Quiz 2 Flashcards
1
Q
Symptoms of Diabetic nephropathy
A
- albuminuria
- Occult hematuria
- Concurrent diabetic symptoms
2
Q
What test is standard of care for management of diabetes mellitus?
A
Immunologic measurement of microalbumin in urine
3
Q
How can we assess diabetic nephropathy
A
-Quantitative measurement of albuminuria
4
Q
What lab test other than albumin do you need to run on patients with diabetic nephropathy?
A
HbA1c
5
Q
What are concurrent symptoms patients with diabetic nephropathy have?
A
- Retinopathy
- Neuropathy
6
Q
Proteinuria in diabetics can be due to what other dz?
-What do you look for?
A
- Glomerular Dz
- Look for urine sediments (cells, casts)
7
Q
What are natural treatment approaches to diabetes
A
- Ginkgo
- Flax and Pumpkin Seed
- Curcumin (antioxidant, renal protective)
- Guggul
- Chromium
- Alpha Lipoic Acid
- Vaccinium
8
Q
What is a major cause of ESRD, especially in the elderly?
A
Renovascular Disease
- Hypertensive
- Nephropathy
- Nephrosclerosis
9
Q
What are steps toward preventing Hypertensive Nephropathy and Nephrosclerosis?
A
- Lifestyle changes may reduce the risk of hypertension
- Exercise to improve cardiac fitness
- Lose weight if overweight
- Dietry adjustments to help control hypertension
- Modify sodium
10
Q
What are symptoms of Hypertensive Nephropathy?
A
- Repeated elevated BP
- Ha, fatigue, confusion
- Vision changes, angina like chest pain
- heart failure
- heamturia
- Difficult to control HTN
- Epistaxis
- Irregulat heartbeat
11
Q
What are signs that indicate complications of hypertensive NEPHROPATHY?
A
- Left ventricular hypertrophy
- Hypertensive retinopathy
- Abdominal Bruit over renal AA
12
Q
What laboratory result shows moderate clinical suspicion of hypertensive nephropathy
A
- Diastolic > 120mm Hg,
- HTN refractory to therapy
Run:
- CBC
- Electrolytes
- glucose
- BUN
- Creatinine
13
Q
What laboratory result shows high clinical suspicion of hypertensive nephropathy
A
- UA
- EKG
- Plasma Renin
- Catopril Challenge Test
14
Q
What is the treatment for hypertensive nephropathy?
A
- Control BP with meds
- Percutaneous transluminal angioplasty (insertion of stent)
- Surgical reconstruction of damaged artery
- Surgical bypass of renal arteries in fibromuscular hyperplasia
- Treat atherosclerosis: guggal, garlic EFA, B vit
- Vascular protectants: bioflavonoids, vaccinium
15
Q
What is nephroptosis?
A
- Floating/Falling Kidney
- Kidney drops >5cm upon moving from supine to standing position
16
Q
Sx of nephroptosis include what?
A
- Severe abdominal, costovertebral and flank pain
- N/V in upright position
- Pain relieved with upward movement of the kidneys, supine position
17
Q
What cases N/V in upright position in the case of nephroptosis?
A
- Acute hydronephrosis kinked proximal ureter
- Renal Vessel lumen narrowing and resultant ischemia
- Visceral nerve stimulation from traction
18
Q
Physical exams for nephroptosis?
A
Kidney palpable in ipsilateral lower abdomen
19
Q
Workup for nephroptosis?
A
- Renal U/S
- IV Urography
- look for hydronephrosis
20
Q
Two treatments for nephroptosis?
A
- Surgical Nephropexy for symptomatic pt with flank pain
2. Laparoscopic nephropexy
21
Q
Symptoms of simple or solitary cysts
A
- Intermittent/dull flank or back pain
- Fever malaise if infection
- Abdominal Mass (tender if infected)
22
Q
Labs for simple or solitary cysts
A
- Normal UA
- Rarely Hematuria
23
Q
U/S for simple or solitary cysts
A
Criteria for simple benign cyst:
- echo-free, sharply demarcated with smooth walls.
- Enhanced back wall indicating good transmission thru the cyst
24
Q
What is Autosomal Dominant Polycystic Kidney Disease
ADPKD
A
- Most common hereditary Dz in US
- Bilaterally enlarged kidneys with multiple cysts
- Poor prognosis
25
Criteria for dx of ADPKD:
- 15-39 yo
- 40-59 yo
- 15-39: atleast 3 cysts in both kidneys
- 40-59 yo: at least 2 cysts
For both: positive FHx
26
common differentials for cystic kidneys?
- hydronephrosis
- bilateral renal tumor(rare)
- tuberous sclerosis
- Von- Hippel Laindau syndrome
27
Sx of Polycystic Kidney Disease?
- Pain over both kidneys due to infection
- Obstruction
- Hemorrhage
- Gross hematuria
- Nocturia
- Palpable Nodular Kidney
- Renal insufficiency will see HA N/V and weight loss
- Infection: fever, chills, tender kidneys
28
What lab findings do you see in Polycystic Kidney Disease?
- Increased erythropoietin leading to increased HGB and HCT
- Anemia from blood loss
- Proteinuria/hematuria
If renal insufficiency (Increased BUN and creatinine)
29
Why would you run a U/S vs. CT for polycystic kidneys
What about MRI?
U/S detects cysts from 1-1.5 cm, its cost effective, good place to start
CT: 95% accurate and detects small cysts 0.5cm
MRI differentiates Renal Cell Carcinoma from Cysts
30
6 complications of Polycystic kidneys
1. ) Gross Hematuria: rupture cyst into renal pelvis/stone/UTI, recurrent bleeding suggest renal carcinoma
2. ) Nephrolithiasis
3. )Hypertension: cyst-induced ischemia activates renin-angiotensin
4. ) ESRF: 50% progress to RF
5. ) Cerebral Aneurysm, MVP, colonic diverticula
31
11 Treatments for Polycystic Kidneys
1. Low protein diet
2. Forced fluid to >3000ml/day
3. Restrict caffeine
4. Flax Oil
5. Reasonable Physical Activity-avoid strenuous
6. Treat uremia, stones, infx
7. Screen for/tx HTN
8. Possible dialysis, renal transplant, cystic decompression
9. Constitutional homeopathy (baryta, calc, pos)
10. Constitutional Hydro
11. Conventional drugs (somatostatin, mTOR inhibitors)
32
What is acquired Renal Cystic Disease?
Multiple cysts found in patients without a hereditary link.
-seen w/ patients on dialysis and CKD
33
What is the most common benign kidney tumor?
Renal Ademona
34
What is renal adenomas appearance?
Small, well-differentiated, glandular tumor or renal cortex
| -Pt is asymptomatic usually
35
What is the name of the renin secreting tumor that causes hypertension
Juxtaglomerular Cell Tumor
36
Where does renal cell carcinoma and adenocarcinoma arise from?
What percentage of primary malignant renal tumors does this account for?
- Glandular tissue
| - 87%
37
Most common site of metastasis for RCC or RCA
-#1 Lung
- bone
- lymph node
- adrenal gland
- brain
- opposite kidney
38
What is paraneoplastic syndrome
- Erythrocytosis
- Hypercalcemia
- HTN
- Non-metastatic hepatic dysfunction
-tumors secrete biologically active products
39
What are two types of cancer staging
1. Robson System (Stage I-IVB0
| 2. Tumor-Node metastasis (TNM)- more commonly uses
40
What do we use to grade cancers?
Fuhrman Grading
-4 grades based on nuclear characteristics (levels of differentiation)
41
What is the presentation for Adenocarcinoma and Renal Cell Carcinoma
- Great masquerader
- Classic triad: Gross hematuria, flank pain, palpable abdominal mass
- fever , weight loss, HTN
Males: possible L varicocele
42
What are symptoms that suggest RCC and RCA metastasized?
- Dyspnea
- Cough
- Seizure
- Bone pain
43
What are the expect laboratory results for RCC and RCA?
- Elevated ESR
- Gross microscopic hematuria
- Low serum Iron
- Low TIBC
- Abnm lLFT
- Increased alpha-feto protein
44
Discuss the Imaging you would preform in RCC and RCA
- US: Defines simple cysts/tumor/thrombs (done first)
- CT: method of choice for staging and extent of brain mets
- CXR: useful for Mets, radio nucleotide useful for bone mets. MRI useful for vascular extension
- Pet: monitors response to systemic therapy
45
Treatment for RCC and RCA
1. Partial or Radical Nephrectomy for localized Stage I/II
2. Chemo and Radiation-not proven effective
3. Biologic Response Modulators
- Interleukin and Interferon
4. Molecularly Targeted Therapies
Inhibitors of VEGF + mTOR
5. Adjuvant Naturopathic care
6. Stage-specific follow up with repeat CTs
46
What is a nephroblastoma
- Wilms' Tumor
- Mixed malignant tumor of kidneys MC in children
-Abnormal Proliferation of metanephric blastema cells
47
Symptoms of Nephroblastoma (Wilms' Tumor)
- Genetic Predisposition
- Abdominal Mass
- Abdominal Pain
- HTN
- Hematuria
- Anemia
48
Gold Standard DX of Nephroblastoma (Wilms' Tumor)
U/S or CT
49
Treatment for Nephroblastoma
- Surgical Removal
| - Chemo for higher stages
50
What is Sarcoma of the Kidney
arise from embryonic mesoderm thus in bone, cartilage, fat, muscle, vascular and blood
51
6 Types of Sarcoma of the Kidney
- Leiomyosarcoma (female)
- Fibrosarcoma
- Liposarcoma
- Hemangiopericytomas
- Osteogenic Sarcoma
- Malignant Schwannomas
52
Sarcoma of the Kidney SX
- Flank/abdominal pain
| - Weight loss
53
Treatment for Sarcoma of the kidney
- Radical nephrectomy for localized disease is the only effective treatment
- Adjuvant chemo reduces incidence of local reccurence
54
MC secondary renal tumors metastasize from wherE?
- Lung (20%)
- Breast (12%)
- Stomach (11%)
- Contralateral Renal (9%)
55
SX of Secondary Renal Tumor
- Albuminuria and hematuria
| - Rare to have renal insufficiency and pain
56
Signs that show high clinical suspicion for hypertensive nephropathy
- Refractory to aggressive therapy
- Severe HTN with progressive renal insufficiency
- Malignant HTN
- Elevated Creatinine
57
What labs must you run on a patient you suspect hypertensive nephropathy
- Renal arteriography
- Doppler US of renal arteries
- MRI(angiography)
- CT
