Everything from Mind-maps Flashcards
Examples of renal cancer
Renal cell carcinoma (RCC)
Transitional cell carcinoma (TCC)
What is renal cell carcinoma
This is an adenocarcinoma originating from the cells that line the proximal convoluted tubule
RCC risk factors
Male Age 50-70 years Smoking Obesity Mutation of the Von Hippel-Lindau tumour suppressor gene on chromosome 3
RCC signs and symptoms
Unintentional weight loss Loin pain Haematuria Palpable mass Fever Hypertension
What paraneoplastic syndromes are involved in RCC
Secretion of adrenocorticotrophic hormone (ACTH) - may produce symptoms of hypercalcaemia
Secretion of erythropoietin (EPO) - may produce symptoms of polycythaemia
Investigations of RCC
Radiology: ultrasound scan, CT scan, MRI scan
Conservative treatment of RCC
Patient education
Supportive, counselling and monitoring of psychological wellbeing (depression)
Refer patients to Macmillan nurses
Medical treatment of RCC
Interferon alpha
Sunitinib
Sorafenib
Bevacizumab
Surgical treatment of RCC
Partial or total nephrectomy is the treatment of choice
Radio-frequency ablation may be considered
Complications of RCC
Metastasis
Hypercalcaemia
Hypertension
Polycythaemia
Sites of RCC metastases
Brain, bone, lung, liver, adrenal glands and lymph nodes
What is a Transitional cell carcinoma
Cancer that arises from transitional urothelium
More common in MEN
Risk factors of TCC
CAPS: Cyclophosphamide Aniline dyes Phenacetin Smoking
TCC signs and symptoms
Depends on the location of the cancer but is usually associated with painless haematuria and lower urinary tract symptoms e.g. frequency and urgency
TCC investigations
Cystoscopy and ureteroscopy with biopsy
Retrograde pyelography
CT scan
MRI scan
TCC conservative treatment
Supportive counselling and monitoring of psychological wellbeing (depression)
Refer patients to Macmillan nurses
TCC medical treatment
Mitomycin GC regimen (gemcitabine and cisplatin) MVAC regimen (methotrexate, vinblastine, adriamycin and cisplatin)
TCC surgical treatment
Nephroureterectomy, cystectomy
Radio-frequency ablation may be considered
Complications of TCC
Metastasis (usually to bone)
Difference between nephrotic and nephritic syndromes
Nephrotic syndrome involves the loss of a lot of protein
Nephritic syndrome involves the loss of a lot of blood
Different groups of signs of varying diseases
Signs of Nephritic syndrome
PHARAOH: (I the Pharaoh lost alot of blood) Proteinuria Haematuria Azotaemia Red blood cell casts Antistreptolysin O titres Oliguria Hypertension
Signs of NephrOtic syndrome
PHHO: Proteinuria Hypoalbuminaemia Hyperlipidaemia Oedema
Why does hyperlipidaemia occur in nephrotic syndrome
Hypoproteinaemia stimulates the production of more proteins form the liver, which results in the synthesis of more lipoproteins
Decreased levels of lipoprotein lipase means that lipid catabolism decreases
Focal proliferative causes of nephritic syndrome
IgA nephropathy
Systemic lupus erythematosus (SLE)
Henoch-Schonlein purpura
Alport’s syndrome
Diffuse proliferative causes of nephritic syndrome
Rapidly progressive glomerulonephritis e.g. Goodpastures syndrome
Systemic lupus erythematosus (SLE)
Membranoproliferative glomerulonephritis
Cryoglobinaemia
Investigations of nephritic or nephrotic syndrome
Bloods Urinalysis Nephritic screen (done in nephrotic investigations also) Renal biopsy Radiology - ultrasound scan
What blood investigations are done in nephritic or nephrotic syndrome
FBC WCC and platelets U and Es LFTs Creatinine Urea CRP ESR Glucose Lipid profile
What is analysed in a urinalysis investigation
Blood Protein Glucose Leucocytes Nitrites Bence Jones protein
What is looked for in nephritic screen
Serum complement (C3 and C4) Antinuclear antibody (ANA) Double stranded DNA Anti-neutrophil cytoplasmic antibody (ANCA) Antiglomerular basement membrane (GBM) HIV serology HBV and HCV serology Blood cultures Venereal Disease Research Laboratory Test for Syphilis
Conservative treatment of nephritic or nephrotic syndrome
Lifestyle advice
Low salt diet
Medical treatment of nephritic or nephrotic syndrome
Depends on the cause: Treat hypertension Treat proteinuria Treat hypercholestrolaemia Give prophylactic anticoagulation therapy Immunotherapy regimen Dialysis if sever
Complications of nephritic syndrome (I the pharaoh lost alot of blood)
Nephrotic syndrome
Chronic glomerulonephritis
Heart failure
Causes of nephrotic syndrome
Minimal change disease Focal segmental glomerulosclerosis Membranous glomerulonephritis Diabetes nephropathy Amyloidosis Mesangial proliferative glomerlonephritis SLE
Complications of nephrotic syndrome
Hypertension
Acute Kidney Injury
Chronic Kidney Injury
Infection
Congenital kidney abnormalities examples
HERD: Horseshoe kidney Ecotopic kidney Renal agenesis Duplex ureters
What is horseshoe kidney
Occurs during development when the lower poles of both kidneys fuse, resulting in the fomration of one horseshoe-shaped kidney
This cannot ascend to the normal anatomical position due to the central fused portion catching the inferior mesenteric artery
Signs and symptoms of horseshoe shaped kidney
Asymptomatic
Recurrent urinary tract infection (UTI)
Renal calculi
Obstructive uropathy
Causes of horseshoe shaped kidney
Congenital abnormality
Investigations of horseshoe shaped kidney
Ultrasound scan is diagnostic
Treatment of horseshoe shaped kidney
Treat complications
Complications of horseshoe shaped kidney
Susceptible to trauma
Renal calculi formation
Increased risk of transitional cell carcinoma of the renal pelvis
What is ectopic kidney
Congenital abnormality in which the kidney lies above the pelvic brim or within the pelvis
Signs and symptoms of ectopic kidney
Usually asymptomatic
Causes of ectopic kidney
Genetic abnormalities
Poor development of the metanephrogenic diverticulum
Teratogen exposure
Investigations of ectopic kidney
Ultrasound is diagnostic
Treatment of ectopic kidney
None
Treat complications should they develop
Complications of ectopic kidney
UTI
Renal calculi
What is renal agenesis
Bilateral or unilateral absence of the kidney
Types of renal agenesis
Bilateral absence (Potters syndrome) Unilateral absence
Signs and symptoms of Bilateral renal agenesis
Low set ears
Limb defects
Receding chin
Flat, broad nose
Signs and symptoms of unilateral renal agenesis
Hypertension
Increased risk of respiratory infections
Proteinuria
Haematuria
Causes of renal agenesis
Failure of ureteric bud development
Investigations of renal agenesis
Antenatal screening
Treatment of bilateral renal agenesis
Neonates usually die afew days after birth
If the baby survives they require chronic peritoneal dialysis
Treatment of unilateral renal agenesis
Treatment of hypertension
Complications of renal agenesis
Susceptible to trauma (unilateral)
Death
What are duplex ureters
Occurs when the ureteric bud splits during embryonic development and results in the development of 2 ureters, which drain 1 kidney
Signs and symptoms of duplex ureters
Asymptomatic
Recurrent UTI
Causes of duplex ureters
Splitting of the ureteric bud
Investigations of duplex ureters
Ultrasound scan and excretory urography is diagnostic
Treatment if duplex ureters
Treat complications
Complications of duplex ureters
Vesicoureteral reflux
Ureterocele
UTI
What are renal calculi
Stones that form within the renal tract
Most stones are made from calcium (radiopaque), but others are made from struvite (staghorn calculus) and uric acid crystals (radiolucent)
What can renal calculi be made of
calcium (radiopaque)
struvite (staghorn calculus)
uric acid crystals (radiolucent)
Signs and symptoms of renal calculi
Asymptomatic Pain (suprapubic and loin pain that may radiate to the genital region) Dysuria Urinary tract infection (UTI) Haematuria
Causes of renal calculi
Idiopathic Hypercalcaemia Hyperuricaemia Hyperoxaluria Recurrent UTI Drugs e.g. lopp diuretics Hereditary conditions increase risk e.g. polycystic kidney disease
Investigations of renal calculi
24-h urine analysis
CT kidney, ureter, bladder for radioplaque stones
Ultrasound and IVU can be used
Chemical analysis of stone compsition
Investigations of renal calculi: what is assessed in 24-h urine analysis
Levels of calcium, uric acid, oxalate and citrate
Complications of renal calculi
Recurrent UTI
Recurrent calculi
Obstruction
Trauma to ureter/ureteric stricture
Conservative treatment of renal calculi
Prevent cause e.g. low calcium diet
Education about risk factors
Medical treatment of renal calculi
Pain - analgesia and tamsulosin Dehydration - IV and oral fluids Nausea/vomitting - antiemetics Hypercalcaemia - Low calcium diet and stop thiazide diuretics if possible High oxalate - low oxalate diet High uric acid - allopurinol
Radiological treatment of renal calculi
Nephrostomy insertion
Antegrade ureteric stent insertion
Surgical treatment of renal calculi
Antegrade or retrograde removal of large stones or staghorn calculus
Extracorporeal shock wave lithotripsy (ESWL) for the treatment of larger stones (>0.5cm)
