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Urology > Quiz 2 > Flashcards

Quiz 2 Flashcards

1
Q

Sx of Diabetic Nephropathy

A

Albuminuria
Occult hematuria
Diabetic symptoms

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2
Q

2 key things to monitor w Diabetic Nephropathy

A
  1. Microalbumin (random am sample or 24hr collection) N=0-30mg/d
    - microalbuminuria: “high” 30-300mg/d
    - macroalbuminuria: “very high” >300mg/d
  2. HbA1c levels (>6.5% diagnostic for DM)
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3
Q

Risk factors for Diabetic Nephropathy

A

FMHx, advanced age, HTN, poor glycemic control, minorities, obesity, smoking, OCP

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4
Q

Tx for Diabetic Nephropathy

A

1 treat diabetes; guidelines recommend drug therapy be initiated immediately

  • Gingko (protect glomerulus)
  • Flax and pumpkin seeds
  • Curcumin (renal protective)
  • Guggul
  • Chromium
  • ALA
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5
Q

Causes of Hypertensive Nephropathy

A

1: Atherosclerosis (deposition of hyaline-like material on arteriole wall)

  • Fibromuscular dysplasias
  • Polyarteritis nodosa
  • AV fistula
  • Aortic aneurism
  • Coarctation of aorta
  • Embolism
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6
Q

Pathogenesis of Hypertensive Nephropathy

A

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

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7
Q

Sx of Hypertensive Nephropathy

A

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

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8
Q

Labs (ish) for Hypertensive Nephropathy

A

Diastolic >120, HTN refractory to therapy. CBC, electrolytes, glucose, BUN, creatinine, UA, EKG, PLASMA RENIN, Captopril challenge test

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9
Q

Tx for Hypertensive Nephropathy

A
  • Control BP
  • Surgical reconstruction of damaged artery or bypass in case of hyperplasia
  • Tx atherosclerosis (guggal, garlic, EFA, B vit)
  • Vascular protectants (bioflavonoids, vaccinium)
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10
Q

Cx of Hypertensive Nephropathy

A 
Early death
Hypertensive heart disease
MI
CHF
Kidney damage
KI failure
Stroke
Loss of vision
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11
Q

What population is Nephroptosis most common?

A

Females, young and thin, more common the right side. 64% of those w fibromuscular dysplasia of renal artery have this

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12
Q

What is happening with Nephroptosis?

A

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

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13
Q

Risk factors of Nephroptosis

A

Excessive weight loss

Frequent intense physical activity

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14
Q

Sx of Nephroptosis

A

Severe abdominal, CVA, flank pain and vomitting in upright position dt

  1. acute hydronephorosis kinked proximal ureter
  2. renal vessel lumen narrowing and ischemia
  3. visceral nerve stimulation from traction
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15
Q

Nephroptosis Crisis sx

A

Severe pain, N/V, chills, tachycardia, oliguria, hematuria, proteinuria.

Pain relieved w upward movement of kidney/supine position

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16
Q

PE of Nephroptosis

A

kidney palpable in ipsilateral lower abdomen

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17
Q

DDX of Nephroptosis

A

Urolithiasis, cholecystitis, spastic bowel, PN, ovarian cyst, appendicitis, divertilucitis

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18
Q

Workup for Nephroptosis

A

renal US, IV urography

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19
Q

Tx for Nephroptosis

A
  • Surgical nephropexy for symptomatic its w flank pain >1yr

- Laparoscopic nephropexy (newer tx)

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20
Q

3 Cystic diseases of the kidney

A
  1. Simple or solitary cyst
  2. Autosomal Dominant Polycystic Kidney Disease (ADPKD)
  3. Acquired Renal Cystic Disease
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21
Q

Presentation of Simple cysts

A

Flank/back intermittent dull back pain, fever and malaise if infect. Abdominal mass, may be tender if infected

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22
Q

Diagnosis of Simple cysts

A

Labs: Normal UA
US: Sharply demarcated w smooth walls, enhanced back wall
CT: Smooth thin wall, sharply demarcated, should not enhance w contrast media

23
Q

Tx of Simple cysts

A

Leave alone if simple
Const. hydrotherapy
Drainage or antimicrobial tx if infected
Surgery if obstruction

24
Q

Dx of ADPKD

A

15-39yo w at least 3 cysts in BOTH kidneys, 40-59yo at least 2 cysts, AND positive FHx

25
Q

Sx of ADPKD

A

Pain over both kidneys, gross hematuria, HTN, nocturne, palpable nodular kidney

Renal insufficiency: HA, N/V, weight loss

Infected: fever, chills, tender kidneys

26
Q

Labs for ADPKD

A
  • Incr. erythropoietin leads to inc HCB and HCT
  • Anemia from blood loss
  • Proteinuria, hematuria, pyuria, bacteriuria
  • Uremia from renal insufficiency (inc BUN and creatinine)
27
Q

Imaging for ADPKD

A

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

28
Q

Cx of ADPKD

A
  1. Gross Hematuria: rupture of cysts, mb CA
  2. Nephrolithiasis: Ca oxalate
  3. HTN
  4. ESRF: 50% leads to renal failure
  5. Pain: from enlarging cysts
  6. Other: Cerebral aneurysm, MVP, aortic aneurysm, colonic diverticula
29
Q

Tx of ADPKD

A
  1. Low protein diet (0.5-0.75g/kg/d)
  2. 3000ml or more fluids
  3. Restrict caffeine
  4. Flax oil
  5. Avoid strenuous activity
  6. Treat uremia, stones, infection
  7. Tx HTN
  8. Constitutional HP
  9. Somatostatin, everolius
30
Q

Dx of ADPKD

A

Kids: poor

35-40 or older: 5-10 year life expectancy

31
Q

5 types of Renal Parenchymal Neoplasms

A
  1. Beingin Tumors
  2. Adenocarcinoma or Renal Cell Carcinoma
  3. Nephroblastoma (Wilms’ Tumor)
  4. Sarcoma of the kidney
  5. Secondary renal tumor
32
Q

MC type of benign tumor

A

Renal Adenomas: small, well differentiate glandular tumors of renal cortex. Asx -identified at autopsy

33
Q

Population most effected by RCC/RCA

A

Males in 50-70’s, blacks and hispanics

34
Q

Risk factors for RCC/RCA

A

Smoking, analgesics, ADPKD, obesity, toxins, coffee, animal fat, dialysis, hysterectomy, contrast IVU, Von Hippel-Landau dz

35
Q

Pathogenesis of RCC/RCA

A

Originates from proximal renal tubular epithelium. Spreads via direct invasion through capsule or extension into renal vein.

36
Q

Most common site of metastasis of RCC/RCA

A

Lung

37
Q

RCC/RCA can cause paraneoplastic syndromes, which top 4 does this include?

A

Erythrocytosis
Hypercalcemia
HTN
Non-metastatic hepatic dysfunction

38
Q

Sx of RCC/RCA

A

“Great masquerader”
Triad: gross hematuria, flank pain, palpable and mass

Fever, weight loss, HTN
Males: L varicocele from blockage of L testicular vein

39
Q

Sx of metastasis of RCC/RCA

A

Dyspnea, cough, seizure, bone pain

40
Q

Labs for RCC/RCA

A

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

41
Q

Procedures for RCC/RCA for diagnosis

A

Renal bx and fine needle aspiration

42
Q

Imaging for RCC/RCA

A

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

43
Q

Tx of RCC/RCA

A
  1. Nephrectomy for localized stage 1 &2
  2. Chemo/radiation (not proven effective)
  3. Biologic response modulators
  4. Molecularly targeted therapies (Inhibitors of VEGF or mTOR)
44
Q

Population most effected by Wilms’ Tumor

A

~3.5 yo

45
Q

Sx of Wilms’ Tumor

A

Abd mass and pain, HTN, hematuria, anemia

46
Q

Dx of WIlms’ Tumor

A

Found on US or CT

47
Q

Tx of Wilms’ Tumor

A

Surgical removal, mb chemo

48
Q

Population most effected by Sarcoma of the Kidney

A

patients >50yo

49
Q

Sx of Sarcoma of the kidney

A

Flank/abd pain, weight loss

50
Q

Types of Sarcomas of the kidney

A 
Leiomyosarcoma (females)
Fibrosarcoma
Liposarcoma
Hemangiopericytomas
Osteogenic sarcoma
Malignant schwannomas
51
Q

Tx of Sarcomas of the kidney

A

Radical nephrectomy for localized disease is the only effective therapy.

52
Q

Top four cancers most likely to metastasize to kidneys?

A

Lung 20%
Breast 12%
Stomach 11%
Contralateral renal 9%

53
Q

2 lab findings found with secondary renal tumors

A

Albuminuria and hematuria

54
Q

Are pain and renal insufficiency common with secondary renal tumors?

A

No, they are rare.

Urology (1 decks)

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