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GU > Lecture 6: Other Renal Disorders > Flashcards

Lecture 6: Other Renal Disorders Flashcards

1
Q

When are renal cell carcinomas most common and in who?

A
  • Usually in males
  • 60s

Most common type of renal cancer.

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2
Q

What is the primary cause of RCCs?

A

Idiopathic, sporadic.

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3
Q

What are the risk factors for developing RCCs?

A
  • Poor lifestyle
  • Chronic diseases (chronic kidney stones)
  • Substance abuse (smoking esp)

analgesics are specifically more toxic to kidneys.

Smoking is the biggest risk factor!!!!!

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4
Q

What is the primary type of RCC?

A
  • Clear cell carcinoma
  • Arise from epithelial cells of proximal tubule

75-85% of all RCCs

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5
Q

What is unique about a papillary tumor?

A
  • Usually bilateral
  • Usually multifocal
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6
Q

What are the S/S of RCCs?

A
  • Hematuria (#1)
  • Flank pain or abdominal mass
  • Metastatic disease symptoms (cough, bone pain)

Usually, the tumor is found incidentally and asymptomatically

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7
Q

What is the classic triad of RCCs?

A
  1. Hematuria
  2. Flank pain
  3. Abdominal mass
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8
Q

What CBC findings are expected in a patient with RCC?

A
  • Anemia (MC)
  • Erythrocytosis

Anemia is due to either heavy hematuria or cancer taking up tissues that make EPO.
Erythrocytosis: pretends to be EPO tissue

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9
Q

What is stauffer syndrome?

A

Hepatic dysfunction with elevated LFTs in the absence of metastases

Kidneys are in close proximity to the liver.

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10
Q

If I see a solid renal mass, what should I suspect and order?

A
  • Any solid renal mass is guilty until proven innocent!
  • Initial with US, but preferred CT or MRI.
  • MRI or US w/ doppler is to check for IVC involvement.
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11
Q

What is the standard evaluation for a suspected RCC?

Labs and imaging

A
  • CT abd/pelvis
  • CXR/CT chest
  • CMP, CBC, UA, urine cytology

Liver: possible metastases or stauffer syndrome
Chest cavity: metastases
CBC: anemia or erythrocytosis

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12
Q

How do the 4 stages of RCC progress in general?

A
  • Increasing in size
  • Stage 3 invades the IVC.
  • Stage 4 involves regional lymph nodes
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13
Q

What is the primary treatment for RCC?

A
  • Surgical excision via radical nephrectomy
  • Can consider partial.
  • Chemo is not very effective.

Radical involves removal of kidney, ipsilateral adrenal gland, and adjacent lymph nodes

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14
Q

What is the survival rate of an RCC confined to the capsule?

A

90-100%

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15
Q

Who is nephroblastoma/Wilms tumor most common in?

A

Pediatric patients who are otherwise healthy.

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16
Q

What is the etiology of a nephroblastoma and characteristics?

A
  1. Abnormal renal development
  2. Loss of tumor suppressor and transcription gene functions
  3. Generally sporadic.
  4. Presents as a single unilateral lesion usually.
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17
Q

What are the primary S/S of a nephroblastoma?

A
  • Abd pain (MC)
  • HTN
  • Hematuria
  • Fever, anemia, N/V

Abd mass symptoms.

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18
Q

What is the preferred initial study for nephroblastoma?

A

Abd US

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19
Q

What is the primary treatment for nephroblastoma?

A

Surgical resection followed by chemo

High survival unless advanced.

Cancer can relapse, so monitoring is required.

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20
Q

What is difficult about diagnosing an oncocytoma?

A

A generally benign tumor that is indistinguishable from RCC on imaging.

Trreatment is identical.

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21
Q

Who is an angiomyolipoma MC in?

A

Middle-aged women

22
Q

How is an angiomyolipoma treated?

A
  1. Bleeding = embolization or nephrectomy
  2. > 5cm = prophylactic embolization

Usually benign, but bleeding risk increases if big

23
Q

What are the most common metastases for secondary renal cancer?

A
  1. Lung (MC)
  2. Breast, stomach, kidney
  3. Lymphoma (sometimes)

AKA lung cancer metastasizing to the kidney.

24
Q

Who are kidney stones more common in?

A
  • Males, esp 30s-50s
25
Q

What are the risk factors for urinary stone disease?

A
  1. High protein and salt intake
  2. Inadequate hydration
  3. High humidity and elevated temps

Primary goal is to prevent the crystals from clumping

26
Q

What are the 2 primary substances that kidney stones are made of?

A
  1. Calcium Oxalate
  2. Calcium Phosphate

Calcium is visible on XRAY

KUB XRAY

27
Q

What is the most common urinary stone not made of calcium?

A

Uric acid stones (gout)

28
Q

When do urinary stones cause symptoms?

A

Entering ureter

Stone size does not correlate with symptom severity.

29
Q

What are the S/S of urinary stone disease?

A
  1. Acute, severe pain in the flank (often episodic)
  2. Urinary urgency and frequency
  3. N/V common

Pain often follows the flank down the ureter.

30
Q

What are the lab abnormalities associated with urinary stone disease?

A
  • Hematuria
  • Abnormal pH

Higher pH = calcium or struvite
Lower pH = uric acid or cystine

31
Q

If a patient presents with recurrent stones/FMHx, what tests can we order?

A

Patient must first decrease Na and protein intake, with increased fluid intake, and then you can order:

  • 24 hour urine
  • Serum PTH/calcium/uric acid/lytes/BUN/Cr
  • Litholink panel
32
Q

What are the primary imaging modalities for kidney stones?

A
  • KUB XRAY
  • Renal US
  • Noncontrast CT (in ER)

A noncon CT can detect all stones

33
Q

What is a staghorn calculus?

A
  • Renal pelvis involvement
  • 2 Calyces involvement
34
Q

What is the treatment for urinary stone disease presenting as acute renal colic?

A
  • Pain Control (NSAIDs or opioids)
  • Hydration (voluntary)
  • Alpha blocker (tamsulosin)
  • Steroids (maybe)

If obstruction + signs of infection = emergency

35
Q

What is the MOA of tamsulosin and the main SEs?

A
  • Alpha-1 antagonist
  • Orthostatic hypotension, HA, dizziness, abnormal ejaculation, or priapism

Caution with other anti-HTNs

36
Q

At what size do urinary stones tend to get stuck and where?

A
  • > 10 mm generally do not pass.
  • Uteropelvic junction
  • Passage of ureter over iliac vessels
  • Ureterovesicular junction

Should pass within 4 weeks!

37
Q

What is ureteroscopic stone extraction?

A

Small endoscope with a laser or mesh basket

OP procedure usually.

38
Q

What is shock wave lithotripsy?

A
  • Energy waves to break up stone.
  • Usually works on smaller stones.
  • Avoid in women of childbearing age!
39
Q

What is percutaneous nephrolithotomy?

A
  • For large stones or inferiorly located.
  • Needle with ureteroscope to pull out the stone

Requires incision in the flank

40
Q

How do you prevent kidney stones?

A
  • Drink water frequently
  • Eat bran (can decrease calciuria)
  • DO NOT DECREASE dietary calcium

Decreasing Na and protein is better for preventing stones.

41
Q

What is the primary cause of hypercalciuric stones?

A

Absorptive hypercalciuria, characterized by increased urine Ca even without high dietary Ca intake.

High Ca absorption in small bowel.

42
Q

What can be given to treat hypercalciuric stones?

A
  • Thiazide diuretics (decreases calciuria)
  • Cellulose phosphate
43
Q

What is resorptive hypercalciuria and its treatment?

A
  • Secondary to hyperparathyroidism.
  • Presents with hypercalcemia, hypophosphatemia, and elevated PTH
  • Need to treat elevated PTH. (Cinacalcet?)
44
Q

What is renal hypercalciuria and its treatment?

A
  • Secondary to tubule instability in reabsorbing Ca
  • Presents with normal or low serum calcium, but high urine calcium
  • Treated with thiazides
45
Q

What are hyperoxaluric calcium stones and the usual precipitating factors and the treatment?

A
  • Primarily oxalate stones.
  • People with intestinal disorders, such as IBD.
  • Treatment is stopping their diarrhea or calcium carbonate.

Avoid excess ascorbic acid

A result of absorbing more oxalate than calcium.

46
Q

What causes hyperuricosuric calcium stones?

A
  • Dietary purine excess or uric acid metabolic defects.
  • Purine restriction works well, but can use allopurinol as well.

Avoid meat and alcohol?

47
Q

What causes hypocitraturic calcium stones and treatment?

A
  • Chronic diarrhea, HCTZ, or metabolic acidosis.
  • Either drink lemonade or potassium citrate supplements
48
Q

What are uric acid calculi usually caused by?

A
  • Hyperuricemia
  • Myeloproliferative disease
  • Cancer
  • Abrupt weight loss

High cell turnover => uric acid

Usually still visible on XRAY due to some calcium.

49
Q

What pH are uric acid calculi and treatment?

A
  • Generally < 5.5 (they have acid in the name)
  • Boosting the pH can make them easier to pass.
  • Treatment: potassium citrate or allopurinol.
50
Q

Who are struvite calculi MC in?

A
  • Women with recurrent UTIs with urease-producing organisms
  • Can present as staghorn calculi
51
Q

What is a cystine calculi?

A
  • Abnormal cystine excretion 2/2 genetic predisposition
  • Can prevent stones by upping urine pH to > 7
  • Treated with potassium citrate or bicarb.
  • Often described as smooth-edged ground glass on XRAY (FYI)

Need to pee 3-4L/day!!!!!

GU (14 decks)

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