Other Renal Disorders - Exam 1 Flashcards by Johannah Crumpton

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

60-80s

males

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

physical inactivity

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

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

clear cell carcinoma

Arise from epithelial cells of proximal tubules

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

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

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What is the classic triad of renal cell carcinoma?

flank pain, hematuria, abdominal mass

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

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

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

incidentally

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What are 3 common lab findings in renal cell carcinoma?

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

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

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

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

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

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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What are the different stages of kidney cancer?

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

sx: either partial or complete nephrectomy

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

+/- chemo, limited effectiveness

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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 _____

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

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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How does a Wilms Tumor present?

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

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

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

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

Angiomyolipomas

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

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

LUNGS- MC 20%

breast, stomach, other kidney- 10% each

or lymphoma

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

30s-50s

2.5x MC in MEN

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

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

Calcium oxalate stones - 75%

Calcium phosphate stones - 15%

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

Uric acid stones

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

cystine stones

types of kidney stones ____ are associated with infection, think chronic UTIs and make up 1%

Struvite stones

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

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

How does a kidney stone present?

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

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

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

What is litholink?

preset lab testing panel that evaluates for stone eval

What is the imaging of choice for kidney stones?

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

approximately ____ of kidney stones are visible on x-ray

~ 85%

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

Noncontrast CT US: will also show hydronephrosis

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

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

What is the tx for kidney stones?

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)

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

Blocks alpha-1 receptors Alpha blockers

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

medical emergency

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

sulfa allergy paroxetine, cimetidine, PDE-5 inhibitors

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

tamsulosin

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?

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

What are some kidney stone extraction options?

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

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

Shock Wave Lithotripsy

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

Percutaneous Nephrolithotomy

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

#1: increased fluid intake!! 1.5-2 Liters of urine/day decrease salt and protein and increase bran

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

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

What are the possible causes of hypercalciuric stones?

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

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

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

_____ binds to calcium and impedes small bowel absorption

Cellulose phosphate

What is resorptive hypercalciuria leading to kidney stones due to?

secondary to hyperparathyroidism high calcium, low phosphate

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

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

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

Hyperoxaluric Calcium Stones stopping diarrhea, calcium carbonate avoid excess ascorbic acid

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

Hyperuricosuric Calcium Stones **purine restriction** allopurinol (decreases uric acid levels)

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

Hypocitraturic Calcium Stones Potassium citrate and oral lemonade

Give some examples of substances that contain purines.

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

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

Uric Acid Calculi (and cystine calculi) hyperuricemia, myeloproliferative disease, cancer, abrupt weight loss potassium citrate and allopurinol (decreases uricemia)

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

struvite calculi Proteus, Pseudomonas, Providencia

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?

Cystine Calculi 3-4L/day potassium citrate/bicarb

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

goal pH >7.0 “Smooth-edged ground glass” and are radiolucent on x-ray