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Foundations of Clinical Practice II > Renal > Flashcards

Renal Flashcards

1
Q

Renal Cell Carcinoma: risk factors

A
  • SMOKING*****
  • HTN*
  • Obesity*
  • Chronic dialysis*
  • Men
  • Heavy ASA, NSAID or acetaminophen use
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2
Q

Renal Cell Carcinoma: which is the most common type?

A

Clear cell (75-85%)

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3
Q

Renal cell carcinoma: clear cell

A
  • deletion of chromosome 3p
  • Proximal tubule
  • usually solid
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4
Q

Renal Cell Classic Triad

A
  1. Hematuria
  2. Abdominal mass
  3. Flank Pain
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5
Q

Renal cell carcinoma clinical presentation (other)

A
  • Left-sided scrotal varicocele
  • Weight loss
  • Hypercalcemia (increased PTH)
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6
Q

Renal Cell carcinoma: diagnostics

A

Abdominal CT with/without contrast

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7
Q

Solid renal mass is found, what do you do?

A

tissue biopsy!

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8
Q

Localized renal cell carcinoma: stage I, II, III: What is the treatment?

A

surgery :)

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9
Q

Advanced RCC (stage IV): Treatment

A
  1. Immunotherapy
  2. Surgery
  3. Radiation
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10
Q

If a small renal mass is found what are two predictors of malignancy?

A
  1. Male

2. Increasing tumor size

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11
Q

When is surveillance an exceptable option for a renal mass?

A

<1cm

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12
Q

Describe the surveillance strategy for a small renal mass

A

If <2cm.
-Imaging and look for metastasis every 3-6 months for 2 years.
After this, image every 6-12 months

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13
Q

MC abdominal malignancy in children

A

Wilms tumor

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14
Q

Wilms tumor: pathology

A
  • pseudocapsule
  • 3 cell types: blastemal cell, stromal cell, epithelial cell
  • solitary lesion
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15
Q

What is the most common feature of Wilms tumor on clinical presentation?

A
  • Abdominal mass
  • Smooth palpable mass
  • Doesn’t cross midline
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16
Q

What is the best initial study for a possible Wilms tumor?

A

abdominal US

17
Q

What is the definitive diagnosis for a suspected Wilms tumor?

A

histologic confirmation (biopsy)

18
Q

What test should follow a US in Wilms tumor diagnosis?

A

CT or MRI with contrast

19
Q

What labs are important to get for a Wilms tumor?

A
  1. renal function
  2. UA
  3. liver function
  4. calcium
  5. CBC
  6. coagulation study**
20
Q

Describe the surveillance for Wilms tumor

A

-managed by pediatric oncologist

  1. CXR
  2. Abdominal ultrasound
  3. CT - chest/abdomen/pelvic every 6-8 weeks during therapy. Then, every 3 months for 2 years
21
Q

What is the most common cause of secondary hypertension?

A

Renovascular hypertension (renal artery stenosis)

22
Q

What are the two most common etiologies of Renovascular hypertension?

A
  1. Atherosclerosis**

2. Fibromuscular dysplasia

23
Q

What are the clinical manifestations of Renovascular hypertension?

A
  • Abdominal bruit**

- HTN with recurrent episodes of flash pulmonary edema

24
Q

Suspect Renovascular hypertension if _________> 30% after starting ACE or ARB

A

serum creatinine

25
Q

Why can’t you give ACE or ARB with bilateral sentosis?

A

ACE reduces renal blood flow and GFR in patients causing acute kidney injury

26
Q

What is the intial test to diagnose someone with renovascular hypertension?

A

Dopper Ultrasound is the initial test

CT angiogram is gold standard

27
Q

How is atherosclerotic renal artery stenosis diagnosed?

A

luminal occlusion of >60-75%

28
Q

Atherosclerotic renal artery stenosis: treatment

A
  • treat the HTN
  • monitor for CKD
  • secondary prevention= STATIN!
  • surgery: angiopasty with stent (or bypass)**
29
Q

Fibromuscular dysplasia

A
  • Women under 50

- noninflammatory, nonatherosclerotic disorder leading to arterial stenosis, dissection and arterial toruosity

30
Q

What are the two angiographic classifications of fibromuscular dysplasia?

A
  1. Multifocal (string of beads)

2. Focal (circumferential or tubular stenosis)

31
Q

Fibromuscular dysplasia: clinical presentation

A
  • Pulsatile tinnitus
  • HA
  • neck pain
  • HTN
  • cervical or ABD bruit
32
Q

What medication would be the most appropriate to start a patient with fibromuscular dysplasia?

A

Medical: ACE or ARB

Surgical: Angioplasty

*This is done by nephrology, so refer!!!!

Foundations of Clinical Practice II (25 decks)

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