LO Kidney 5.

2 Dapots

1. Describe the abnormality associated with the common congenital anomalies of the genitourinary tract,
specifically congenital obstruction, vesicoureteral reflux, cryptochidism, and hypospadias
Congenital Abnormalities of the Kidney and Urinary Tract (CAKUT)
 Vesicoureteral Reflux (VUR)  Abnormal backflow of urine from the bladder into the ureter
and up to the kidney
2 Types of VUR :
- Primary VUR  Defect of the ureterovesical junction
Ureterovesical junction berfungsi untuk prevent kalau bladder penuh urine nya tidak
backflow ke ureter dengan cara menutup junctionnya. Terjadi mislocation (ureterovesical
junctionnya terlalu pendek sehingga tidak dapat menutup saat bladder penuh)  Urine
backflow ke ureter
- Secondary VUR (Most common)  Ada obstruction sehingga membuat pressure yang tinggi
dan urine backflow ke atas (ureter or kidney). Obstruction bisa berupa :
o UTI  Inflammation membuat ureter swelling dan menyempit  Akhirnya menutup
 Increased pressure  Urine backflow
o Posterior Uretheral Valve Disorder  Diagnosed in babies
 Ada membrane forms di urethra sehingga menutup urethra (ujung bladder) 
Urine tidak bisa keluar dan backflow ke ureter
o Flaccid neurogenic bladder  Results from trauma, disease, or nervous system
Bladder penuh tapi tidak bisa contract untuk mengeluarkan urine

Reflux grading: /urology.ucsf.edu

Grade I: urine refluxes into the ureter only
Grade II: urine refluxes into the ureter and up to the kidney without dilation
Grade III: urine refluxes into the ureter and kidney and causes mild dilation
Grade IV: urine refluxes into ureter and kidney and causes dilation without twisting of the ureter
Grade V: urine refluxes into ureter and kidney and causes significant dilation with twisting of the ureter

Grading : dari Osmosis  Depends on how far urine back up

 Grade 1  Urine back up ke setengah dari ureter

 Grade 2  Urine back up ke seluruh ureter & renal pelvis

 Grade 3  Urine sudah stretch ureter & renal pelvis

 Grade 4  Urine sampai ke calyces, moderately swollen, and distorted  Ureter menjadi curvy

 Grade 5  Ureter completely swollen up and can cause kidney failure

Bakteri di bladder back up ke ureter dan ginjal can cause pyelonephritis (inflame) and renal scarring (fibrosis).
VUR dapat reduce blood to the kidney dan sebagai kompensasinya aka nada increase blood pressure  Cause
hypertension

 Cryptorchidism (Undescended testes)  Failure of one or both testes to descend into the
scrotum as the male fetus develops. Undescended testes are more often seen in babies who are
born early (preterm babies).

Pathogenesis :
LO Kidney 5.2 Dapots
o Passage through the inguinal canal begins in the 28th week of gestation.Failure to descend may be due
to gonadotropin deficiency in utero, decreased Mullerian inhibiting factor, or increased estradiol in
the placenta. Absent testes are due to agenesis or intrauterine vascular compromise (eg, torsion).

o This is because the testes don’t descend from the belly into the scrotal sac until month 7 of a baby’s
growth in the uterus. Other causes may include hormone problems or spina bifida.

o It may be caused by a reflex that causes a testicle to move up and down from the scrotum back into the
groin (retractile testes). In some cases, the testes are missing. In rare cases, a boy who has inguinal
hernia repair may develop undescended testes.

Biasanya didiagnosa when a healthcare provider can’t feel the testes during an exam. In some cases, imaging
tests such as ultrasound or MRI are needed to find the testicles within the pelvis. Biasanya the misplaced
scrotum ditemukan di inguinal canal.

 Hypospadias  A condition in which the urethra does not develop completely. This results in
an opening that is somewhere on the ventral (undersite) of the penis, scrotum or perineum.

The defect ranges in severity depending on the location of urethral

meatus. In mild variants, the meatus will be located near the end
of the penis, and in severe cases the meatus will be positioned at
the base of the penis or in the scrotum.

Embriology

17th Week of gestation  Urethra bertumbuh ke tip of the penis.

Saat hypospadias terjadi, urethra nya gagal bertumbuh kea rah
glans penis malah ke bawah

2. All about RCC and its management (algorithm)

Types of Kidney Cancer

Renal Kidney Cancer

Renal Cell Carcinoma (RCC) is the most common type of kidney cancer, accounting for approximately 85%
of all malignant kidney tumors. In RCC, cancerous (malignant) cells develop in the lining of the kidney tubules
and grow into a mass called a tumor. Like many other cancers, the growth begins small and grows larger over
time. RCC typically grows as a single mass. However, there are cases where a kidney may contain more than
one tumor, or tumors are found in both kidneys at the same time.

Sub-Types of Renal Cell Carcinoma (RCC):? There are five main sub-types of renal cell carcinoma that are
identified by examining the tumor under a microscope: clear cell, papillary, chromophobe, collecting duct and
"unclassified."

 Clear Cell RCC is the most common form of renal cell carcinoma, accounting for about 80% of people
with kidney cancer. When viewed under a microscope, the individual cells that make up clear cell renal
cell carcinoma appear very pale or clear.
LO Kidney 5.2 Dapots
 Papillary RCC is the second most common type and approximately 10% to 15% of people have this
form. These cancers form little finger-like projections (called papillae).

 Chromophobe RCC is the third most common form of renal carcinoma, accounting for about 5% of
cases. Like clear cell carcinoma, the cells of these cancers are also pale, but are much larger and have
certain other distinctive features.

 Collecting Duct RCC is the rarest form of renal cell carcinoma. The major characteristic of collecting
duct RCC is that the cancer cells can form irregular tubes.

 About 5% of renal cancers are unclassified because their appearance does not fit into any of the other
categories.

Recent data suggests that clear cell RCC has a slightly worse prognosis as compared to papillary or
chromophobe cell RCC. However, the majority of low stage tumors, regardless of cell type, can be cured with
surgical resection. Spindle cell types, or sarcomas, tend to grow and spread more quickly than the other kinds of
renal cell carcinoma. It can be associated with any of the subtypes mentioned, and this subtype is a sign of a
poor prognosis.

Other Types of Cancerous Kidney Tumors

RCC accounts for about 90% of malignant kidney tumors. Less common types of cancerous tumors include
transitional cell carcinomas, Wilms tumors and renal sarcomas.

Transitional Cell Carcinoma:

About 5% to 10% of all kidney tumors are transitional cell carcinomas, also known as urothelial carcinomas.
Transitional cell carcinomas begin in the renal pelvis (the junction of ureter and kidney). Under the microscope,
transitional cell carcinomas look like bladder cancer cells and act very much like bladder cancer. Studies have
shown that, like bladder cancer, these cancers are linked to cigarette smoking and occupational exposures to
certain cancer-causing chemicals.

The signs and symptoms of transitional cell carcinoma are typically the same as with the signs and symptoms
of kidney cancer - blood in the urine and, sometimes, back pain.

Transitional cell carcinomas are usually treated by surgically removing the entire kidney and the ureter, as well
as the section of the bladder where the ureter is attached. Chemotherapy and radiation therapy are often used in
addition to surgery, depending on how much cancer is found. As with RCC, with early stage transitional cell
carinomas, there are several treatments. If you have early transitional cell carcinoma, you have several treatment
options available. There are different ways to surgically treat early disease. Newer surgical techniques are also
being studied. You should talk with your surgeon and be aware of your options and the benefits and risks of
those options.

About 90% of transitional cell carcinomas of the kidney are curable if they are found early enough. The chances
for cure drop dramatically if the tumor has grown into the ureter wall, or if it has a more aggressive (high-grade)
appearance when viewed under the microscope.

 Wilms Tumor:
About 5% to 6% of all kidney cancers are Wilms tumors. This type of cancer is almost always found in
children and is extremely rare among adults.
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 Renal Sarcoma:
Renal sarcomas are a rare type of kidney cancer (less than 1% of all kidney tumors) that begins within
the kidney's connective tissue.

Benign (Non-Cancerous) Kidney Tumors

Some types of kidney tumors (including renal cell adenomas, renal oncocytomas and angiomyolipomas) do not
usually spread (metastasize) to other parts of the body, although they can still grow and cause problems.

 Renal Adenoma:
Renal adenomas are very small, slow growing, benign tumors that, under a microscope, look a lot like
low-grade renal cell carcinomas. In rare cases, tumors first thought to be renal adenomas may turn out to
be small renal cell carcinomas.

 Oncocytoma:
Oncocytomas are a type of benign kidney tumor that can sometimes grow quite large. Because
oncocytomas do not normally metastasize to other organs, removing the kidney can often produce a
cure.

 Angiomyolipoma:
Angiomyolipomas are another rare benign kidney tumor. They often develop in people with tuberous
sclerosis (a disease charachterized by several bumps on the skin, seizures, mental retardation, and cysts
in the kidneys, liver and pancreas).