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Tim CP3 @ UoN - Medicine & Surgery > Obstructive & Neoplastic Conditions of the Kidney & Ureter > Flashcards

Obstructive & Neoplastic Conditions of the Kidney & Ureter Flashcards

1
Q

What are the complications of acute ureteric obstruction?

A

Enlargement of the urinary tract superior to the obstruction

-dilation of renal pelvis (hydronephrosis)

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2
Q

What are the three parts of the ureter that can be affected, causing acute/chronic ureteric obstruction?

A

Luminal
Mural
Extramural

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3
Q

What are the luminal causes of acute/chronic ureteric obstruction?

A 
Calculus
Sloughed renal papilla
Blood clot
TCC of renal pelvis/ureter
Bladder tumour
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4
Q

What are the mural causes of acute/chronic ureteric obstruction?

A

Ureteric stricture
Congenital pelviureteric neuromuscular dysfunction
Congenital megaureter

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5
Q

What are the extramural causes of acute/chronic ureteric obstruction?

A

Pelviureteric compression

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6
Q

What are the Sx/signs of acute/chronic ureteric obstruction

A

Varying loin pain (greater w/ urine volume)
Anuria (bilateral blockage)
Polyuria (partial blockage causing renal failure)
Loin tenderness
Palpable hydronephrotic kidney

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7
Q

What are renal calculi?

A

Kidney stones

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8
Q

Where do renal calculi form?

A

Collecting duct

-can be deposited anywhere from renal pelvis to urethra

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9
Q

What are the classic sites for renal calculi deposition?

A

Pelviureteric junction
Pelvic brim
Vesicoureteric junction

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10
Q

What are renal calculi made from?

A

Calcium oxalate (75%) OR
Magnesium ammonium phosphate OR
Urate

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11
Q

How do renal calculi present?

A

Renal colic (excruciating loin to groin spasms, nausea/vomiting) OR
Dull loin pain OR
UTI

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12
Q

What investigations are appropriate in suspected acute ureteric obstruction?

A 
Urine MCS
USS (?upper tract dilation)
AXR
CT
Retrograde pyelogram
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13
Q

What are the management options for acute ureteric obstruction?

A 
Nephrostomy
   -decompresses pelvicalyceal system, preserves kidney function, prevents infection
Surgical management (stenting)
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14
Q

What are the risk factors for renal calculi?

A 
15% lifetime risk
20-40yrs
3:1 male preponderance
Obesity
Dehydration/llow fluid intake
Family/personal hx
Anatomical abnormalities
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15
Q

What investigations are appropriate in suspected renal calculi?

A 
Bloods (Ca, PO4, G6, HCO3, urate)
Urine dip (95% +ve for blood)
Pregnancy test
Urine MCS
AXR (80% calculi visible)
Non-contrast CT (99% calculi visible)
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16
Q

What are the acute management options for renal calculi?

A 
A-E resus
75mg diclofenac IM
IV metoclopramide (if N/V)
IV a/b (if infec)
Assess for admission/active treatment (surg)
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17
Q

What factors indicate hospital admission in renal calculi pts?

A

Severe pain at 1hr
Risk of AKI
Signs of shock/infection
Uncertainty over dx

18
Q

What are the indications for active treatment of renal calculi?

A 
Low chance of spontaneous passage (>10mm)
Persistent pain
Ongoing obstruction
Signs of infec
Renal insufficiency
19
Q

What are the conservative (medical) options for managing renal calculi?

A

Tamsolusin (1st line) OR Nifedipine (inc rate of spontaneous expulsion)
Advice on discharge
-80% pass naturally
-high fluid intake
-return if increase in pain/signs of infec
-if 1st stone catch in sieve for analysis
Refer to urology w/i 1wk

20
Q

What are the active (surgical) options for managing renal calculi?

A

Extracorporeal shockwave lithotripsy (ESWL)
Uretoscopy
Percutaneous nephrolithotomy

21
Q

Describe Extracorporeal Shocwave Lithotripsy (ESWL)

A

Outpt procedure focusing shockwaves on stone to break it up and allow spontaneous passage
-if hydonephrosis present may need percutaneous nephrostomy

22
Q

What is Wilm’s Tumour?

A

Undifferentiated mesodermal tumour

20% of childhood malignancies

23
Q

How does Wilm’s Tumour present?

A

3.5yrs w/ flank pain & abdo mass

24
Q

What are the management options for Wilm’s Tumour?

A

DO NOT BIOPSY

Nephrectomy & pre-op chemo

25
Q

What are Renal Cell Carcinomas?

A

Vascular tumours arising from proximal tubular epithelium

26
Q

What are the risk factors for RCCs?

A

90% of renal tumours

Prolonged haemodialysis main risk factor (15%)

27
Q

How do RCCs present?

A 
50% incidental
10% w/ classic triad of sx
   -haematuria
   -loin pain
   -abdo mass + B sx
Varicoele (if invasion of L renal vv)
Polycythaemia/HTN (if renin/EPO secretion)
28
Q

How should suspected RCCs be investigated?

A 
Urine cytology
USS (solid/cystic)
CT/MRI
CXR
Renal angiography
29
Q

What are the management options for RCCs?

A 
Radical nephrectomy
Partial nephrectomy
   -if peripheral tumours <5cm
   -if bilat tumours OR contralateral poor kidney func
Post-op chemo
30
Q

What is the prognosis of RCCs?

A

65% 5yr survival if N0
25% if nodal involvement
5% if distant mets

31
Q

What are the common causes of renal cysts?

A 
Solitary/multiple cysts occur commonly in the elderly
   -50% by 50yrs
Polcystic kidney disease
Medullary cystic disease
Medullary sponge kidney
32
Q

How do solitary/multiple cysts in the elderly present?

A

Often asymptomatic OR

Haematuria/pain

33
Q

What are Transitional Cell Carcinomas?

A

Carcinoma of transitional cell epithelium

-most commonly bladder (50x more common)

34
Q

What structures are lined by transitional cell epithelium?

A 
Calyces
Renal pelvis
Ureter
Bladder
Urethra
35
Q

What are the risk factors for TCCs?

A

Smoking
Aromatic amines (rubber/plastic/dye industry workers)
Chronic cystitis
Pelvic irradiation

36
Q

How do TCCs present?

A

Painless haematuria +/- clots
Recurrent UTI
Voiding sx
Pain from local invasion

37
Q

What investigations are appropriate in suspected TCC?

A

Urine MCS/cytology (?sterile pyuria)
Cystoscopy/biopsy (gold standard)
CT/MRI or lymphangiography

38
Q

What are the management options for carcinoma in situ/T1 bladder carcinomas?

A

Transurethral resection of bladder tumour

  • at cystoscopy w/ intravesical chemo
  • 5yr survival 95%
39
Q

What are the management options for T2/T3 TCC?

A

Radical cystectomy w/ pre-op chemo

-ileal conduit used to leave urostoma

40
Q

What are the management options for T4 TCC?

A

Palliative treatment

41
Q

What long term management is required for all TCCs?

A

Long term follow up w/ cystoscopy

42
Q

Describe squamous cell carcinoma of the bladder

A

Rarer, present similarly to TCC

Risk factors - anything that irritates the bladder lining

Tim CP3 @ UoN - Medicine & Surgery (136 decks)

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