Quiz 2 Flashcards
Sx of Diabetic Nephropathy
Albuminuria
Occult hematuria
Diabetic symptoms
2 key things to monitor w Diabetic Nephropathy
- Microalbumin (random am sample or 24hr collection) N=0-30mg/d
- microalbuminuria: “high” 30-300mg/d
- macroalbuminuria: “very high” >300mg/d - HbA1c levels (>6.5% diagnostic for DM)
Risk factors for Diabetic Nephropathy
FMHx, advanced age, HTN, poor glycemic control, minorities, obesity, smoking, OCP
Tx for Diabetic Nephropathy
1 treat diabetes; guidelines recommend drug therapy be initiated immediately
- Gingko (protect glomerulus)
- Flax and pumpkin seeds
- Curcumin (renal protective)
- Guggul
- Chromium
- ALA
Causes of Hypertensive Nephropathy
1: Atherosclerosis (deposition of hyaline-like material on arteriole wall)
- Fibromuscular dysplasias
- Polyarteritis nodosa
- AV fistula
- Aortic aneurism
- Coarctation of aorta
- Embolism
Pathogenesis of Hypertensive Nephropathy
Decreased blood flow causes kidney to secrete renin, retain NaCl and H2O –> inc BP
Renin secretion also caused by Na depletion, hemorrhage, shock, CHF, renal artery stenosis
Sx of Hypertensive Nephropathy
Mb asx
HA, fatigue, confusion, vision changes, angina, HF, hematuria, epistaxis, irregular heartbeat, ear buzzing, pulmonary edema, uncontrollable HTN, L ventricular hypertrophy, HTN retinopathy, abdominal bruit
Labs (ish) for Hypertensive Nephropathy
Diastolic >120, HTN refractory to therapy. CBC, electrolytes, glucose, BUN, creatinine, UA, EKG, PLASMA RENIN, Captopril challenge test
Tx for Hypertensive Nephropathy
- Control BP
- Surgical reconstruction of damaged artery or bypass in case of hyperplasia
- Tx atherosclerosis (guggal, garlic, EFA, B vit)
- Vascular protectants (bioflavonoids, vaccinium)
Cx of Hypertensive Nephropathy
Early death Hypertensive heart disease MI CHF Kidney damage KI failure Stroke Loss of vision
What population is Nephroptosis most common?
Females, young and thin, more common the right side. 64% of those w fibromuscular dysplasia of renal artery have this
What is happening with Nephroptosis?
Kidney drops >5cm upon moving from supine to standing. Theorized o be dt lack of perirenal fat and fascial support and/or longer renal vascular pedicle
Risk factors of Nephroptosis
Excessive weight loss
Frequent intense physical activity
Sx of Nephroptosis
Severe abdominal, CVA, flank pain and vomitting in upright position dt
- acute hydronephorosis kinked proximal ureter
- renal vessel lumen narrowing and ischemia
- visceral nerve stimulation from traction
Nephroptosis Crisis sx
Severe pain, N/V, chills, tachycardia, oliguria, hematuria, proteinuria.
Pain relieved w upward movement of kidney/supine position
PE of Nephroptosis
kidney palpable in ipsilateral lower abdomen
DDX of Nephroptosis
Urolithiasis, cholecystitis, spastic bowel, PN, ovarian cyst, appendicitis, divertilucitis
Workup for Nephroptosis
renal US, IV urography
Tx for Nephroptosis
- Surgical nephropexy for symptomatic its w flank pain >1yr
- Laparoscopic nephropexy (newer tx)
3 Cystic diseases of the kidney
- Simple or solitary cyst
- Autosomal Dominant Polycystic Kidney Disease (ADPKD)
- Acquired Renal Cystic Disease
Presentation of Simple cysts
Flank/back intermittent dull back pain, fever and malaise if infect. Abdominal mass, may be tender if infected
Diagnosis of Simple cysts
Labs: Normal UA
US: Sharply demarcated w smooth walls, enhanced back wall
CT: Smooth thin wall, sharply demarcated, should not enhance w contrast media
Tx of Simple cysts
Leave alone if simple
Const. hydrotherapy
Drainage or antimicrobial tx if infected
Surgery if obstruction
Dx of ADPKD
15-39yo w at least 3 cysts in BOTH kidneys, 40-59yo at least 2 cysts, AND positive FHx
Sx of ADPKD
Pain over both kidneys, gross hematuria, HTN, nocturne, palpable nodular kidney
Renal insufficiency: HA, N/V, weight loss
Infected: fever, chills, tender kidneys
Labs for ADPKD
- Incr. erythropoietin leads to inc HCB and HCT
- Anemia from blood loss
- Proteinuria, hematuria, pyuria, bacteriuria
- Uremia from renal insufficiency (inc BUN and creatinine)
Imaging for ADPKD
KUB: enlarged renal shadows up to 5x size
CT: 95% accurate, can detect from 0.5cm
US: Most cost effective, can detect 1-1.5cm
MRI: Differentiate Renal Cell Carcinoma
Cx of ADPKD
- Gross Hematuria: rupture of cysts, mb CA
- Nephrolithiasis: Ca oxalate
- HTN
- ESRF: 50% leads to renal failure
- Pain: from enlarging cysts
- Other: Cerebral aneurysm, MVP, aortic aneurysm, colonic diverticula
Tx of ADPKD
- Low protein diet (0.5-0.75g/kg/d)
- 3000ml or more fluids
- Restrict caffeine
- Flax oil
- Avoid strenuous activity
- Treat uremia, stones, infection
- Tx HTN
- Constitutional HP
- Somatostatin, everolius
Dx of ADPKD
Kids: poor
35-40 or older: 5-10 year life expectancy
5 types of Renal Parenchymal Neoplasms
- Beingin Tumors
- Adenocarcinoma or Renal Cell Carcinoma
- Nephroblastoma (Wilms’ Tumor)
- Sarcoma of the kidney
- Secondary renal tumor
MC type of benign tumor
Renal Adenomas: small, well differentiate glandular tumors of renal cortex. Asx -identified at autopsy
Population most effected by RCC/RCA
Males in 50-70’s, blacks and hispanics
Risk factors for RCC/RCA
Smoking, analgesics, ADPKD, obesity, toxins, coffee, animal fat, dialysis, hysterectomy, contrast IVU, Von Hippel-Landau dz
Pathogenesis of RCC/RCA
Originates from proximal renal tubular epithelium. Spreads via direct invasion through capsule or extension into renal vein.
Most common site of metastasis of RCC/RCA
Lung
RCC/RCA can cause paraneoplastic syndromes, which top 4 does this include?
Erythrocytosis
Hypercalcemia
HTN
Non-metastatic hepatic dysfunction
Sx of RCC/RCA
“Great masquerader”
Triad: gross hematuria, flank pain, palpable and mass
Fever, weight loss, HTN
Males: L varicocele from blockage of L testicular vein
Sx of metastasis of RCC/RCA
Dyspnea, cough, seizure, bone pain
Labs for RCC/RCA
Hematuria (gross or microscopic)
Elevated ESR; anemia
Abnormal LFT from toxin build up (inc alk phase, dec albumin)
Maybe inc alpha-fetoprotein or beta-hCG
Procedures for RCC/RCA for diagnosis
Renal bx and fine needle aspiration
Imaging for RCC/RCA
US: simple cysts, thrombus
CT: method of choice for staging and extent of brain mets
CXR: useful for mets
PET: monitor response to systemic therapy
Tx of RCC/RCA
- Nephrectomy for localized stage 1 &2
- Chemo/radiation (not proven effective)
- Biologic response modulators
- Molecularly targeted therapies (Inhibitors of VEGF or mTOR)
Population most effected by Wilms’ Tumor
~3.5 yo
Sx of Wilms’ Tumor
Abd mass and pain, HTN, hematuria, anemia
Dx of WIlms’ Tumor
Found on US or CT
Tx of Wilms’ Tumor
Surgical removal, mb chemo
Population most effected by Sarcoma of the Kidney
patients >50yo
Sx of Sarcoma of the kidney
Flank/abd pain, weight loss
Types of Sarcomas of the kidney
Leiomyosarcoma (females) Fibrosarcoma Liposarcoma Hemangiopericytomas Osteogenic sarcoma Malignant schwannomas
Tx of Sarcomas of the kidney
Radical nephrectomy for localized disease is the only effective therapy.
Top four cancers most likely to metastasize to kidneys?
Lung 20%
Breast 12%
Stomach 11%
Contralateral renal 9%
2 lab findings found with secondary renal tumors
Albuminuria and hematuria
Are pain and renal insufficiency common with secondary renal tumors?
No, they are rare.
