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Clin Med Exam 4 > Kidneys: Part 3 (paulson) > Flashcards

Kidneys: Part 3 (paulson) Flashcards

1
Q

Cystic Kidney Disease=

A

Renal cysts made of epithelial cells from renal tubules and collecting ducts

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2
Q

Cystic Kidney Disease:

-list the 2 types of cysts

A
  • Simple Cysts (most renal masses)

- Complex Cysts

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3
Q

Cystic Kidney Disease:

-MUST differentiate ______

A

Malignancy, Abscess, PKD, Benign

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4
Q

Describe simple cysts

A

Simple Cysts=Thin wall

WITHOUT septa, NO calcifications, & NO solid components

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5
Q

Cystic kidney disease: simple cysts

  • demographic?
  • Symptoms?
A
  • Men > women
  • Patients >50 more common
  • Can see 1 cyst or multiple & bilateral
  • Asymptomatic
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6
Q

Cystic kidney disease: simple cysts

-may be associated with ____

A

HTN

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7
Q

Cystic kidney disease: simple cysts

-If ruptures: _____ (which Sx occur?)

A

Hematuria, flank pain

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8
Q

Cystic kidney disease: simple cysts

-If they get infected:

A

Can form renal abscess

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9
Q

Cystic kidney disease: simple cysts

-diagnostic imaging?

A

Diagnosis: Ultrasound or CT

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10
Q

Cystic kidney disease: simple cysts

-diagnostic imaging?

A

Diagnosis: Ultrasound or CT

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11
Q

Cystic kidney disease: Complex cysts

-describe the components

A

May have septa, calcifications, or solid components

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12
Q

Cystic kidney disease: Complex cysts

-associated with increased risk of _________

A

malignancy

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13
Q

Cystic kidney disease: Complex cysts

-which classification system is used?

A

Bosniak Classification System used

the higher the #, the more concerning

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14
Q

Cystic kidney disease: Complex cysts

-diagnostic imaging?

A

Needs further imaging (CT with contrast)

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15
Q

Polycystic Kidney Disease (PKD)= inherited diseases that cause _____

A

renal cyst development and progressive renal failure from continued enlargement of cysts

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16
Q

Polycystic Kidney Disease (PKD):

-List the 2 known genetic mutations that cause autosomal dominant PKD

A

PKD1 & PKD2

17
Q

Polycystic Kidney Disease (PKD):

___% get ESRD by age 60

A

50%

18
Q

Polycystic Kidney Disease (PKD):

-what decade does renal function start to decline?

A

4th decade of life (in their 30s)**

-**Then declines 4-6 ml/min/year

19
Q

PKD:

-List possible clinical presentation/Renal Manifestations

A
  • Hypertension
  • Hematuria
  • Proteinuria
  • Renal insufficiency found on labs
  • Flank pain
  • Nephrolithiasis–> Most uric acid stones, the rest calcium oxalate
  • Renal Cell Carcinoma
20
Q

PKD:

-what is the MC symptom reported by Pts? what is the cause?

A

**Flank pain= MC symptom reported by Pts–> From renal hemorrhage, calculi, or UTI

21
Q

PKD: Extrarenal Manifestations

A
  • Cerebral aneurysms
  • Hepatic cysts
  • Pancreatic cysts
  • Cardiac valve disease
  • Colonic diverticula
  • Abdominal wall and inguinal hernia
22
Q

PKD:

Describe the MC complications of Cerebral Aneurysms

A
  • SAH or ICH most serious complication

- 5% (younger)-20% (>60 years) of patients

23
Q

PKD: diagnosis

-imaging study MC used? and findings?

A
  • Ultrasound MC used
  • -Large kidneys and extensive bilateral cysts
  • -Recommended for screening of those with positive FH
  • -Less reliable in younger patients

-**CT & MRI more sensitive

24
Q

PKD:

-which diagnostic test is preferred in younger Pts (since US is less reliable in this age group)

A

genetic testing

25
Q

Autosomal Dominant Polycystic Kidney Disease (ADPKD): tx?

A
  • HTN: Rigorous control of BP
  • Dietary Sodium Restriction (<2 grams per day)
  • Statin therapy
  • +/- Tolvaptan (Samsca)
26
Q

ADPKD: tx

  • why is rigorous control of BP (HTN) so important?
  • initial agent should be ____
A
  • **Prevents progression of renal disease and ↓risk of CV mortality
  • **ACEI should be initial agent
27
Q

PKD: tx

-describe statin therapy

A
  • Treat HLD aggressively with statins
  • Considered a coronary heart disease risk equivalent
  • Statins may (?) help to preserve renal function
28
Q

PKD: tx

  • When should Tolvaptan (Samsca) be initiated?
  • Medication fx?
A
  • **For those 18-55 with a GFR >25 at high risk for progression to ESRD–> Selection of patients by TKV (total kidney volume), CT, or MRI
  • Slows progression of PKD–> Disease-modifying
  • Need to ensure adequate PO water intake
    (notes: Pts with high risk for progressing to ESRD (end stage renal disease) will get this Medication–> Tolvaptan (Samsca)-– this is a very specialized medication)
29
Q

Tolvaptan (Samsca):

-contraindicated in which Pt population?

A

-Contraindicated in: liver failure, hypovolemia, hypernatremia

30
Q

Tolvaptan (Samsca):

-S/E?

A

↑ LFTs/liver toxicity, polyuria, polydipsia, chest pain, headache

31
Q

PKD:

-other forms of treatment?

A
  • Increased fluid intake
  • -Suppresses ADH levels–> inhibits cyst growth
  • -3 liters/day
  • Dialysis
  • Kidney transplant
  • Pain management–> Surgical aspiration or sclerosis of cysts
32
Q

PKD: prognosis

-most Pts die from _____

A
  • Most patients die from cardiac causes

- Neurologic deaths from ruptured intracranial aneurysm & hypertensive intracerebral hemorrhage

Clin Med Exam 4 (14 decks)

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