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GU > Other Renal Disorders - Exam 1 > Flashcards

Other Renal Disorders - Exam 1 Flashcards

1
Q

What age is the peak incidence of renal cancer? MC in males or females?

A

60-80s

males

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2
Q

What are some risk factors for renal cell carcinoma? What is the major one?

A

physical inactivity

HTN
obesity
nephrolithiasis
sickle cell
chronic analegesic
chemo
environmental toxins
**smoking- MAJOR ONE TO REMEMBER

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3
Q

75-85% of renal cell carcinomas are _______. What do they arise from?

A

clear cell carcinoma

Arise from epithelial cells of proximal tubules

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4
Q

renal cell carcinomas that are papillary tumors tend to be _____ and ______

A

papillary tumors tend to be BILATERAL and MULTIFOCAL (combo of chemo, toxins and anagelsic)

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5
Q

What is the classic triad of renal cell carcinoma?

A

flank pain, hematuria, abdominal mass

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6
Q

What is the typical presentation of renal cell carcinoma? _____ is present in 50% of pts. What s/s are from metastatic disease?

A

flank pain
abdominal mass
fever of unknown origin
scrotal varicocele
gross or microscopic hematuria

cough- metastatic dz
bone pain- metastatic dz

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7
Q

scrotal varicocele are commonly associated with ______. MC to be right or left sided? Why?

A

rencal cell carcinoma

Left sided

because the left testicular vein attaches to the left renal artery before dumping into the IVC

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8
Q

rencal cell carcinoma are often found _____ on renal imaging in asymptomatic patients

A

incidentally

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9
Q

What are 3 common lab findings in renal cell carcinoma?

A

Hematuria - 60% of pts
anemia or erythrocytosis (anemia is MC)
high calcium

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10
Q

What is Stauffer syndrome? What dz is it associated with?

A

hepatic dysfunction with elevated LFTs in the absence of liver metastases in renal cell carcinoma

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11
Q

What is the FIRST imaging study usually ordered in RCC? then what?

A

US- first because its cheap and easy for the pt

CT/MRI: usually CT to loo at cancer mass itself

Doppler: to see if IVC is involved or not

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12
Q

Once you have a suspicion of RCC, what is the order of imaging you want to order and why?

A

CT of abdomen and pelvis

Chest imaging (CXR or chest CT)

Initial Labs - renal function, hepatic function, CBC, UA, urine cytology

to look for mets

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13
Q

What are the different stages of kidney cancer?

A

1: mass LESS than 7cm and only in the kidney
2: Mass GREATER than 7cm and only in the kidney
3: mass is in the kidney and IVC
4: mass is in kidney, IVC and has spread to other lymph nodes

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14
Q

What is the tx for RCC? What is considered “standard?”

A

sx: either partial or complete nephrectomy

standard: Removal of kidney, ipsilateral adrenal gland and adjacent lymph nodes

+/- chemo, limited effectiveness

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15
Q

What is a Wilms Tumor? What is another name for it? What is a classic pt presentation? It is usually dx before the age of _____

A

tumor of the kidney that mainly occurs in pediatric pts, 5-6% of renal tumors

Nephroblastoma

an otherwise healthy kid that has abdominal pain and mass

⅔ diagnosed before age 5; 95% before age 10

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16
Q

What causes a Wilms Tumor? Is there a genetic component? Most tumors are commonly a _____ ______ lesion

A

caused by 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

single unilateral lesion

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17
Q

How does a Wilms Tumor present?

A

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

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18
Q

For a Wilms Tumor ____ is the initial study. What will you order after? What are you worried about? What is the tx?

A

abdominal US is first

f/u with renal CT/MRI WITH CONTRAST to further investigate

lung metastasis: order CXR or chest CT

sx and chemo

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19
Q

Besides renal cell carcinoma and Wilms Tumor, name 2 additional types of kidney tumors. Which is looks exactly like RCC on imaging?

A

Oncocytomas- looks exactly like RCC on imaging NOT CANCER!!!

Angiomyolipomas

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20
Q

What is an angiomyolipomas? What is the MC pt population? What is the tx?

A

rare benign tumors composed of fat, smooth muscle, and blood vessels

young/middle aged women

Tx - if < 6 cm and asymptomatic, observation
If bleeding - embolization or nephrectomy
If > 6 cm - prophylactic embolization

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21
Q

_____ is the second MC place kidney cancer is going to migrate. Give 3 additional places

A

LUNGS- MC 20%

breast, stomach, other kidney- 10% each

or lymphoma

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22
Q

kidney stones usually present in _____ (age range) and are more common in (males/females?)

A

30s-50s

2.5x MC in MEN

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23
Q

**What are risk factors for urinary stone dz? What are the 2 major ones?

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

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24
Q

75% of kidney stones are composed of ______. 15% are made up of ______

A

Calcium oxalate stones - 75%

Calcium phosphate stones - 15%

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25
Q

types of kidney stones

_______ are associated with gout and metabolic syndrome and make up 8% of stones

A

Uric acid stones

26
Q

types of kidney stones

_____ are typically hereditary and make up 1-2% of kidney stones

A

cystine stones

27
Q

types of kidney stones

____ are associated with infection, think chronic UTIs and make up 1%

A

Struvite stones

28
Q

T/F: Larger kidney stones typically are associated with more severe symptoms when compared to smaller stones

A

FALSE!! the size of the kidney stone does NOT correlate with severity of s/s

29
Q

How does a kidney stone present?

A

severe and acute onset of pain that may radiate into the abdomen or groin
Urinary urgency and frequency
N/V

30
Q

What is the normal pH of urine? What is it for uric acid and cystine stones? calcium oxalate stones? calcium phosphate/struvite stones?

A

Normal - 5.8-5.9
<5.5 - uric acid or cystine stones
5.5-6.8 - calcium oxalate stones
>7.2 - calcium phosphate or struvite stone

31
Q

What is litholink?

A

preset lab testing panel that evaluates for stone eval

32
Q

What is the imaging of choice for kidney stones?

A

Plain abdominal radiograph (KUB) and renal US will diagnose most renal stones

33
Q

approximately ____ of kidney stones are visible on x-ray

A

~ 85%

34
Q

______ is often first used tool in evaluation and frequently ordered in ER setting. _____ is imaging of choice for pregnant pts

A

Noncontrast CT

US: will also show hydronephrosis

35
Q

What is a staghorn calculus? What is the common material?

A

huge kidney stones that has morphed into one giant mass that involves the renal pelvis and at least 2 calyces

struvite calculi

36
Q

What is the tx for kidney stones?

A

NSAIDs/opioids for pain control

hydration: ORAL ONLY!!! IV is not helpful

meds:
***tamsulosin - preferred
nifedipine (adjuct or second line)
antispasmodic agent
short course of steroids (prednisone)

37
Q

**What is the MOA for tamulosin? What is the drug class?

A

Blocks alpha-1 receptors

Alpha blockers

38
Q

a kidney stone that is either obstructed or has signs of infection is considered _____

A

medical emergency

39
Q

tamsulosin may have some sensitivity in pts with a known ____ allergy. What are the 3 drug-drug interactions?

A

sulfa allergy

paroxetine, cimetidine, PDE-5 inhibitors

40
Q

Orthostatic hypotension, HA, dizziness, abnormal ejaculation, priapism and SE of ______

A

tamsulosin

41
Q

What are the 3 most likely places for a kidney stone to get stuck? What size of the stone will you more than likely be able to pass on your own? What size usually requires intervention?

A

ureteropelvic junction
passage of ureter over iliac vessels
ureterovesicular junction

Most stones 5 mm or less pass spontaneously
Most stones 10 mm or more do not pass

42
Q

What are some kidney stone extraction options?

A

Ureteroscopic Stone Extraction: stone is caught with a basket using a small endoscope that is passes through ureter

shock wave lithotripsy: send shockwaves to break up the larger stone and then it will pass on its own usually within 2 weeks

percutaneous nephrolithotomy: usually done for stones larger than 1.5cm

43
Q

Which kidney stone removal technique do you need to use caution in women of childbearing age with stone in lower ureter?

A

Shock Wave Lithotripsy

44
Q

What kidney stone removal technique would be best for larger calculi (>1.5 cm) or located in inferior pole?

A

Percutaneous Nephrolithotomy

45
Q

**What is the most important way to prevent a kidney stone? What is the goal urine volume?What is another helpful strategy?

A

1: increased fluid intake!!

1.5-2 Liters of urine/day

decrease salt and protein and increase bran

46
Q

What is a helpful pt education tip about drinking water to prevent kidney stones?

A

Recommended to drink fluids with meals, 2 hrs after each meal, and prior to going to sleep as well as during the night

47
Q

What are the possible causes of hypercalciuric stones?

A

absorptive hypercalciuria due to high Ca absorption in the small bowel

resorptive hypercalciuria due to high PTH

renal hypercalciura due to tubule inability to reabsorb Ca

48
Q

What drug can decrease renal calcium excretion and lead to increased absorptive hypercalciuria?

A

thiazide diuretics decrease renal calcium excretion and have no impact on absorption

49
Q

_____ binds to calcium and impedes small bowel absorption

A

Cellulose phosphate

50
Q

What is resorptive hypercalciuria leading to kidney stones due to?

A

secondary to hyperparathyroidism

high calcium, low phosphate

51
Q

What is renal hypercalciuria leading to kidney stones due to? _____ can be helpful

A

secondary to tubule inability to reabsorb Ca
which leads to a normal/low serum calcium and HIGH URINE calcium

thiazide diuretics

52
Q

______ type of kidney stones are due to primary intestinal disorders (think Crohns, UC, IBD). What is the tx? Need to avoid _______

A

Hyperoxaluric Calcium Stones

stopping diarrhea, calcium carbonate

avoid excess ascorbic acid

53
Q

_______ type of kidney stones are due to dietary purine excess or uric acid metabolic defects. What is the tx? _____ medication may be helpful

A

Hyperuricosuric Calcium Stones

purine restriction

allopurinol (decreases uric acid levels)

54
Q

________ are due to chronic diarrhea, chronic HCTZ, metabolic acidosis. ______ and _____ can help

A

Hypocitraturic Calcium Stones

Potassium citrate and oral lemonade

55
Q

Give some examples of substances that contain purines.

A

meat, fish, seafood, beer, whole grains, sweetened beverages, high fructose corn syrup

56
Q

What type of kidney stone is LESS likely to show up on KUB? What are some causes? What is the medication tx options?

A

Uric Acid Calculi (and cystine calculi)

hyperuricemia, myeloproliferative disease, cancer, abrupt weight loss

potassium citrate and allopurinol (decreases uricemia)

57
Q

What type of kidney stone is MC in women with recurrent UTIs? What are the 3 MC organisms?

A

struvite calculi

Proteus, Pseudomonas, Providencia

58
Q

What type of kidney stone may have a genetic predisposition and are difficult to manage? What is the goal urinary volume? What is the medication options?

A

Cystine Calculi

3-4L/day

potassium citrate/bicarb

59
Q

What is the “goal urine pH” for a person who frequently gets cystine calculi kidney stones? What will they look like on xray?

A

goal pH >7.0

“Smooth-edged ground glass” and are radiolucent on x-ray

60
Q
A

GU (13 decks)

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