Other Renal Disorder Flashcards
1
Q
what is the MC demographic of renal cell carcinoma
A
Peak incidence in 60s
2x as common in men
2
Q
what is the MCC of renal cell carcinomas
A
sporadic tumors
also linked ot familial causes and dialysis acquired cysts
3
Q
what are risk factors for renal cell carcinoma
A
- physical inactivity
- chronic disease - HTN, obesity, nephrolithiasis
- substances - chronic analgesics, toxins, smoking
4
Q
what are the types of renal cell carcinomas
A
- 75-85% are clear cell carcinomas
- 10-15% are papillary tumors
5
Q
what are the s/s of renal cell carcinoma
A
classic triad:
- flank pain
- hematuria
- abdominal mass
metastatic disease will present as cough and bone pain
6
Q
what are the labs for renal cell carcinoma
A
- hematuria
- anemia, erythrocytosis
- hypercalcemia
- stauffer syndrome
7
Q
what is stauffer syndrome
A
hepatic dysfunction with elevated LFTs in the absence of metastases
8
Q
what imaging studies are used for renal cell carcinomas
A
US is initial test!
CT or MRI are used after and are most valuable
also use: bone scan, brain imaging
9
Q
what is each imaging test used to evaluate
A
- CT - often used to look at cancer mass itself
- MRI or doppler US - to evaluate IVC involvement
- Bone scan - if bony metastases suspected
- Brain imaging - if brain metastases suspected
10
Q
what is included in the standard evaluation of suspected RCC
A
- CT abdomen and pelvis
- chest imaging (CXR and CT)
- Initial labs are - renal function, hepatic function, CBC, UA, Urine cytology
11
Q
what is the treatment for renal cell carcinoma
A
surgical excision with radical nephrectomy (entire kidney)
12
Q
what is the prognosis for renal cell carcinoma
A
13
Q
what is a wilms tumor (nephroblastoma)
A
a renal tumor occurring mainly in pediatric patients.
5-6% of renal tumors
14
Q
what is the etiology of wilms tumor? what type of lesion is it?
A
Etiology - caused by abnormal renal development → loss of tumor suppressor and transcription gene functions
usually is a SINGLE unilateral lesion!
15
Q
what are s/s of wilms tumor
A
- abdominal mass or swelling
- abdominal pain
- hematuria
- HTN
- fever, anemia, N/V
16
Q
what is typically the imaging of choice in wilms tumors?
A
- abdominal US is typically initial study
- followed by renal CT or MRI w contrast for further investigation
- may obtain CXR or CT chest to look for lung metastasis
17
Q
what are labs that are ordered for wilms tumors
A
CBC, CMP, UA and coag studies typically done to prep for surgery and look for complications
18
Q
what are the lab values that may be seen in wilms tumors
A
- anemia
- decreased GFR
- increased BUN/Cr
19
Q
what is the treatment for wilms tumor
A
surgical resection followed by chemo and radiation
20
Q
what is the prognosis for wilms tumor
A
5 year survival rate - 90%
21
Q
what tumors are usually benign and indistinguishable from RCC on imaging?
A
oncocytomas
22
Q
what are angiomyolipomas
A
rare benign tumors filled with fat, smooth muscle and blood vessels
23
Q
who are angiomyolipomas MC in
A
young to middle aged women
24
Q
what would a CT reveal in angiomyolipomas
A
fat component of mass
25
what is the treatment for angiomyolipomas
- if < 5 cm and asymptomatic, observation
- if bleeding, embolization and nephrectomy
- if >5cm - prophylactic embolization
26
what are the primary renal tumors?
* renal cell carcinomas
* Wilms tumor
* Ococytomas
* angiomyolipomas
27
what are the MC metastatic diseases causing secondary renal tumors
1. lung cancer (20%)
2. breast, kidney, stomach (10% each)
3. lymphomas
28
what are the demographics for urinary stone disease?
2.5x more common in men, usually ages 30-50s
29
what are risk factors for urinary stone disease
30
what are the types of urinary stones
* calcium oxalate stones (75%)
* calcium phosphate stones (15%)
* uric acid stones (8%)
* struvite stones (1%)
* cystine stones (<1%)
31
what makes kidney stones visible on Xrays
calcium content
32
which stones are assocaited with gout and metabolic syndrome
uric acid stones
33
which stones are assocaited with infection
struvite stones
34
which stones are typically hereditary
cystine stones
35
where are stones found
they grown on the renal papillae or in the urine collecting systems
36
when do symptoms occur with urinary stone disease?
* most cause no symptoms
* most symptoms appear when the stone enters ureter
37
how does stone size correlate to severity of symptoms?
it DOESNT!
38
If symptoms are present with urinary stone disease, what are they?
* acute, severe, sudden onset pain in flank that radiates to abdomen or groin
* urinary urgency and frequency
* N/V
39
what are the labs found in urinary stone disease
* hematuria
* abnormal urine pH
40
what urine pH indicates the following:
- uric acid or cystine stones
- calcium oxalate stones
- calcium phosphate or struvite stones
<5.5 - uric acid or cystine stones
5.5-6.8 - calcium oxalate stones
>7.2 - calcium phosphate or struvite stones
41
when is a metabolic evaluation warranted in urinary stone disease?
In pts who have recurrent stones or + family hx
42
what does a metabolic evaluation consist of?
pt decreases Na and protein
increases fluid intake
then obtain:
- 24 hr urine
- serum PTH, Ca, Uric acid, Cr, and BUN
- litholink
43
what is litholink
Litholink - preset lab testing panel for stone evaluation
44
what imaging is used to assess urinary stone disease
plain abdominal radiograph and renal US.
noncontrast CTs are often ordered in ER and are first tools used in evaluation.
45
in over 60% of patients with pain during urinary stone disease have a stone found in what spot?
the distal ureter
46
what is a staghorn calculus?
stone involving renal pelvis and at least 2 calyces
idk if we need this
47
what is the treatment for urinary stone disease?
* pain control w NSAIDS or opioids
* hydration (not IV)
* Alpha blocker therapy to facilitate stone passage
* if obsructing or signs of infections its a medical emergency!
48
what is used as alpha blockers?
tamsulosin and a short course of prednisone
49
what is the MOA of tamsulosin
blacks alpha 1 receptors
50
what are CI for tamsulosin
allergy
sulfa allergy
51
what are DDI for tamsulosin
- anti HTN especially alpha-blockers
- cimetidine
- paroxetine
- PDE-5 inhibitors
52
what are SE of tamsulosin
- orthostatic hypotension
- HA
- dizziness
- abnormal ejaculation
- priapism
53
when should you intervene with a urinary stone
- failure to pass in 4 weeks
- large stone
- obstruction
- severe symptoms
54
what are the ways urinary stones can be removed
* ureteroscopic stone extraction
* shock wave lithotripsy
* percutaneous nephrolithotomy
55
what is ureteroscopic stone extraction
small endoscope passed through ureter and stone caught in basket and broken into pieces
56
what is shock wave lithotripsy
external energy source sends waves that impact stone and cause it to break up - stones then pass spontaneously
57
when should you use caution with chock wave lithotripsy
Caution in women of childbearing age with
stone in lower ureter
58
what is percutaneous nephrolithotomy
Needle is inserted into the appropriate renal calyx and ureteroscope is advanced directly into kidney (rather than through ureter)
59
when is percutaneous nephrolithotomy use
in larger calculi (>1.5cm) or if they are located in inferior pole
what the heck is a pole. idk.
60
How do you prevent urinary stone disease?
* drink fluids w meals, after meals and before going to sleep, oh and at night (just constantly drink fluids)
* excrete a goal of 1.5-2liters of urine a day
* decrease sodium and protein in diet
* bran may decease calciuria, DO NOT decrease calcium
61
what is the cause of hypercalciuric stones
* absorptive hypercalciuria (high ca absorption in small bowel) can occur even if your diet isnt high in Ca
* resorptive hypercalciuria - 2nd to hyperparathyroidism
62
how do you treat hypercalciuric stones d/t absorptive hypercalciuria
* thiazide diuretics to decease renal calcium excretion (MC used)
* cellulose phosphate TID to impede Ca absorption in bowels
63
what is the cause of resorptive hypercalciuria
secondary to hyperparathyroidism
64
what is seen in resorptive hypercalciuria
hypercalcemia
hypophosphatemia
elevated PTH
65
how do you treat hypercalciuric stones secondary to resorptive hypercalciuria
treatment of elevated PTH
66
what causes renal hypercalciuria
secondary to tubule inability to reabsorb Ca
67
what is seen in renal hypercalciuria
normal-low serum Ca
high urine Ca
seconadary hyperparathyroidism
68
what is the treatment for hypercalciuric stones d/t renal hypercalciuria
thiazide diuretics can be helpful
69
what causes hyperoxaluric calcium stones? what is the MC hx finding in these patients?
* caused by primary intestinal disorders where pts absorb oxalate more than calcium
* hx often includes chronic diarrhea and IBD
70
what is the tx for hyperoxaluric calcium stones
* stop diarrhea with calcium carbonate
* avoid excess ascorbic acid
71
what causes Hyperuricosuric Calcium Stones and how do you treat them?
* Due to dietary purine excess or uric acid metabolic defects
* 85% can be treated with purine restrictions
* Allopurinol (gout medication) can also help
72
what are Hypocitraturic Calcium Stones? how do you treat them?
* Due to chronic diarrhea, chronic HCTZ, metabolic acidosis
* Potassium citrate supplements reduce
* Oral lemonade can also help
73
what are causes of uric acid calculi
* hyperuricemia
* myeloproliferative disease
* cancer
* abrupt weight loss
74
what is urinary pH in a patient with uric acid calculi
<5.5
75
what is the treatment for uric acid calculi
* increasing pH to over 6.2
increases uric acid solubility
* Potassium citrate - alkalizes urine
* Allopurinol 300 mg/day - if hyperuricemia
76
who is struvite calculi MC in?
women with recurring UTIs with urease-producing organisms such as:
- proteus
- psuedomonas
- providencia
77
what type of calculi can be discovered as a staghorn calculus
struvite caculi
78
what is the cause of cystine calculi
abnormal cystine excretion d/t genetic predisposition
79
what is the management for cystine calculi
* urinary alkalization with goal pH >7.0 (use potassium citrate or bicarbonate)
* increase urinary volume (3-4L/day)
80
how do cystine calculi present on Xray
radiolucent with "smooth-edged ground glass"
