein.
- Urothelial (transitional cell) carcinoma of the bladder is linked to smoking and aniline dye exposure and presents with painless haematuria.
Nephritic versus nephrotic syndrome
- **Nephritic:** Haematuria, hypertension, oliguria, mild proteinuria; post-streptococcal GN, IgA nephropathy.
- **Nephrotic:** Heavy proteinuria, hypoalbuminaemia, oedema, hyperlipidaemia; minimal change, membranous.
- **Crescents:** Rapidly progressive glomerulonephritis with rapid renal decline.
- **Diabetic kidney:** Kimmelstiel-Wilson nodules; leading cause of chronic kidney disease.
NMC competencies in this chapter
- **PA28.1:** Normal histology of the kidney
- **PA28.2:** Definition and classification of the clinical renal syndromes
- **PA28.3:** Aetiology, pathogenesis, pathology and complications of acute renal failure
- **PA28.4:** Aetiology, pathogenesis, pathology and complications of chronic renal failure
- **PA28.5:** Glomerular diseases: classification and pathology
- **PA28.6:** IgA nephropathy: pathogenesis, pathology and complications
- **PA28.7:** Glomerular manifestations of systemic disease
- **PA28.8:** Classification of tubulointerstitial diseases
- **PA28.9:** Acute tubular necrosis: pathogenesis, pathology and complications
- **PA28.10:** Acute and chronic pyelonephritis and reflux nephropathy
- **PA28.11:** Vascular disease of the kidney
- **PA28.12:** Cystic disease of the kidney
- **PA28.13:** Renal stone disease and obstructive uropathy
- **PA28.14:** Renal tumours: classification, pathology and spread
- **PA28.15:** Thrombotic microangiopathies of the kidney
- **PA28.16:** Integrated approach to urinary tract pathology
Frequently Asked Questions
How do nephritic and nephrotic syndromes differ?
Nephritic syndrome features haematuria, hypertension and mild proteinuria, while nephrotic syndrome features heavy proteinuria, hypoalbuminaemia, oedema and hyperlipidaemia.
What is the commonest cause of nephrotic syndrome in children?
Minimal change disease, which shows effacement of podocyte foot processes on electron microscopy and responds well to steroids.
What is the commonest cause of acute kidney injury?
Acute tubular necrosis, which follows ischaemia or exposure to nephrotoxins and damages the tubular epithelium.
What is the most common glomerulonephritis worldwide?
IgA nephropathy, also called Berger disease, characterised by mesangial deposits of IgA.
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