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Urology > Quiz 2 > Flashcards

Quiz 2 Flashcards

1
Q

Symptoms of Diabetic nephropathy

A
  • albuminuria
  • Occult hematuria
  • Concurrent diabetic symptoms
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2
Q

What test is standard of care for management of diabetes mellitus?

A

Immunologic measurement of microalbumin in urine

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3
Q

How can we assess diabetic nephropathy

A

-Quantitative measurement of albuminuria

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4
Q

What lab test other than albumin do you need to run on patients with diabetic nephropathy?

A

HbA1c

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5
Q

What are concurrent symptoms patients with diabetic nephropathy have?

A
  • Retinopathy

- Neuropathy

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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)

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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
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8
Q

What is a major cause of ESRD, especially in the elderly?

A

Renovascular Disease

  • Hypertensive
  • Nephropathy
  • Nephrosclerosis
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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
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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
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11
Q

What are signs that indicate complications of hypertensive NEPHROPATHY?

A
  • Left ventricular hypertrophy
  • Hypertensive retinopathy
  • Abdominal Bruit over renal AA
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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
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13
Q

What laboratory result shows high clinical suspicion of hypertensive nephropathy

A
  • UA
  • EKG
  • Plasma Renin
  • Catopril Challenge Test
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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
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15
Q

What is nephroptosis?

A
  • Floating/Falling Kidney

- Kidney drops >5cm upon moving from supine to standing position

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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
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17
Q

What cases N/V in upright position in the case of nephroptosis?

A
  1. Acute hydronephrosis kinked proximal ureter
  2. Renal Vessel lumen narrowing and resultant ischemia
  3. Visceral nerve stimulation from traction
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18
Q

Physical exams for nephroptosis?

A

Kidney palpable in ipsilateral lower abdomen

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19
Q

Workup for nephroptosis?

A
  • Renal U/S
  • IV Urography
  • look for hydronephrosis
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20
Q

Two treatments for nephroptosis?

A
  1. Surgical Nephropexy for symptomatic pt with flank pain

2. Laparoscopic nephropexy

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21
Q

Symptoms of simple or solitary cysts

A
  • Intermittent/dull flank or back pain
  • Fever malaise if infection
  • Abdominal Mass (tender if infected)
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22
Q

Labs for simple or solitary cysts

A
  • Normal UA

- Rarely Hematuria

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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
Q

Criteria for dx of ADPKD:

  • 15-39 yo
  • 40-59 yo
A
  • 15-39: atleast 3 cysts in both kidneys
  • 40-59 yo: at least 2 cysts

For both: positive FHx

26
Q

common differentials for cystic kidneys?

A
  • hydronephrosis
  • bilateral renal tumor(rare)
  • tuberous sclerosis
  • Von- Hippel Laindau syndrome
27
Q

Sx of Polycystic Kidney Disease?

A
  • 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
Q

What lab findings do you see in Polycystic Kidney Disease?

A
  • Increased erythropoietin leading to increased HGB and HCT
  • Anemia from blood loss
  • Proteinuria/hematuria

If renal insufficiency (Increased BUN and creatinine)

29
Q

Why would you run a U/S vs. CT for polycystic kidneys

What about MRI?

A

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
Q

6 complications of Polycystic kidneys

A
  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
Q

11 Treatments for Polycystic Kidneys

A
  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
Q

What is acquired Renal Cystic Disease?

A

Multiple cysts found in patients without a hereditary link.

-seen w/ patients on dialysis and CKD

33
Q

What is the most common benign kidney tumor?

A

Renal Ademona

34
Q

What is renal adenomas appearance?

A

Small, well-differentiated, glandular tumor or renal cortex

-Pt is asymptomatic usually

35
Q

What is the name of the renin secreting tumor that causes hypertension

A

Juxtaglomerular Cell Tumor

36
Q

Where does renal cell carcinoma and adenocarcinoma arise from?

What percentage of primary malignant renal tumors does this account for?

A
  • Glandular tissue

- 87%

37
Q

Most common site of metastasis for RCC or RCA

A

-#1 Lung

  • bone
  • lymph node
  • adrenal gland
  • brain
  • opposite kidney
38
Q

What is paraneoplastic syndrome

A
  • Erythrocytosis
  • Hypercalcemia
  • HTN
  • Non-metastatic hepatic dysfunction

-tumors secrete biologically active products

39
Q

What are two types of cancer staging

A
  1. Robson System (Stage I-IVB0

2. Tumor-Node metastasis (TNM)- more commonly uses

40
Q

What do we use to grade cancers?

A

Fuhrman Grading

-4 grades based on nuclear characteristics (levels of differentiation)

41
Q

What is the presentation for Adenocarcinoma and Renal Cell Carcinoma

A
  • Great masquerader
  • Classic triad: Gross hematuria, flank pain, palpable abdominal mass
  • fever , weight loss, HTN

Males: possible L varicocele

42
Q

What are symptoms that suggest RCC and RCA metastasized?

A
  • Dyspnea
  • Cough
  • Seizure
  • Bone pain
43
Q

What are the expect laboratory results for RCC and RCA?

A
  • Elevated ESR
  • Gross microscopic hematuria
  • Low serum Iron
  • Low TIBC
  • Abnm lLFT
  • Increased alpha-feto protein
44
Q

Discuss the Imaging you would preform in RCC and RCA

A
  • 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
Q

Treatment for RCC and RCA

A
  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
Q

What is a nephroblastoma

A
  • Wilms’ Tumor
  • Mixed malignant tumor of kidneys MC in children

-Abnormal Proliferation of metanephric blastema cells

47
Q

Symptoms of Nephroblastoma (Wilms’ Tumor)

A
  • Genetic Predisposition
  • Abdominal Mass
  • Abdominal Pain
  • HTN
  • Hematuria
  • Anemia
48
Q

Gold Standard DX of Nephroblastoma (Wilms’ Tumor)

A

U/S or CT

49
Q

Treatment for Nephroblastoma

A
  • Surgical Removal

- Chemo for higher stages

50
Q

What is Sarcoma of the Kidney

A

arise from embryonic mesoderm thus in bone, cartilage, fat, muscle, vascular and blood

51
Q

6 Types of Sarcoma of the Kidney

A
  • Leiomyosarcoma (female)
  • Fibrosarcoma
  • Liposarcoma
  • Hemangiopericytomas
  • Osteogenic Sarcoma
  • Malignant Schwannomas
52
Q

Sarcoma of the Kidney SX

A
  • Flank/abdominal pain

- Weight loss

53
Q

Treatment for Sarcoma of the kidney

A
  • Radical nephrectomy for localized disease is the only effective treatment
  • Adjuvant chemo reduces incidence of local reccurence
54
Q

MC secondary renal tumors metastasize from wherE?

A
  • Lung (20%)
  • Breast (12%)
  • Stomach (11%)
  • Contralateral Renal (9%)
55
Q

SX of Secondary Renal Tumor

A
  • Albuminuria and hematuria

- Rare to have renal insufficiency and pain

56
Q

Signs that show high clinical suspicion for hypertensive nephropathy

A
  • Refractory to aggressive therapy
  • Severe HTN with progressive renal insufficiency
  • Malignant HTN
  • Elevated Creatinine
57
Q

What labs must you run on a patient you suspect hypertensive nephropathy

A
  • Renal arteriography
  • Doppler US of renal arteries
  • MRI(angiography)
  • CT

Urology (4 decks)

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