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
Why can’t you give ACE or ARB with bilateral sentosis?
ACE reduces renal blood flow and GFR in patients causing acute kidney injury
What is the intial test to diagnose someone with renovascular hypertension?
Dopper Ultrasound is the initial test
CT angiogram is gold standard
How is atherosclerotic renal artery stenosis diagnosed?
luminal occlusion of >60-75%
Atherosclerotic renal artery stenosis: treatment
- treat the HTN
- monitor for CKD
- secondary prevention= STATIN!
- surgery: angiopasty with stent (or bypass)**
Fibromuscular dysplasia
- Women under 50
- noninflammatory, nonatherosclerotic disorder leading to arterial stenosis, dissection and arterial toruosity
What are the two angiographic classifications of fibromuscular dysplasia?
- Multifocal (string of beads)
2. Focal (circumferential or tubular stenosis)
Fibromuscular dysplasia: clinical presentation
- Pulsatile tinnitus
- HA
- neck pain
- HTN
- cervical or ABD bruit
What medication would be the most appropriate to start a patient with fibromuscular dysplasia?
Medical: ACE or ARB
Surgical: Angioplasty
*This is done by nephrology, so refer!!!!
