Unit 3: Urinary and reproductive system pathology
Basic Cellular Pathology notes · PTU syllabus (BMLS401-18)
On this page
- Unit summary
- Glomerulonephritis and nephrotic syndrome
- Renal failure
- Renal calculi and urinary obstruction
- Urinary tract infection
- Sexually transmitted diseases and PID
- Cervical intraepithelial neoplasia
- Diseases of the ovary and ectopic pregnancy
- Prostatitis and infertility
- Key terms
- Quick revision
- Important questions
Unit summary
Kidney and reproductive diseases are diagnosed largely through urine, blood and smear tests. This unit covers glomerulonephritis, nephrotic syndrome, renal failure, renal calculi, urinary obstruction and infection, sexually transmitted diseases, pelvic inflammatory disease, cervical intraepithelial neoplasia, ovarian disease, ectopic pregnancy, prostatitis and infertility.
After this unit you can
- Describe glomerular diseases and renal failure
- Describe renal stones, obstruction and urinary infection
- Describe STDs, PID, CIN and ovarian disease
- Describe ectopic pregnancy, prostatitis and infertility
PTU syllabus topics
- Glomerulonephritis
- nephrotic syndrome
- renal failure
- renal calculi
- urinary obstruction
- urinary tract infection
- sexually transmitted diseases
- pelvic inflammatory disease
- cervical intraepithelial neoplasia
- disease of the ovaries
- ectopic pregnancy
- prostatitis
- infertility
Main feature
Inflammation of glomeruli
Leaky glomerular filter
Urine
Blood (haematuria), RBC casts
Heavy protein (> 3.5 g/day)
Blood
Raised urea and creatinine
Low albumin, high cholesterol
Signs
Hypertension, mild oedema
Marked oedema
Topic 1
Glomerulonephritis and nephrotic syndrome
Example
Post-streptococcal glomerulonephritis (after throat or skin infection)
Minimal change disease (children), membranous nephropathy, diabetic nephropathy
Urine
Haematuria with red cell casts; mild proteinuria
Heavy proteinuria (more than 3.5 g/day); fatty casts
Blood
Raised urea and creatinine; raised ASO; low C3
Low albumin; high cholesterol
Signs
Hypertension, oliguria, mild oedema
Marked oedema
Topic 2
Renal failure
Onset
Hours to days
Months to years
Causes
Shock, sepsis, drugs, obstruction
Diabetes, hypertension, glomerulonephritis
Reversibility
Often reversible
Progressive
Lab
Rising creatinine and urea, hyperkalaemia, acidosis
Low eGFR, anaemia, low calcium, high phosphate
Topic 3
Renal calculi and urinary obstruction
- Stones: calcium oxalate (commonest), calcium phosphate, uric acid, struvite (with Proteus infection), cystine. Colicky pain and haematuria; urine crystals; stone analysis.
- Obstruction: stones, enlarged prostate, strictures, tumours → hydronephrosis and infection.
Topic 4
Urinary tract infection
- Causes: E. coli (most), Klebsiella, Proteus, Enterococcus. Common in women. Diagnosis: midstream urine; pus cells (more than 5 per high-power field), nitrite and leucocyte esterase strips; culture with 10⁵ CFU/mL or more significant bacteriuria.
Topic 5
Sexually transmitted diseases and PID
Gonorrhoea
Neisseria gonorrhoeae
Gram-negative intracellular diplococci; culture; NAAT
Syphilis
Treponema pallidum
VDRL/RPR, TPHA
Chlamydia
Chlamydia trachomatis
NAAT
Trichomoniasis
Trichomonas vaginalis
Wet mount — motile flagellates
Genital herpes, HIV, HPV
Viruses
PCR, serology (HIV ELISA)
- Pelvic inflammatory disease: ascending infection of uterus, tubes and ovaries (gonorrhoea, chlamydia) — pain, fever; complications infertility and ectopic pregnancy.
Topic 6
Cervical intraepithelial neoplasia
- CIN: precancerous changes of cervical epithelium caused mainly by high-risk HPV 16 and 18; graded CIN 1 (lower third), CIN 2, CIN 3 (full thickness). Screening by Pap smear (Bethesda reporting — LSIL, HSIL), HPV testing and VIA; prevented by HPV vaccination.
Topic 7
Diseases of the ovary and ectopic pregnancy
- Ovarian diseases: polycystic ovary syndrome (irregular cycles, high LH and testosterone), functional and dermoid cysts, ovarian tumours (CA-125 marker).
- Ectopic pregnancy: implantation outside the uterus, mostly in the fallopian tube; risk factors PID and previous surgery; pain and bleeding; serum β-hCG rises more slowly than in normal pregnancy; rupture is an emergency.
Topic 8
Prostatitis and infertility
- Prostatitis: bacterial (E. coli) or non-bacterial; diagnosed with urine and prostatic secretion tests. Benign prostatic hyperplasia in older men causes obstruction; PSA is a tumour marker.
Common causes
Low sperm count or motility, varicocele, infections, hormonal problems
Ovulation problems (PCOS), tubal block (PID), endometriosis, uterine causes
Tests
Semen analysis, hormones (FSH, LH, testosterone)
Hormone tests (FSH, LH, AMH, prolactin, thyroid), ultrasound, tubal patency
Key terms
- Nephrotic syndrome
- Heavy proteinuria with low albumin and oedema
- Significant bacteriuria
- 10⁵ or more bacteria per mL of urine
- PID
- Infection of the upper female genital tract
- CIN
- Precancerous dysplasia of the cervix
- Ectopic pregnancy
- Implantation outside the uterine cavity
Quick revision
- Nephritic vs nephrotic; AKI vs CKD.
- Stone types; obstruction; UTI diagnosis.
- STDs and tests; PID.
- CIN grades; Pap smear; HPV.
- PCOS, ovarian tumours, ectopic pregnancy (β-hCG); prostatitis, BPH, PSA; male and female infertility.
Important exam questions
Practice questions written to the PTU exam pattern for this unit's syllabus: short answers (Section A style) and long answers (Sections B and C style).
Short-answer questions
- Q1.Distinguish nephritic and nephrotic syndromes.
- Q2.Which is the commonest kidney stone?
- Q3.What count indicates significant bacteriuria?
- Q4.Which HPV types cause CIN?
- Q5.Which hormone is measured in suspected ectopic pregnancy?
- Q6.Name two tests for male infertility.
Long-answer questions
- Q1.Describe glomerulonephritis and nephrotic syndrome.
- Q2.Describe renal failure and its laboratory findings.
- Q3.Describe sexually transmitted diseases and their diagnosis.
- Q4.Describe CIN and cervical screening.
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