Renal 3 Flashcards
- 50% of patients with these stones have hyperuricemia (gout)
- Other people w/ these stones have diseases w/ rapid cell turnover (leukemia)
- The stones are usually radiolucent (unlike others)
Uric Acid Stones
- Rare stones
- Found in patients w/ an inborn error of amino acid metabolism
Cysteine Stones
(Cystinosis = inborn error)
Why do people w/ leukemia get uric acid stones?
Due to the treatment for their condition
Most urinary stones are found where? (2)
- Renal pelvis
- Urinary bladder
Which stones grow larger and can fill the entire renal pelvis?
Staghorn calculi
What is “spasmotic pain caused by contraction of obstructed ureter?”
Urinary colic (typical symptom of urinary stones)
Other common symptom is hematuria
- Young men get this and think they have a hernia (but with no hx of fall/strain)
- Paroxysms of flank pain radiating towards the groin
- Fevers
Renal Colic from urinary stones
Tx for urinary stones
- Smaller stones may be voided w/ relief of sxs
- Larger stones require surgery or mechanical extraction (after stones have been broken into smaller pieces)
- Breaking urinary stones into smaller pieces
- Ultrasonic targeting to stones
Lithotripsy
Where do urinary tract obstructions occur?
- May occur at any level of the urinary tract (urethra to renal pelvis)
What 3 things can result from not recognizing a Urinary Tract Obstruction?
Increase susceptibility to:
- infection
- stone formation
- permanent renal atrophy (hydronephrosis)
Where are 90% of obstructions located?
Below the level of the glomeruli (therefore cause obstructions to urine flow)
What 3 developmental defects can cause Urinary Tract Obstructions?
- strictures
- stenoses
- bladder neck obstructions
What other 7 things cause Urinary Tract Obstructions besides defects and inflammation?
- urinary calculi
- pregnancy
- BPH
- prostate cancer
- infection
- spinal cord injury
- uterine prolapse
Which 3 inflammations can cause Urinary Tract Obstructions?
- Urethritis
- Prostatitis
- Ureteritis
Dilation of the renal pelvis and calyces associated w/ progressive atrophy of the kidney due to obstruction to the outflow of urine
Hydronephrosis
Hydronephrosis
- Progressive pressure and dilation affects the collecting ducts and cortical regions (compressing the renal vasculature) which can affect ___.
GFR
Hydronephrosis
- Obstruction can trigger an interstitial inflammatory reaction (mediated by leukocytosis) eventually leading to ____ ____.
Interstitial Fibrosis
Kidneys may become transformed into a thin walled cystic structure w/ striking parenchymal atrophy, obliteration of pyramids and thinning of cortex
“far advanced cases of hydronephrosis”
An acute obstruction may cause what type of pain
Colic-type pain (attributed to distention of the collecting system)
Which type of hydronephrosis?
- may remain silent for long periods
Unilateral, (complete or partial)–> (as the unaffected kidney maintains renal function)
Which type of hydronephrosis?
- Results in an inability to concentrate urine, reflected by polyuria and nocture, leading to nephritis
Bilateral, partial hydronephrosis
Which type of hydronephrosis?
- Results in oliguria or anuria, incompatible w/ long survival, due to irreversible kidney damage
(WORST ONE)
Bilateral, complete hydronephrosis
- Are neoplams of the urinary tract usually malignant or benign?
- Who are they more common in?
- Malignant
- Older patients and Men
What are the 3 most common types of renal cancers?
- Renal Cell Carcinoma (RCC)
- Transitional Cell Carcinoma of renal pelvis
- Wilms Tumor (pediatric)
What are the 2 benign tumors of the kidney?
- Renal cortical adenomas
- Fibromas
- RCC is more common in males or females?
- Median age?
- Etiology?
- Males
- 55 yrs
- Idiopathic, but studies indicate link to cigarette smoking
Compared to RCC (Silent/bastard killer), which cancer is more common, slower growing, and easier to tx?
Bladder cancer
- Grossly appear as nodules or masses that are sharply demarcated from remaining renal parenchyma
- Arise from either upper or lower poles of kidneys
RCC
- On cross section, appear as yellow, somewhat bosselated (jets out of blood), encapsulated tumors that can extend through the renal capsule into the perirenal fat, adrenals, or renal vein
RCC
What vessel allows for spread of cancer (quick metastasis) of RCC?
Renal vein is involved early on
Where does distant metastasis spread to w/ RCC?
- Lungs
- Bones
What cells make up RCC?
Cuboidal cells reminiscent of renal tubules that have either clear or granular cytoplasm
The cuboidal cells of RCC are filled with which 2 things?
- Glycogen
- Lipids
(adenocarcinoma)
What is the most frequent presenting symptom of RCC, occuring 50% of patients
Hematuria
What is the classic triad of RCC?
- Hematuria
- Dull flank pain
- Palpable abdominal mass
How are 50% of RCC tumors diagnosed?
Accidentally on CT scan performed for an unrelated reason
A significant number of patients with RCC exhibit which sxs?
Non-specific sxs:
- weight loss
- long standing fever
- HTN
What are 2 rare lab findings of RCC?
Metabolic Paraneoplastic findings:
- Hypercalcemia
- Polycythemia
- How is RCC treated?
- 5 year survival, what % live?
- What % die?
- Surgically
- 35% live
- 65% die
