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Clin Med GI > Other Renal Disorders > Flashcards

Other Renal Disorders Flashcards

1
Q

What is the MC kidney cancer and when is it dx?

A

Renal cell carcinoma
90-95% of renal cancers
4% of cancers
60 yo MC
2x as common in men

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2
Q

What is the MC cause of renal cell carcinoma?

A

Sporadic MC
but there is familial cause

Also inactivitivty
Chronic disease causing inflammation
NSAIDs

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3
Q

What is the biggest risk factor for renal cell carcinoma?

A

Smoking

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4
Q

What is the MC renal cell carcinoma? What is the other cause?

A

75-85% are clear cell carcinomas
Arise from PT

Other cause (10-15%) is papillary tumors

also some other types

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5
Q

What is the MC symptom of renal cell carcinoma?

A

Hematuria - occurs in 50-60%

Often is brown, because it is further down

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6
Q

What is the classic triad of renal cell carcinoma and how common is it?

A

Flank pain
Hematuria
Abdominal mass

rare though

HAF the MC cancer

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7
Q

What is the MC way renal cell carcinoma is found?

A

Incidentally on renal imaging b4 symptoms

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8
Q

What would cough and bone pain suggest for renal cell carcinoma?

A

Metastis :(
seen in 20-30% on initial dx

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9
Q

What are the lab findings of renal cell carcinoma?

A

MC hematuria 60%
Anemia or erythrocytosis (from blood loss)
Hypercalcemia (metastasis)

Stauffer syndrome

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10
Q

What is stauffer syndrome?

A

Hepatic dysfunction with elevated LFTs secondary to renal cell carcinoma (not metastisis)

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11
Q

Why do you have anemia in renal cell carcinoma?

A

Losing too much blood
Can tack away tissue of kidney that makes erythropoietin

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12
Q

Why do you sometimes see erythrocytosis?

A

Differentiated cancer can retain characteristics of original tissue making erythropoietin

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13
Q

What is the initial imaging of renal cell carcinomas?

A

US (start here)
CT of abdomen and pelvis and MRI is most valuable

sometimes doppler US, bone scan, brain imaging (if AMS)

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14
Q

What labs should you get for renal cell cariconma?

A

renal function, hepatic function (abnormal = stauffer syndrome sometimes), CBC (do they have anemia), UA, urine cytology

all of these reaffirm dx, but do not confirm it

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15
Q

What differs the CT in polycystic kidney versus renal cell carcinoma?

A

Polycystic = cysts everywhere on kidney, well defined margins

RCC: bumpy margins, not as well defined

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16
Q

What is the treatment for an isolated renal cell carcinoma?

A

Surgical excision including the kidney, ipsilateral adrenal gland, and adjacent lymph nodes (in case they spread their)

-can consider partial nephrectomy

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17
Q

If metastatic renal cell carcinoma, what is the treatment?

A

Stage IV, surgery does not improve outcomes

Limited effect of chemotherapy :(

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18
Q

What is the 5 survival rate for renal cell carcinoma confined to the renal capsule, beyond the renal capsule, and lymph node involvement?

A

90-100%
50-60%
0-15% :(

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19
Q

What is a nephroblastoma?

A

Wilms Tumor seen in pediatric patients
Kids like having a blast

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20
Q

What is the MC renal cancer in peds?

A

Nephroblastoma
2/3 before 5
95% before 10

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21
Q

What causes nephroblastoma?

A

Sporadic loss of renal development and loss of tumor suppressor and transcription gene functions, leading to a single unilateral lesion most commonly

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22
Q

What are the s/s of nephroblastoma?

A

Abdominal pain (MC)
HTN
Hematuria
fever, anemia, N/V

often think it is a stomach bug

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23
Q

What is the initial imaging of nephroblastoma?

A

Abdominal US

then you can
Renal CT or MRI

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24
Q

What labs do you order for nephroblastoma?

A

CBC, CMP, UA, coag studies

sometimes see anemia and decreased GFR and increased BUN and Cr

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25
Q

What is the treatment of nephroblastoma?

A

surgical resection and then chemo

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26
Q

what is the 5 year survival rate of nephroblastoma?

A

90%

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27
Q

What is a complication of nephroblastoma?

A

Recurrent disease

15% with favorable histology
50% anaplastic tumor
50-80%: post-relapse survival rates

this is why you need chemo!

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28
Q

What is an oncocytoma?

A

Rare kidney tumor that is often benign - but looks like an RCC on imaging

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29
Q

What do we do with oncocytoma?

A

Treat it as if it was cancer and remove it

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30
Q

What is an angiomyolipoma?

A

Fat, smooth muscle, and blood vessel cancers

MC in young-middle age women

CT reveal fat component

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31
Q

How do you treat angiomyoploma?

A

<5 cm = observe
If bleeding, embolize and nephroctomy
> 5cm prophylatic embolization

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32
Q

What is the MC metastatic?

A

Lung is MC

also can be breast, stomach, or other kidney

33
Q

What are kidney stones aka?

A

nephrolithiasis

34
Q

Who is kidney stones MC in?

A

2.5 x more common in men

usually 30-50, but can be younger or older

35
Q

What are risk factors for kidney stones?

A

Inadequate hydration
High protein
High salt

All of these can lead to crystals
Often in patients that have sensory issues

also sedentary lifestyle

36
Q

What envirnoment leads to kidney stones?

A

High humidity and temperature

37
Q

What are the MC types of kidney stones? less common ones?

A

Calcium stones make up 85%

Uric acid stones (8%)

Struvite stones (infections)
Cystine stones: heridtary

38
Q

What are the s/s of kidney stones?

A

Sometimes asymptomatic

Severe flank pain that raps to the front of the abdomen to the bladder
-continuous or episodic (smooth muscle contracts)
- urinary incontinence
-N/V from pain

Can cause isolated hematuria

Move to the urterer -size does not change

39
Q

When do symptoms typically stop for kidney stones in women?

A

At the bladder

40
Q

What is the MC lab of kidney stones?

A

Hematuria (micro or gross) 90%

41
Q

What stones make lower urine pH?

A

Uric acid or cystaline

42
Q

What stones make higher urine pH?

A

calcium stones or struvite stone

43
Q

When do you workup a patient with kidney stones?

A

Recurrent kidney stones
Fx

44
Q

How do you work up a patient with kidney stones?

A

First, decrease Na, protein, increase fluid intake then do the following labs:

24 hr urine
Serum blood work (kidney function, PTH)
Litholink (preset so you don’t have to worry)

45
Q

What dx kidney stones? Pregnant patients?

A

Plain abdominal radiograph and renal US in preggos (85% visible) 65% already make it to distal ureter

KUB (kidney, ureter, bladder)

Noncontrast CT in ER - show up all types of stones

46
Q

What does a stone look like on xray or CT?

A

bright white spot (like bone = calcium)

47
Q

What are staghorn calculus?

A

Look like a branch of cauliflower - sticks up through renal pelvis and goes into the calyces

48
Q

How do you manage kidney stones?

A

Pain control of flank:
NSAIDs
Opioids if intense pain

Hydration: oral, don’t force IV it can make it worse pain - but may be necessary if severe dehydration

Alpha blocker
prednisone (relieve swelling and pain)

49
Q

What is the preferred alphablocker for kidney stones?

A

tamsulosin

50
Q

What is tamsulin MOA?

A

Blocks alpha-1 receptors

opens urinary track and

51
Q

What are the Ci of tamsulin?

A

Hypersensitivity and sulfa allergy

Caution with anti-HTN drugs d/t additive effect

52
Q

What are the SE of tamsulin?

A

Orthostatic hypotension, HA, dizziness, abnormal ejaculation, priapism

Typically not worried about in acute problems

53
Q

Where do stones tend to get stuck?

A

Uretropelvic junction MC

Also ureter over iliac vessels, ureterovesicular junction

54
Q

What size do stones tend to pass and when do they not pass? When do you intervene?

A

Pass at 5 mm
Don’t pass at 10 mm

intervention if does not pass in 4 weeks, large stone, severe symptoms

55
Q

Explain the process of a ureterscopic stone extraction?

A

Take a camera, through the urthera, bladder, into urter, catch stone with a basket tool or laser, have a stent

56
Q

If there is a pretty big stone, what do you use for extraction that does not involve surgery?

A

Shock wave lithotripsy

57
Q

Explain shock wave lithotripsy

A

External energy waves that break stone
Individual stone fragements pass spontaneously w/in 2 weeks
If super large, may have issue

caution in women of childbearing age, may be preggo and dmg a fetus

58
Q

Why does shock therapy not lead to kidney damage?

A

Waves focus on the stone

59
Q

What is the most invasive surgery for a kidney stone and when is it done?

A

Percutaneous nephrolithotomy

done for massive stones >1.5cm or in the inferior pole of kidney and stuck

60
Q

Explain Percutaneous nephrolithotomy

A

Needle inserted into the back
Advance into the kidney
Scope through the needle
Pull the stone through the needle
Done under radioscopic guidance

61
Q

What is the most important thing for stop getting future kidney stones from forming?

A

1.5-2L of urine a day (need more water than that)
-drink fluids throughout the day
-constant water to stop crystals from clumping into a stone

62
Q

What should you include and decrease in diet for kidney stones?

A

Include bran
Don’t reduce calcium intake
Cut down on protein and sodium

63
Q

If a patient has recurrent kidney stones, what can you recommend to see what type of stone?

A

Urinary strainer so that you can see the type of stone

64
Q

What are hypercalcuric stones caused by?

A

Absorptive hypercalcuria (see increased urine calcium w/out high dietary intake of Ca)

65
Q

What meds can help with hypercalcuric stones?

A

Thiazide dieurtics
Cellulose phosphate (specifically binds calcium and impedes small bowel abs)

66
Q

What causes resporptive hypercalcuria and what do you see?

A

hyperparathyroidism
see hypercalcemia, hypophosphotemia, and elevated PTH

67
Q

What is renal hypercalcuria and how is it treated?

A

Normal or low serum calcium with high urine calcium

can develop 2ndary hyperparathryoidism

Treated with thiazides

68
Q

What is hyperoxaluric calcium stone and symptoms?

A

Mainly oxalate, but there is still Ca2+ - abs oxalate more than calcium because of diarrhea not allowing time to abs calcium

history of chornic diarrhea and often IBD

69
Q

How do you treat hyperoxaluric calcium stone?

A

manage diarrhea so you don’t poop out too much calcium
calcium carbonate (tums)
avoid excess ascorbic acid (vitamin C)

70
Q

What are hyperuricosuric calcium stone?

A

mainly uric acid but some calcium
problems with uric acid metabolism or too many purines

71
Q

How do you treat hyperuricosuric calcium stone?

A

Reducing purine intake including less beer and meat

Allopurinol (reduces uric acid)

72
Q

What is hypocitraturic calcium stones?

A

Due to chronic diarrhea
Have potassium citrate or lemonade to help (low citrate)

73
Q

What is uric acid calcuil and what is it seen in?

A

Often does not show up in xray because no calcium

caused by too much uric acid - too much purines, chemo, abrupt weight loss causing cell death

low urinary pH

74
Q

How to treat uric acid calcuil?

A

potassium citrate (raises pH)
allopurinol

75
Q

When is struvite calculi often seen?

A

Recurrent UTIs in women

Seen in bacteria with P in it
Proteus, psedomonas, providencia (not typically E coli)

76
Q

What stone is MC to form staghorn calculus?

A

struvite calculi

77
Q

What are cystine calculi?

A

Genetic predisposition

78
Q

How do you treat cystine calculi?

A

Difficult to manage
Goal urinary pH very high >7
3-4L of urinary volume a day!

Clin Med GI (10 decks)

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