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Renal > Chronic Renal Failure & Renal/LUT Carcinoma > Flashcards

Chronic Renal Failure & Renal/LUT Carcinoma Flashcards

1
Q

3 most common causes of chronic renal failure

A

diabetes mellitus,
hypertension,
glomerular disease

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2
Q
  1. Uremia
  2. Salt and water retention –> HTN
  3. Hyperkalemia w/ metabolic acidosis (anion gap)
  4. Anemia
  5. Hypocalcemia
  6. Renal osteodystrophy
A

chronic renal failure

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3
Q 
Nausea, 
anorexia, 
pericarditis, 
platelet dysfunction, 
encepalopathy with asterixis, 
deposition of urea crystals in skin
A

Chronic renal failure –> increased nitrogenous waste products in blood (azotemia) –>

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4
Q

why do you get anemia in chronic renal failure?

A

Decreased epo production by renal peritubular interstitial cells

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5
Q

why do you get hypocalcemia in chronic renal failure?

A
  1. decreased I-alpha-hydroxylation of vitamin D by proximal renal tubule cells
  2. hyperphosphatemia
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6
Q

Why do patients with CRF get platelet dysfunction?

A

uremia –> impairs platelet aggregation and adhesion

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7
Q

Why do patients with CRF get renal osteodystrophy?

A
  1. secondary hyperparathyroidism –> osteitis fibrosa cystica
  2. osteomalacia (can’t mineralize osteoid made by osteoblasts)
  3. osteoporosis (leach calcium from bone due to metabolic acidosis)
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8
Q

treatment of CRF

A

dialysis or renal transplant

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9
Q

what develops in the shrunken end-stage kidneys during dialysis?

A

cysts

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10
Q

patients on dialysis for chronic renal failure have increased frisk for

A

renal cell carcinoma

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11
Q

hamartoma comprised of blood vessels, smooth muscle, and adipose tissue; associated with tuberous sclerosis

A

angiomyolipoma

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12
Q

triad of renal cell carcinoma

A

hematuria, palpable mass, flank pain

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13
Q

malignant epithelial tumor arising from kidney tubules

A

renal cell carcinoma

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14
Q

paraneoplastic syndromes associated with RCC

A

EPO, renin, PTHrP, ACTH

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15
Q

involvement of the left renal vein by carcinoma blocks drainage of the left spermatic vein

A

RCC –> left variocele

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16
Q

why do you not get right-side varicocele in RCC?

A

right spermatic vein drains directly into the IVC

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17
Q

Increased IGF-1 –>

A

promotes growth

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18
Q

Increased HIF transcription factor –>

A

increased VEGF and PDGF

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19
Q

pathogenesis of RCC

A

loss of VHL (3p) tumor suppressor gene –> increased IG-F and HIF transcription facot

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20
Q

on what chromosome is VHL

A

3p

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21
Q

major risk factor for sporadic RCC

A

cigarette smoke

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22
Q

sporadic tumors classically arise in adult males (average age is 60) as a single tumor where?

A

upper pole of kidney

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23
Q

what disease –> hereditary RCC (wh/ arises in younger adults and is often bilateral)?

A

Von Hippel Lindau disease

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24
Q

Besides RCC, VHL dz increases risk for?

A

Hemangioblastoma of the cerebellum

25
based on size and involvement of renal vein (occurs commonly and increases risk of hematogenous spread to lungs and bone)
T staging of RCC
26
spread to retroperitoneal lymph nodes
N staging of RCC
27
Malignant kidney tumor comprised of blastema (immature kidney mesenchyme), primitive glomeruli and tubules, and stromal ce;;s
Wilms tumor
28
average age of onset of Wilms tumor
3
29
Large, unilateral flank mass with hematuria and HTN (due to renin secretion) in a 3 yo
Wilms tumor
30
WAGR syndome
Wilms tuomr Aniridia Genetial abnormalities mental and motor Retardation
31
WAGR syndrome is associated with DELETION of what tumor suppressor gene?
WT1
32
Where is WT1 located?
11p13
33
``` Wilms tumor, progressive renal (glomerular) dz. male pseudohermaphroditism ```
Denys-Drash syndrome
34
What causes Denys-Drash syndrome?
MUTATION of WT1
35
deletion of WT1 -->
WAGR syndrome
36
mutation of WT1 -->
Denys-Drash
37
Wilms tumor, neonatal hypoglycemia, muscular hemihypertrophy, organomegaly (including tongue)
Beckwith-Wiedmann
38
Beckwith-Wiedman is associated with mutations in what gene cluster?
WT2, particularly IGF-2
39
WT2 gene cluster = imprinted genes at ?
11p15.5
40
Types of lower urinary tract carcinoma
1. urothelial (transitional cell) carcinoma 2. squamous cell carcinoma 3. adenocarcinoma
41
malignant tumor arising from the urothelial lining of the renal pelvis, ureter, bladder, or urethra
urothelial carcinoma
42
most common type of lower urinary tract cancer
urothelial carcinoma of bladder
43
major risk factors for urothelial carcinoma
cigarrettes (polycyclic aromatic hydrocarbons), napthylamine (also in cigarrettes), azo dyes (used for coloring - hairdressers) , long term cyclophosphamide or phenacetin use
44
two pathways by which urothelial carcinoma arises
flat | papillary
45
Painless hematuria
urothelial carcinoma
46
urothelial carcinoma that develops as a low-grade papillary tumor that progresses to high-grade papillary tumor and then invades
Papillary pathway
47
urothelial carcinoma that develops as a high grade flat tumor and then invades
flat pathway
48
flat pathway of urothelial carcinoma is associated with
p53 mutation
49
why are urothelial carcinomas often multifocal and recurrent
field defect - all urothelial cells are mutated
50
malignant proliferation of squamous cells, usually involving bladder, that arise in a background of metaplasia
squamous cell carcinoma
51
Risk factors of squamous cell carcinoma of LUT
``` chronic cystitis schistosoma hematobium (young middle eastern male) long-standing nephrolithiasis ```
52
malignant proliferation of glands usually involving bladder
adenocarcinoma
53
Do you normally have glandular epithelium lining the bladder?
No
54
LUT adenocarcinoma arises from
urachal remnant cystitis glandularis exstrophy
55
congenital failure to form the caudal portion of the anterior abdominal and bladder walls
exstrophy
56
when adenocarcinoma arises from urachal remnant, the tumor develops where?
at the dome of the bladder
57
What connects the fetal bladder to the yolk sac?
urachus (duct)
58
chronic inflammation of bladder --> columnar metaplasia
Cystitis glandularis

Renal (22 decks)

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