Kidney, Bladder and

Prostate Pathologies for

Allied Health Sciences

Prof. Nicholas Titiloye

MBChB, FMCPath, FICS
Dept of Pathology
KSMD
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 6th 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 slow
growing tumours
THANK YOU