Urinary tract Cytology Kidneys and ureter

Anatomy of the Kidneys

Kidneys are bean-shaped organs located in the back of the abdomen on each side of the spine.
The right kidney is slightly lower than the left due to the position of the liver. The kidneys are
vital organs of the urinary system, responsible for filtering and processing blood to remove
waste products and excess fluids, ultimately forming urine.

The kidney is internally divided into two main regions: the cortex and the medulla. The
cortex is the outer layer, while the medulla (pyramide renal with the part de arriba )is located
inside.

→ The outer layer of the kidney, known as the renal cortex, contains renal corpuscles
(glomeruli) and renal tubules(Proximal and distal ). This is where the initial stages of urine
formation occur.
→ The renal medulla is the inner part of the kidney, consisting of renal pyramids. Each
pyramid has a base facing the cortex and a papilla that projects into the renal pelvis. The
medulla is involved in the concentration of urine.

→ The renal pelvis is a funnel-shaped structure that collects urine from the calyces. It funnels
the urine into the ureter for transport to the bladder.

→ The renal calyces are cup-like structures that collect urine from the collecting ducts in the
renal pyramids. Major calyces unite to form the renal pelvis.

The renal artery supplies blood to the kidney, which then branches into arterioles and
capillaries within the nephron.

The filtered blood returns to the bloodstream through the renal vein, while the excess and
waste form urine.
Nephron

The basic functional unit of the kidney is the nephron. Each kidney contains approximately a
million nephrons. Nephrons are responsible for filtering the blood and regulating the
composition of the fluid that will become urine.

The nephron begins with the renal corpuscle, which consists of the Bowman's capsule and the
glomerulus. The glomerulus is a network of tiny blood vessels (capillaries) where blood is
filtered. Blood pressure forces fluid and small molecules out of the blood and into the
Bowman's capsule.
proximal glucosa, aminoácidos, sodio

The filtrate then moves into the loop of Henle, which has a descending and ascending limb.
The loop of Henle plays a crucial role in concentrating the urine by reabsorbing water and
electrolyte

Distal Convoluted Tubule (DCT):() After the loop of Henle, the filtrate enters the distal
convoluted tubule. The DCT is involved in further reabsorption and secretion of ions to
regulate the final composition of the urine. Collecting Duct: The distal convoluted tubules of
multiple nephrons merge into a collecting duct. The collecting duct carries the urine through
the renal medulla to the renal pelvis, where urine is collected before being funneled into the
ureter.

Nephrons (kidney) | Urinary System

Juxtaglomerular apparatus → presión arterial

Collection of specimens and preparation methods.

Voided urine is the simplest method of collection. Early morning urine should be avoided
because of the poor morphological details shown by the cells exfoliated during the night and
being exposed to urine for several hours. The best is a mid-morning specimen. The sample
should be sent to the laboratory as soon as possible. If a short delay is inevitable the container
should be kept in a refrigerator. In case of longer delay some alcohol should be added to the
sample.

- Catheter specimens. This method facilitates the collection of good samples without
contamination and is the method of choice when urine must be collected from one of
ureters.

- Bladder washings. This is also known as barbotage. It is performed by irrigating the

bladder with a saline or fixative solution. It has the same disadvantages of catheter
specimens, but the cellularity obtained and the cell preservation are very good and
superior to voided urine.

FNA

Fine-needle aspiration (FNA) of the kidney is a useful technique for the diagnosis of selected
renal lesions. FNA, as it turns out, is not necessary for most renal masses. In adults, the great
majority of renal lesions are either radio- logically benign cysts requiring no treatment or
radio- logically malignant masses for which FNA is redundant.

A fine-needle aspiration is indicated when:

1. Probable advanced-stage (unresectable) RCC (Renal Cell Carcinoma).

2. Possible metastasis to the kidney (e.g., history of lung cancer).
3. Small solid mass ("low-fat" angiomyolipoma versus oncocytoma versus RCC).
4. An infection (pyelonephritis or abscess) is suspected.

Adequacy

Up to 30% of renal aspirates are non-diagnostic (inadequate); a repeat aspiration is helpful in

approximately one half of cases. Although there is no consensus on adequacy criteria, it is
reasonable to consider a renal FNA specimen adequate if a specific (benign or malignant)
diagnosis can be made or if there is sufficient cellularity to suggest a limited differential
diagnosis. A specimen composed exclusively of macrophages (typically from a cystic lesion)
is best reported as "non-diagnostic" rather than negative because a cystic RCC cannot be
excluded.

Comparación de células normales con las enfermedades que las podemos confundir.

Benign lesions

Oncocytoma

Oncocytoma, a benign tumor of oncocytes (cells with abundant granular cytoplasm),

comprises 3% to 5% of all renal tumors. Lesión benigna que se da en el túbulo contorneado
distal (distal convoluted tubele).

Renal cysts

Renal cysts are common. Of all renal lesions 70% to 85% are cysts. The majority of these
cysts are benign, acquired, and solitary; only 1% to 4% of cysts are cystic RCCs, usually of
clear cell or papillary type.

The prognosis of a patient with a cystic RCC is general excellent but metastases do occur
(cancer)

The pretest probability that a renal cyst is malignant depends, in part, on the radiologic
appearance.

Types of renal cell carcinoma

Clear Cell Renal Cell Carcinoma

1. Clear cell (also called conventional) RCC comprises75% to 80% of all RCCs
 2. Size is not a determinant of malignancy, but the frequency of metastases does
correlate with increasing size of the primary tumor.
3. Necrosis, hemorrhage, calcification are common, calcification are common.

Cytomorphology of Clear Cell RCC

1. Blood.
2. Large cohesive cell groups.
3. Abundant clear cytoplasm with ill-defined edges.
4. Cytoplasmic vacuoles.
5. Large, round, eccentrically placed nucleus.

Papillary Renal Cell Carcinoma

Papillary RCC represents between 7% and 15% of all RCCs.

És més gran que el clear.

Type 1, the more common type, is low-grade tumors composed of small cells with scant
cytoplasm. (cells: papillae, foamy macrophages).

Type 2 is less common, high-grade tumors composed of large cells with abundant granular
cytoplasm.(cell: large nuclei with grade 3 nucleoli abundant granular cytoplasm).