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PHA 521 > Renal > Flashcards

Renal Flashcards

1
Q

Renal Cell Carcinoma: Epidemiology

A

MC primary renal malignancy

M>F

6-8th decade

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2
Q

Renal Cell Carcinoma: Risk Factors

A

SMOKING

htn
obesity
chronic dialysis
toxic exposures
heavy aspirin, acetaminophen, nsaids
genetics
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3
Q

Renal Cell Carcinoma: Pathology

A 
MC: clear cell
papillary (chromophilic)
chromophobe
oncocytic
collecting duct (bellini's duct)
unclassified
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4
Q

Clear Cell RCC

A

deletion of chromosome 3p
proximal tubule
usually solid

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5
Q

Papillary RCC

A

proximal tubule

type 1: good prognosis
tupe 2: aggressive

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6
Q

Renal Cell Carcinoma: Clinical Presentation

A

asymptomatic until advanced disease

MC: HEMATURIA
ABDOMINAL MASS
FLANK PAIN

weight loss
L side scrotal varicocele
IVC involvement (LE edema, ascites, hepatic dysfunction, pulmonary emboli)
metastasis (lungs, lymph nodes, bone, liver, brain)
paraneoplastic syndromes

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7
Q

Paraneoplastic Syndromes

A 
anemia
hepatic dysfunction
fever
hypercalcemia
cachexia
erythrocytosis
secondary amyloidosis
thrombocytosis
polymyalgia rheumatica
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8
Q

Renal Cell Carcinoma: Diagnostics

A

Preferred test:
abdominal CT with/without contrast

MRI if US or CT nondiagnostic/contraindicated

Definitive diagnosis: 
tissue biopsy (nephrectomy, partial nephrectomy)
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9
Q

Renal Cell Carcinoma: Diagnostics: evaluation of metastasis

A

bone scan

CT chest

MRI w/ gad

PET or PET/CT

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10
Q

Renal Cell Carcinoma: Treatment: stage I, II, III

A

surgery is curative

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11
Q

Renal Cell Carcinoma: Treatment: stage IV

A

systemic therapy

surgery

radiation

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12
Q

Management of a Small Renal Mass: predictors of malignancy

A

male sex

increasing tumor size

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13
Q

Management of a Small Renal Mass: <2cm

A

20-40% benign
<10% high-grade RCC
<1% present with/develop mets

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14
Q

Management of a Small Renal Mass: 4+cm

A

5-10% benign

20-30% high-grade or advanced RCC

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15
Q

Management of a Small Renal Mass: Diagnostics

A

1st line: renal CT
2nd line: MRI
without then with IV contrast

CMP, CBC (paraneoplastic syndrome)

renal function (CKD)

chest imaging (malignancy, mets)

biopsy

urology

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16
Q

Management of a Small Renal Mass: Treatment Options

A

surgery (partial nephrectomy)

thermal ablation (<3cm)

surveillance (<2cm)
with imaging and mets evaluation every 3-6mo for 2 years – then every 6-12mo

surveillance (<1cm)

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17
Q

Wilms Tumor: Epidemiology

A

95% of primary renal malignancies in children under 15yo

sporadic

18
Q

Wilms Tumor: Pathology

A

abnormal renal development

loss of function of tumor suppressor genes

19
Q

Wilms Tumor: Features

A

solitary lesion

surrounded by pseudocapsule

composed of 3 cell types:

  • blastemal cells
  • stromal cells
  • epithelial cells
20
Q

Wilms Tumor: Clinical Presentation

A

abdominal mass

less common:
abdominal pain
hematuria
fever
hypertension
21
Q

Wilms Tumor: Diagnostics

A

definitive diagnosis: histologic confirmation (surgical excision, biopsy)

initial study:
abdominal US

CT or MRI w/ contrast

Labs: 
renal function
UA
liver function
Ca
CBC
coag studies

**be sure to evaluate contralateral kidney

22
Q

Wilms Tumor: Treatment

A

refer to peds cancer

chest imaging for mets

chemotherapy and surgical excision

surveillance
CXR, abd US, chest/abd/pelvic CT
-every 6-8wk during therapy
-every 3 months x 2 years
-every 6 months x 2 years
23
Q

Wilms Tumor: Prognosis

A

5 yr survival: 90%

inc risk of premature death in adulthood due to secondary neoplasms and other late complications

24
Q

Renovascular Disease

A

cause of secondary HTN

  • MC: atherosclerotic RAS
  • fibromuscular dysplasia

associated w/ accelerated target organ injury

  • LVH
  • renal fibrosis
25
Q

When to consider renovascular disease

A

young onset
severe or resistant
acute rise over stable value

serum creatinine >30% after ACE-I or ARB

HTN w/ recurrent episodes of flash pulmonary edema

stage II HTN onset after 55yo

HTN w/ diffuse atherosclerosis, unilateral small kidney, asymmetric renal size

abdominal bruit

26
Q

Renovascular Disease: Diagnostics

A

Labs: elevated BUN, Cr

Imaging:

  • MC: CTA
  • GOLD STANDARD: renal arteriography
  • duplex doppler US
  • MRA

**CTA is not great at picking up distal vessels (fibromuscular dysplasia)

27
Q

Renovascular Disease: Atherosclerotic Renal Artery Stenosis

A

aka ischemic nephropathy
>age 45
comorbidities: CAD, PAD

28
Q

Renovascular Disease: Atherosclerotic Renal Artery Stenosis: Etiology

A

reduced blood flow to kidney

involves

  • aortic orifice
  • proximal main renal artery
29
Q

Renovascular Disease: Atherosclerotic Renal Artery Stenosis: Risk Factors

A

hyperlipidemia
cigarette smoking
age >50yo

30
Q

Renovascular Disease: Atherosclerotic Renal Artery Stenosis: Diagnosis

A

luminal occlusion of at least 60-75%

31
Q

Renovascular Disease: Atherosclerotic Renal Artery Stenosis: Treatment

A

treat the HTN

monitor CKD

CV secondary prevention

revascularization (angioplasty w/ or w/out stenting or bypass)

32
Q

Renovascular Disease: Fibromuscular Dysplasia

A

women

33
Q

Renovascular Disease: Fibromuscular Dysplasia: Etiology

A

noninflammatory, nonatherosclerotic disorder leading to arterial stenosis, occlusion, aneurysm, dissection and arterial tortuosity

reduced blood flow to kidney

usually involves distal main renal artery or intrarenal branches

34
Q

Renovascular Disease: Fibromuscular Dysplasia: Angiographic Classification

A

multifocal (string of beads)
vs
focal (circumferential or tubular stenosis)

35
Q

Renovascular Disease: Fibromuscular Dysplasia: Clinical Presentation

A

HA
pulsatile tinnitus
neck pain
flank or abd pain

HTN
cervical or abd bruit
TIA
stroke

36
Q

Renovascular Disease: Fibromuscular Dysplasia: Medical Management

A

ACE-I or ARB
F/U with:
-serum creatinine every 6mo
-duplex US every 6-12mo

37
Q

Renovascular Disease: Fibromuscular Dysplasia: Surgical Management

A 
angioplasty
F/U with duplex US and serum creatinine at 
-1st post op visit
-every 6 mo x 2 yrs
-annually
38
Q

Renovascular Disease: ACE-I’s and ARBs

A

renal perfusion dec due to stenosis

autoregulation maintains GFR – inc in efferent arteriolar resistance

medical blockade of angiotensin II formation blunts autoregulation –> reduced GFR –> possible AKI

39
Q

Renovascular Disease: Surgical Treatment: Complications

A

renal artery dissection

capsular perforation

hemorrhage

atheroembolic disease

40
Q

Renovascular Disease: Surgical Treatment: most likely to benefit

A

short duration of BP elevation prior to dx

failure of medical therapy to control BP

intolerance to medical therapy

recurrent flash pulmonary edema and/or refractor HF

PHA 521 (12 decks)

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