Renal Flashcards
Renal Cell Carcinoma: risk factors
- SMOKING*****
- HTN*
- Obesity*
- Chronic dialysis*
- Men
- Heavy ASA, NSAID or acetaminophen use
Renal Cell Carcinoma: which is the most common type?
Clear cell (75-85%)
Renal cell carcinoma: clear cell
- deletion of chromosome 3p
- Proximal tubule
- usually solid
Renal Cell Classic Triad
- Hematuria
- Abdominal mass
- Flank Pain
Renal cell carcinoma clinical presentation (other)
- Left-sided scrotal varicocele
- Weight loss
- Hypercalcemia (increased PTH)
Renal Cell carcinoma: diagnostics
Abdominal CT with/without contrast
Solid renal mass is found, what do you do?
tissue biopsy!
Localized renal cell carcinoma: stage I, II, III: What is the treatment?
surgery :)
Advanced RCC (stage IV): Treatment
- Immunotherapy
- Surgery
- Radiation
If a small renal mass is found what are two predictors of malignancy?
- Male
2. Increasing tumor size
When is surveillance an exceptable option for a renal mass?
<1cm
Describe the surveillance strategy for a small renal mass
If <2cm.
-Imaging and look for metastasis every 3-6 months for 2 years.
After this, image every 6-12 months
MC abdominal malignancy in children
Wilms tumor
Wilms tumor: pathology
- pseudocapsule
- 3 cell types: blastemal cell, stromal cell, epithelial cell
- solitary lesion
What is the most common feature of Wilms tumor on clinical presentation?
- Abdominal mass
- Smooth palpable mass
- Doesn’t cross midline
What is the best initial study for a possible Wilms tumor?
abdominal US
What is the definitive diagnosis for a suspected Wilms tumor?
histologic confirmation (biopsy)
What test should follow a US in Wilms tumor diagnosis?
CT or MRI with contrast
What labs are important to get for a Wilms tumor?
- renal function
- UA
- liver function
- calcium
- CBC
- coagulation study**
Describe the surveillance for Wilms tumor
-managed by pediatric oncologist
- CXR
- Abdominal ultrasound
- CT - chest/abdomen/pelvic every 6-8 weeks during therapy. Then, every 3 months for 2 years
What is the most common cause of secondary hypertension?
Renovascular hypertension (renal artery stenosis)
What are the two most common etiologies of Renovascular hypertension?
- Atherosclerosis**
2. Fibromuscular dysplasia
What are the clinical manifestations of Renovascular hypertension?
- Abdominal bruit**
- HTN with recurrent episodes of flash pulmonary edema
Suspect Renovascular hypertension if _________> 30% after starting ACE or ARB
serum creatinine
