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Clin med A 2 > Other Renal Disorder > Flashcards

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

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2
Q

what is the MCC of renal cell carcinomas

A

sporadic tumors

also linked ot familial causes and dialysis acquired cysts

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3
Q

what are risk factors for renal cell carcinoma

A
  • physical inactivity
  • chronic disease - HTN, obesity, nephrolithiasis
  • substances - chronic analgesics, toxins, smoking
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4
Q

what are the types of renal cell carcinomas

A
  • 75-85% are clear cell carcinomas
  • 10-15% are papillary tumors
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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

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6
Q

what are the labs for renal cell carcinoma

A
  • hematuria
  • anemia, erythrocytosis
  • hypercalcemia
  • stauffer syndrome
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7
Q

what is stauffer syndrome

A

hepatic dysfunction with elevated LFTs in the absence of metastases

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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

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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
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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
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11
Q

what is the treatment for renal cell carcinoma

A

surgical excision with radical nephrectomy (entire kidney)

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12
Q

what is the prognosis for renal cell carcinoma

A
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13
Q

what is a wilms tumor (nephroblastoma)

A

a renal tumor occurring mainly in pediatric patients.

5-6% of renal tumors

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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!

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15
Q

what are s/s of wilms tumor

A
  • abdominal mass or swelling
  • abdominal pain
  • hematuria
  • HTN
  • fever, anemia, N/V
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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
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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

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18
Q

what are the lab values that may be seen in wilms tumors

A
  • anemia
  • decreased GFR
  • increased BUN/Cr
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19
Q

what is the treatment for wilms tumor

A

surgical resection followed by chemo and radiation

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20
Q

what is the prognosis for wilms tumor

A

5 year survival rate - 90%

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21
Q

what tumors are usually benign and indistinguishable from RCC on imaging?

A

oncocytomas

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22
Q

what are angiomyolipomas

A

rare benign tumors filled with fat, smooth muscle and blood vessels

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23
Q

who are angiomyolipomas MC in

A

young to middle aged women

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24
Q

what would a CT reveal in angiomyolipomas

A

fat component of mass

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25
Q

what is the treatment for angiomyolipomas

A
  • if < 5 cm and asymptomatic, observation
  • if bleeding, embolization and nephrectomy
  • if >5cm - prophylactic embolization
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26
Q

what are the primary renal tumors?

A
  • renal cell carcinomas
  • Wilms tumor
  • Ococytomas
  • angiomyolipomas
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27
Q

what are the MC metastatic diseases causing secondary renal tumors

A
  1. lung cancer (20%)
  2. breast, kidney, stomach (10% each)
  3. lymphomas
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28
Q

what are the demographics for urinary stone disease?

A

2.5x more common in men, usually ages 30-50s

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29
Q

what are risk factors for urinary stone disease

A
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30
Q

what are the types of urinary stones

A
  • calcium oxalate stones (75%)
  • calcium phosphate stones (15%)
  • uric acid stones (8%)
  • struvite stones (1%)
  • cystine stones (<1%)
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31
Q

what makes kidney stones visible on Xrays

A

calcium content

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32
Q

which stones are assocaited with gout and metabolic syndrome

A

uric acid stones

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33
Q

which stones are assocaited with infection

A

struvite stones

34
Q

which stones are typically hereditary

A

cystine stones

35
Q

where are stones found

A

they grown on the renal papillae or in the urine collecting systems

36
Q

when do symptoms occur with urinary stone disease?

A
  • most cause no symptoms
  • most symptoms appear when the stone enters ureter
37
Q

how does stone size correlate to severity of symptoms?

A

it DOESNT!

38
Q

If symptoms are present with urinary stone disease, what are they?

A
  • acute, severe, sudden onset pain in flank that radiates to abdomen or groin
  • urinary urgency and frequency
  • N/V
39
Q

what are the labs found in urinary stone disease

A
  • hematuria
  • abnormal urine pH
40
Q

what urine pH indicates the following:
- uric acid or cystine stones
- calcium oxalate stones
- calcium phosphate or struvite stones

A

<5.5 - uric acid or cystine stones
5.5-6.8 - calcium oxalate stones
>7.2 - calcium phosphate or struvite stones

41
Q

when is a metabolic evaluation warranted in urinary stone disease?

A

In pts who have recurrent stones or + family hx

42
Q

what does a metabolic evaluation consist of?

A

pt decreases Na and protein
increases fluid intake
then obtain:
- 24 hr urine
- serum PTH, Ca, Uric acid, Cr, and BUN
- litholink

43
Q

what is litholink

A

Litholink - preset lab testing panel for stone evaluation

44
Q

what imaging is used to assess urinary stone disease

A

plain abdominal radiograph and renal US.

noncontrast CTs are often ordered in ER and are first tools used in evaluation.

45
Q

in over 60% of patients with pain during urinary stone disease have a stone found in what spot?

A

the distal ureter

46
Q

what is a staghorn calculus?

A

stone involving renal pelvis and at least 2 calyces

idk if we need this

47
Q

what is the treatment for urinary stone disease?

A
  • 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
Q

what is used as alpha blockers?

A

tamsulosin and a short course of prednisone

49
Q

what is the MOA of tamsulosin

A

blacks alpha 1 receptors

50
Q

what are CI for tamsulosin

A

allergy
sulfa allergy

51
Q

what are DDI for tamsulosin

A
  • anti HTN especially alpha-blockers
  • cimetidine
  • paroxetine
  • PDE-5 inhibitors
52
Q

what are SE of tamsulosin

A
  • orthostatic hypotension
  • HA
  • dizziness
  • abnormal ejaculation
  • priapism
53
Q

when should you intervene with a urinary stone

A
  • failure to pass in 4 weeks
  • large stone
  • obstruction
  • severe symptoms
54
Q

what are the ways urinary stones can be removed

A
  • ureteroscopic stone extraction
  • shock wave lithotripsy
  • percutaneous nephrolithotomy
55
Q

what is ureteroscopic stone extraction

A

small endoscope passed through ureter and stone caught in basket and broken into pieces

56
Q

what is shock wave lithotripsy

A

external energy source sends waves that impact stone and cause it to break up - stones then pass spontaneously

57
Q

when should you use caution with chock wave lithotripsy

A

Caution in women of childbearing age with
stone in lower ureter

58
Q

what is percutaneous nephrolithotomy

A

Needle is inserted into the appropriate renal calyx and ureteroscope is advanced directly into kidney (rather than through ureter)

59
Q

when is percutaneous nephrolithotomy use

A

in larger calculi (>1.5cm) or if they are located in inferior pole

what the heck is a pole. idk.

60
Q

How do you prevent urinary stone disease?

A
  • 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
Q

what is the cause of hypercalciuric stones

A
  • absorptive hypercalciuria (high ca absorption in small bowel) can occur even if your diet isnt high in Ca
  • resorptive hypercalciuria - 2nd to hyperparathyroidism
62
Q

how do you treat hypercalciuric stones d/t absorptive hypercalciuria

A
  • thiazide diuretics to decease renal calcium excretion (MC used)
  • cellulose phosphate TID to impede Ca absorption in bowels
63
Q

what is the cause of resorptive hypercalciuria

A

secondary to hyperparathyroidism

64
Q

what is seen in resorptive hypercalciuria

A

hypercalcemia
hypophosphatemia
elevated PTH

65
Q

how do you treat hypercalciuric stones secondary to resorptive hypercalciuria

A

treatment of elevated PTH

66
Q

what causes renal hypercalciuria

A

secondary to tubule inability to reabsorb Ca

67
Q

what is seen in renal hypercalciuria

A

normal-low serum Ca
high urine Ca
seconadary hyperparathyroidism

68
Q

what is the treatment for hypercalciuric stones d/t renal hypercalciuria

A

thiazide diuretics can be helpful

69
Q

what causes hyperoxaluric calcium stones? what is the MC hx finding in these patients?

A
  • caused by primary intestinal disorders where pts absorb oxalate more than calcium
  • hx often includes chronic diarrhea and IBD
70
Q

what is the tx for hyperoxaluric calcium stones

A
  • stop diarrhea with calcium carbonate
  • avoid excess ascorbic acid
71
Q

what causes Hyperuricosuric Calcium Stones and how do you treat them?

A
  • Due to dietary purine excess or uric acid metabolic defects
  • 85% can be treated with purine restrictions
  • Allopurinol (gout medication) can also help
72
Q

what are Hypocitraturic Calcium Stones? how do you treat them?

A
  • Due to chronic diarrhea, chronic HCTZ, metabolic acidosis
  • Potassium citrate supplements reduce
  • Oral lemonade can also help
73
Q

what are causes of uric acid calculi

A
  • hyperuricemia
  • myeloproliferative disease
  • cancer
  • abrupt weight loss
74
Q

what is urinary pH in a patient with uric acid calculi

A

<5.5

75
Q

what is the treatment for uric acid calculi

A
  • increasing pH to over 6.2
    increases uric acid solubility
  • Potassium citrate - alkalizes urine
  • Allopurinol 300 mg/day - if hyperuricemia
76
Q

who is struvite calculi MC in?

A

women with recurring UTIs with urease-producing organisms such as:
- proteus
- psuedomonas
- providencia

77
Q

what type of calculi can be discovered as a staghorn calculus

A

struvite caculi

78
Q

what is the cause of cystine calculi

A

abnormal cystine excretion d/t genetic predisposition

79
Q

what is the management for cystine calculi

A
  • urinary alkalization with goal pH >7.0 (use potassium citrate or bicarbonate)
  • increase urinary volume (3-4L/day)
80
Q

how do cystine calculi present on Xray

A

radiolucent with “smooth-edged ground glass”

Clin med A 2 (30 decks)

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