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GU: Clin Med IIA > Other Renal disorders > Flashcards

Other Renal disorders Flashcards

1
Q

what is the MC renal cancer (90-95% of renal cancers)?

A

Renal Cell Carcinoma

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2
Q

Renal Cell Carcinoma is MC when and in who?

A

Peak incidence - 60s
2x as common in males

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3
Q

cause of renal cell carcinoma?

A

Most common - sporadic tumors
Also linked to familial causes, dialysis-related acquired cysts

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4
Q

risk factors of renal cell carcinoma

A
  1. Lifestyle - physical inactivity
  2. Chronic disease - HTN, chronic HCV, obesity, nephrolithiasis
  3. Substances - chronic analgesics, environmental toxins, smoking
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5
Q

pathogenesis of renal cell carcinoma

A
  1. 75-85% - clear cell carcinoma- from epithelial cells of proximal tubules
  2. Papillary tumors - 10-15% - bilateral and multifocal
  3. Other categories - chromophobic, oncocytic, collecting duct tumors
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6
Q

presentation of renal cell carcinoma

A
  1. gross or microscopic hematuria MC
  2. Flank pain or abd mass - 30%
  3. Classic triad - flank pain, hematuria, abd mass - 10% - Often sign of advanced disease
  4. Metastatic (cough, bone pain) - 20-30% at initial dx
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7
Q

how are renal cell carcinoma MC found?

A

Often found incidentally on renal imaging in ax pts

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8
Q

labs of renal cell carcinoma

A

Hematuria
Hematologic - anemia > erythrocytosis
Hypercalcemia - 10% of pts

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9
Q

when hepatic dysfunction with elevated LFTs in the absence of metastases
what is this called?

A

Stauffer syndrome

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10
Q

you found a solid renal mass upon imaging, what must you assume?

A

RCC until r/o

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11
Q

imaging choices for renal cell carcinoma

A

US - often initial study
CT/MRI - most valuable imaging tests

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12
Q

which imaging to order to look at the cancer mass itself

renal cell carcinoma

A

CT

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13
Q

what imaging order is to evaluate IVC involvement

renal cell carcinoma

A

MRI or doppler US

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14
Q

what imaging order if bony metastases suspected

renal cell carcinoma

A

bone scan

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15
Q

what imaging order if brain metastases suspected

renal cell carcinoma

A

Brain imaging

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16
Q

what is the Standard evaluation of suspected RCC

imaging and labs

A
  • CT of abd and pelvis
  • Chest imaging (CXR or chest CT)
  • Initial Labs - renal function, hepatic function, CBC, UA, urine cytology
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17
Q

staging of renal cell carcinoma

A
  • stage 1 - < 7cm
  • stage 2 - > 7cm
  • stage 3 - 1LN
  • stage 4 - >1 LN
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18
Q

tx for RCC

A

surgical excision
* Radical nephrectomy - Removal of kidney, ipsilateral adrenal gland, adjacent lymph nodes
* May consider partial nephrectomy
* If metastatic - surgery is limited
* Limited effective chemotherapy for RCC

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19
Q

what is the prognosis of RCC

A

confined to renal capsule > beyond renal capsule > LN involvement

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20
Q

which renal cancer occurs mainly in pediatric patients and rare (5-6% of renal tumors)

A

Wilms Tumor (Nephroblastoma)

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21
Q

most of Wilms Tumors (Nephroblastoma) are dx when? (what age)

A

In children < 15 years old - 95% of renal cancers
⅔ diagnosed before age 5; 95% before age 10

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22
Q

cause of Wilms Tumor (Nephroblastoma)

A
  • abnormal renal development → loss of tumor suppressor and transcription gene functions
  • Usually sporadic - only 1-2% have a positive family hx
  • Some rare genetic disorders are linked to Wilms Tumor
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23
Q

how does wilms tumor (nephroblastoma) MC present as?

not s/s

A

single unilateral lesion
May be multifocal or bilateral

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24
Q

s/s of Wilms Tumor (Nephroblastoma)

A

abd mass or swelling +/- other s/s
* Abd pain - 30-40% of pts
* HTN - 25 %
* Hematuria - 12-25% of pts
* Other s/s - fever, anemia, N/V

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25
Q

imaging choice for Wilms Tumor (Nephroblastoma)

A

Abd US is typical initial study
* Renal CT or MRI w/ contrast for further eval
* CXR or chest CT to look lung metastasis

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26
Q

labs for Wilms Tumor (Nephroblastoma)

A

CBC, CMP, UA, coag
* typically done to prep for surgery and look for complications
* May see anemia
* May see decreased GFR / increased BUN and Cr

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27
Q

tx for Wilms Tumor (Nephroblastoma)

A

Surgical resection followed by chemotherapy +/- radiation

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28
Q

prognosis of wilms tumor (nephroblastoma)?
can it happen again?

A
  • Overall 5-year survival rate is 90%
  • More anaplastic, more metastasis - worse rates; 33% for stage 4 Wilms Tumor
  • Recurrent disease is possible
  • 15% - with favorable histology
  • 50% - anaplastic tumors
  • Post-relapse survival rates: 50-80%
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29
Q

what are the other primary renal tumors that are usually benign?

A

Oncocytomas
Angiomyolipomas

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30
Q

which benign primary remal tumor is Indistinguishable from RCC on imaging

A

Oncocytomas

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31
Q

which renal tumors rare benign tumors
Fat, smooth muscle, and blood vessels

A

Angiomyolipomas

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32
Q

Angiomyolipomas is MC in who? how to manage?

imaging and tx

A
  • young to middle aged women
  • CT - may reveal fat component of mass
  • Tx - if < 5 cm and asx = observation
  • bleeding = embolization / nephrectomy
  • > 5 cm = prophylactic embolization
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33
Q

Metastatic disease secondary from renal tumors is MC where?

A
  • Lung cancer - MC (20%)
  • Breast, stomach, kidney - 10% each
  • Lymphoma may involve kidney - Diffuse infiltration rather than distinct mass
34
Q

Urinary Stone Disease is MC in who and when?

A
  • 2.5x more in males
  • ~19% of men
  • ~9% of women
  • Usual presentation - 30s-50s
35
Q

risk factors of urinary stone disease

A
  • High protein and salt intake
  • Inadequate hydration
  • High humidity and elevated temperatures
  • Sedentary lifestyles
  • Genetic predisposition
  • GI malabsorption syndromes
  • HTN, obesity, gout, excessive exercise, may all be linked
36
Q

what are the types of urinary stones? what is the MC?

A
  1. Calcium oxalate / Calcium phosphate
  2. Uric acid stones
  3. Struvite stones
  4. Cystine stones
37
Q

how are kidney stones visible on x-ray?

A

because of the calcium content in kidney stones

38
Q

which urinary stone is MC in men and associated with gout, MetS

A

Uric acid stones

39
Q

which urinary stone is associated with infection

A

struvite stones

40
Q

which urinary stones are typically hereditary

A

cystine stones

41
Q

where are stones grown that it would present asx or isolated hematuria

A

on renal papillae or in the urine collecting system

42
Q

urinary stone disease usually become symptomatic upon entering ?

A

ureter
Stone size does not correlate with severity of symptoms

43
Q

s/s of urinary stone disease

A
  • often sudden onset
  • Usually in flank - may radiate to abdomen or groin
  • May be episodic - Typically diminishes after stone passes into bladder
  • Urinary urgency and frequency - Especially if trapped at ureterovesical junction
  • N/V
44
Q

labs of urinary stone disease

A

Hematuria (micro or gross)
Abnormal urine pH

45
Q

what is normal urine pH?

A

5.8-5.9

46
Q

pt with suspected urinary stone disease has a urine pH of < 5.5, what type of stone could it be?

A

uric acid or cystine stones

47
Q

pt with suspected urinary stone disease has a urine pH of 5.5 - 6.8, what type of stone could it be?

A

calcium oxalate stones

48
Q

pt with suspected urinary stone disease has a urine pH of > 7.2, what type of stone could it be?

A

calcium phosphate or struvite stone

49
Q

for pts who have recurrent stones or +FHx, what other additional labs could be done

A

Metabolic evaluation - Pt decreases Na and protein, increases fluid intake, then:
* 24 hr urine - volume, pH, Ca, oxalate, phosphate, Na, citrate
* Serum - PTH, calcium, uric acid, electrolytes, Cr, BUN
* Litholink - preset lab testing panel for stone evaluation

50
Q

what imaging will diagnose most renal stones

A

Plain abdominal radiograph (KUB) and renal US will
~ 85% of stones visible on x-ray

51
Q

> 60% of pts with acute pain will have stone where?

A

distal ureter

52
Q

what imaging is often first used tool in evaluation

A

Noncontrast CT
Frequently ordered in ER setting
Virtually all stones visible on CT

53
Q

tx for Urinary Stone Disease

A

Acute renal colic

Pain control
* NSAIDs - decrease ureteral smooth muscle tone
* Opioids may be necessary

Hydration - oral hydration preferred
* No benefit to forced IV hydration - may worsen pain

Alpha blocker - facilitate stone passage
* tamsulosin
* Short course of steroids (prednisone 10 mg QD x 3-5 days) may help

If obstructing + signs of infection → medical emergency

54
Q

CI, DDI, SE of Tamsulosin

A
  • CI: hypersensitivity - with known sulfa allergy
  • DDI: anti-HTN rxs, esp alpha-blockers
  • May interact with paroxetine, cimetidine, PDE-5 inhibitors
  • SE: Orthostatic hypotension, HA, dizziness, abnormal ejaculation, priapism
55
Q

where would a stone lodge that would cause impediment for passage?

A
  • ureteropelvic junction
  • passage of ureter over iliac vessels
  • ureterovesicular junction
56
Q

what size of stone will pass spontaneously and what will not?

A
  • < 5 mm - pass spontaneously
  • > 10 mm - do not pass
57
Q

how does a Ureteroscopic Stone Extraction
work

A
  • Small endoscope passes through ureter
  • Stone “caught” with basket or a laser is used beforehand to break the stone up
  • outpatient
58
Q

which urinary stone intervention uses External energy source that sends energy waves that impact stone and causes it to break up
Most fragments then pass < 2 wks

A

Shock Wave Lithotripsy
Less successful if large stone burden

59
Q

what must be cautious about with shock wave lithotripsy

A

women of childbearing age with
stone in lower ureter

60
Q

which urinary stone disease intervention is done for larger calculi (>1.5 cm) or located in inferior pole? how does it work?

A

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

61
Q

prevention+management of urinary stone disease

A
  • Most importance - increased fluid intake
  • Goal - urine volume of 1.5-2 Lof urine/day
  • Recommended to drink fluids with meals, 2 hrs after each meal, and prior to going to sleep as well as during the night
  • Diet - decrease Na and protein
  • Bran may decrease calciuria
  • Do not decrease dietary calcium
62
Q

cause of hypercalciruic stones from high Ca absorption in small bowel
what is this called?

A

Absorptive hypercalciuria
Increased urine Ca even without high dietary Ca intake

63
Q

how to tx absorptive hypercalcuria

A
  • Thiazide - decrease renal Ca excretion - No impact on absorption
  • Cellulose phosphate - Binds to Ca and impedes small bowel absorption - Not used as often as thiazide diuretics
64
Q

this cause of hypercalciuric stone is secondary to hyperparathyroidism
what is this called? what is this caused by? tx?

A
  • Resorptive hypercalciuria
  • Hypercalcemia, hypophosphatemia, elevated PTH
  • tx of elevated PTH
65
Q

which hypercalciuric stone cause is secondary to tubule inability to reabsorb Ca? presentation? tx?

what labs are seen?

A
  • Renal hypercalciuria
  • Normal or low serum calcium, high urine calcium
  • Secondary hyperparathyroidism possible
  • Thiazide diuretics can be helpful
66
Q
  • Due to primary intestinal disorders
  • Hx of chronic diarrhea - often have IBD
  • Absorb oxalate more than calcium
    what type of renal stone?
A

Hyperoxaluric Calcium Stones

67
Q

tx for Hyperoxaluric Calcium Stones?
what should you avoid?

A
  • stopping diarrhea, calcium carbonate
  • Avoid excess ascorbic acid
68
Q

Due to dietary purine excess or uric acid metabolic defects
what type of renal stone?

A

Hyperuricosuric Calcium Stones

69
Q

tx for Hyperuricosuric Calcium Stones

A

purine restrictions
Allopurinol

70
Q

Due to chronic diarrhea, chronic HCTZ, metabolic acidosis
what type of renal stone?

A

Hypocitraturic Calcium Stones

71
Q

tx for Hypocitraturic Calcium Stones

A

Potassium citrate supplements reduce
Oral lemonade can also help

72
Q

causes of Uric Acid Calculi

A

hyperuricemia, myeloproliferative disease, cancer, abrupt weight loss
Most have some degree of calcium and are therefore visible on x-ray

73
Q

how does Pure uric acid present on xray?

A

radiolucent

74
Q

urinary pH of uric acid calculi? tx?

A

< 5.5
* increasing pH >6.2 = increases uric acid solubility
* Potassium citrate - alkalizes urine
* Allopurinol 300 mg/day - if hyperuricemia

75
Q

MC in women with recurrent UTIs with urease-producing organisms

what type of renal stone?

A

Struvite Calculi

76
Q

what pathogens MC cause Struvite Calculi

A

Proteus, Pseudomonas, Providencia
Not usually seen with E. coli

77
Q

May be discovered as staghorn calculus
what type of renal stone?

A

Struvite Calculi

78
Q

Abnormal cystine excretion
May be genetic predisposition
Difficult to manage
what type of renal stone?

A

Cystine Calculi

79
Q

urinary volume goal of Cystine Calculi?

A

3-4 L/d

80
Q

tx for Cystine Calculi

A

Urinary alkalinization
goal pH >7.0
Potassium citrate/bicarbonate

81
Q

radiolucent on x-ray
“Smooth-edged ground glass”
what type of renal stone?

A

Cystine Calculi

GU: Clin Med IIA (13 decks)

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