Renal Cancer Flashcards
Exam 3
RENAL CANCER:
Epidemiology- What is the most common kind?
Renal cell carcinoma or adenocarcinoma is most common
RENAL CANCER:
Epidemiology- Who does it occur more often in?
Occurs more often in males age 50-70 than females
RENAL CANCER:
Pathophysiology: Where is it usually found?
Usually found in the cortex or pelvis of the kidney
RENAL CANCER:
Pathophysiology: What is more common in the kidney?
malignant tumors in the kidney are more frequent than benign tumors
RENAL CANCER:
Epidemiology: What ethnicity is it most common?
African Americans and American Indians Alaskan native populations have slightly highly rates of renal cancer for unknown reasons
Renal Cancer:
Clinical manifestations: How are patients intially?
Initially asymptomatic
Renal Cancer:
Clinical manifestations: How does 10% of the population present?
10% present with the classic triad
Renal Cancer:
Clinical manifestations: What is the classic triad?
Flank mass
flank pain
hematuria
RENAL CANCER
Management: What is needed to diagnose?
Several studies needed to diagnose
RENAL CANCER
Management:
Biological immunotherapy- boost immune system or cytokines
Radical nephrectomy
Renal cancer:
When it metastizes, where does it go/
Usually to the lungs, liver and long bones of the body
RENAL CANCER
What are risk factors?
obesity, hypertension, and exposure to certain substances such as gasoline, abestos, medications like diuretics
smoking
People with any type of cystic disease or ESRD
RENAL CANCER:
Clinical Manifestations: What are other symptoms of Renal Cancer? (not classic triad)
other symptoms include weight loss, fatigue, hypertension, fever that is not related to an infection and anemia
If men have renal cancer, what could it cause?
Compression of the testicular vein
Enlargement of the scrotum
RENAL CANCER:
What are used to differentiate between solid mass tumors and cysts?
There are a number of studies that need to be done to diagnose renal cancers
ultrasounds are used to differentiate between solid masses tumors and cysts
RENAL CANCER:
What other tests are used?
other tests include angiography, percutaneous needle aspiration, CT scan an MRI
RENAL CANCER:
What does radionuclide isotopes used for?
radionuclide isotopes scanning is used to detect metastasis
RENAL CANCER:
What is urine cystoscopy testing for?
urine cystoscopy testing shows the presence of neoplastic or atypical cells
Most renal cancer cells, how do they react to chemotherapy?
They don’t react to chemo
RENAL CANCER:
What is renal biopsy for?
renal biopsy is sometimes utilized to look at cancerous tissue cells
RENAL CANCER:
How can diagnosed cancer be staged?
Once diagnosed cancer can be staged to aid in treatment decisions.
Robson system of staging renal carcinoma is one of the staging system utilized. (don’t need to know different stages just know it exists?)
RENAL TRAUMA
Epidemiology: Who is most likely affected?
Most accidents involve males less than 30 years old and represent blunt force trauma
RENAL TRAUMA
Epidemiology: How does it occur?
Sharp blow may cause contusions, tearing, or rupture
RENAL TRAUMA
Pathophysiology and clinical manifestations:
How can injuries to renal system range?
Injuries to the renal system can range from contusion or hematoma to a shattered kidney
RENAL TRAUMA:
Pathophysiology and clinical manifestations: How is urine?
Urinary output can be reduced or absent
Hematuria
Renal Trauma: Why are kidneys vulnerable to injury?
The kidneys are vulnerable to injury because of the lack of bone protection
Renal Trauma: What kind of fractures damage renal system? How?
pelvic fractures can cause proliferation and tearing of the tissues in the renal system
Renal Trauma: What does hematuria NOT predict?
the amount of hematuria does not necessarily predict the degree of damage to the renal system
CHRONIC KIDNEY DISEASE:
Epidemiology: How is it world wide?
Worldwide health problem
CHRONIC KIDNEY DISEASE:
Epidemiology: Who are rates higher in? (ethnicity or gender)
Rates higher in African Americans and Native Americans
CHRONIC KIDNEY DISEASE:
Pathophysiology: What is it?
Progressive, irreversible loss of kidney function
CHRONIC KIDNEY DISEASE:
Pathophysiology: What are the most common causes?
Most common causes are diabetes and hypertension
CHRONIC KIDNEY DISEASE:
Pathophysiology: How is it characterized?
Characterized in 5 stages delineated by GFR
CHRONIC KIDNEY DISEASE
Clinical Manifestations
Devastating effect on every body system
CHRONIC KIDNEY DISEASE
Management: What kind of therapies?
Renal replacement therapies
CHRONIC KIDNEY DISEASE
Management: What is management needed for?
Hyperkalemia, hypertension, renal osteodystrophy, hypocalcemia, hyperparathyroidism, anemia, and dyslipidemia
CHRONIC KIDNEY DISEASE
Management: What kind of surgery may be necessary?
Renal transplantation
CHRONIC KIDNEY DISEASE
Alterations in potassium expression can lead to what?
alterations in potassium expression result in lethal arrhythmias
CHRONIC KIDNEY DISEASE
What happens to acid clearance? What does this result in?
a decrease in acid clearance and bicarbonate results in metabolic acidosis
CHRONIC KIDNEY DISEASE
What is there a decrease in production of?
a decrease in the production of erythropoietin results in chronic anemia
CHRONIC KIDNEY DISEASE
What is the diagnosis of CKD based on?
the diagnosis of chronic kidney disease is based on the consistent elevation of serum creatinine levels and a decrease creatinine clearance
CHRONIC KIDNEY DISEASE
What is another clear indicator of CKD?
another clear indicator is the presence of protein or albumin in the urine
CHRONIC KIDNEY DISEASE
What can urinalysis indicate for CKD?
urine analysis can detect red blood cells white blood cells protein cast and glucose
CHRONIC KIDNEY DISEASE
What can imaging studies indicate for CKD?
imaging studies such as renal ultrasound, a CT scan and a renal biopsy can provide additional information as to the status of the structure of the kidney and their function
CKD:
What kind of recipients benefit from kidney transplant the most?
recipients who are in good health except for the primary kidney disease are between the ages of five and 50 have the best outcome and prognosis
What are the three types of donors?
There are three types of donors
- deceased donors,
- living relative donors
- living unrelated donors
RENAL REPLACEMENT THERAPIES:
What do they do?
Artificial processes for removing waste and water from the body when kidneys no longer function
RENAL REPLACEMENT THERAPIES:
Renal replacement therapy techniques
include:
Intermittent hemodialysis (HD)
Continuous hemofiltration and HD
Peritoneal dialysis (PD)
RENAL REPLACEMENT THERAPIES:
Renal replacement therapy techniques
include:
Continuous hemofiltration and HD- What are they known as?
Known as continuous renal replacement therapies
Hemodialysis Vascular Access:
How may IV access be secured?
intravenous vascular access may be secured by using a central venous double lumen catheter in the subclavian or internal jugular vein
Hemodialysis Vascular Access:
Central venous double lumen catheter- When is it used?
this type of access typically is used for a short period of time and is used to treat patients with intermittent hemodialysis or when waiting for secured longer access such as atrial venous fistula or an AV graft
Hemodialysis Vascular Access:
How is an AV fistula created?
an av fistula is created by surgically joining an artery and a vein typically in the radial artery or the cephalic vein in the non dominant hand
Continuous Renal Replacement Therapy:
What is there a risk of occurring? Why?
Bleeding- because heparin is used
Muscle cramps, headaches because of the rapid removal of electrolytes
Peritoneal Dialysis:
What does this offer the patient? (How can patient take this dialysis)
it offers increased patient control and flexibility with options of home treatments
Peritoneal Dialysis:
What does it require of the patient?
it requires training of the patient that can be performed independently by the patient or even by the family members.
Peritoneal Dialysis:
How are dietary restrictions and mobility for patients?
How is clearance of metabolic waste?
typically peritoneal dialysis involves fewer dietary restrictions and greater mobility for patients.
Peritoneal Dialysis:
What does this type of dialysis avoid?
It avoids the rapid fluctuations in extracellular fluid compartments and associated symptoms
Peritoneal Dialysis:
How is clearance of metabolic waste?
The clearance of metabolic waste is slower but more continuous.
Peritoneal Dialysis:
Who is it indicated for?
peritoneal dialysis is indicated for patients who desire more control who have vascular access problems and who respond poorly to hemodialysis
Peritoneal Dialysis:
Who may PD be easier?
older patients with end stage renal disease and diabetes may more easily be maintained with PD
Peritoneal Dialysis:
What is used as a dialyzing layer?
with PD the peritoneal cavity is used as the dialyzing layer
Peritoneal Dialysis:
What does the process consist of?
the PD process consists of filling, dwelling and the draining phase
Peritoneal Dialysis:
What occurs in the filling phase?
in the filling phase room temperature sterile diacetate is instilled into the peritoneal cavity via a permanent indwelling PD catheter
What are the most common bacterial infections in the world?
UTI’s are one of the most common bacterial infections in the world and it accounts for 10 million healthcare visits
What are the most common reason for antibiotic prescription?
UTI’s are the most common reason for antibiotic prescription
Urinary tract infection:
How does bacteria enter?
bacteria usually enters the bladder through the urethra.
Population at risk for UTI
Women due to the female anatomy
Men of advanced age who have an enlarged prostate
Individuals with diabetes
Individual who require catheterization or incomplete emptying of the bladder
Poor hygiene
Estrogen deficiency
Clinical Manifestation of UTI
Bladder irritation/ painful urination (dysuria)
Urinary frequency
Urinary urgency
Urinating in small amounts/volume
Gross hematuria/microhematuria
Fever, nausea, vomiting
Flank pain in pyelonephritis
Foul smell urine
Medical Management for UTI:
What would a urinalysis show?
A urinalysis will show if there are nitrates , leukocytes, myoglobin or bacteria present.
Medical Management for UTI:
Why would leukocytes be present in the urine?
Leukocytes may be present in the urine if there is some type of inflammation or infectious process going on.
Medical Management for UTI:
Why would nitrates be present in the urine?
Nitrates can be seen if there are certain bacteria.
Medical Management for UTI:
What do nitrites convert to?
Nitrates converts into nitrites.
Medical Management for UTI:
What is the most common bacteria seen in uncomplicated UTIs?
E coli is a very common bacteria that is seen in uncomplicated uti’s.
Treatment of UTI:
Uncomplicated UTIs- who is it in?
Uncomplicated UTI (a female who is not pregnant, does not have diabetes and is afebrile)
Treatment of UTI:
Uncomplicated UTIs- What is the first line therapy? How long? What are examples?
First line are antimicrobial therapy
3-day course
Bactrim, Cipro and Macrobid
Treatment of UTI:
Complicated UTIs- Who do they occur in?
(occurs in patient with diabetes, febrile and male sex)
Treatment of UTI:
Complicated UTIs- How long is treatment?
Treatment last for 7 to 10 days
Treatment of UTI:
What does the choice of antibiotics depend on?
Choice of antibiotics depends on the culture
Complications Of UTI
Drug resistance
Pyelonephritis
Renal abscess
Urosepsis
UROLITHIASIS
Epidemiology: Where does it occur? What is the most prevalent?
Occur in kidneys, ureter, and bladder, with renal stones being the most prevalent
UROLITHIASIS
Pathophysiology
What occurs? Where?
Calcifications in the urinary system
UROLITHIASIS
Pathophysiology
What is it commonly referred to as?
Commonly referred to as kidney stones
UROLITHIASIS
Pathophysiology
How do stones form?
Microscopic crystals in the urinary tract aggregate together causing a stone to occur
UROLITHIASIS:
The calcification in urinary system commonly referred to as
Kidney Stones
nephrolithiasis
nephrolithiasis refers to the calculus in the kidneys
ureterolithiasis
ureterolithiasis refers to the calculus in the uterus
UROLITHIASIS: Who does it occur in the most?
kidney stones occur more frequently in male individuals and affects the white population more than the black population
UROLITHIASIS: What time of year does it occur the most? Why?
it occurs in the United states more commonly in the summer months likely because of humidity sweating and a decrease water consumption leading to dehydration
UROLITHIASIS:
The majority of stones are what? What are the others?
the majority of stones are calcium and the remaining include uric acid, cystine and Xanthine .
UROLITHIASIS:
Clinical manifestations include:
Severe pain when stone lodges in the ureter, causing distention and obstruction of urine flow
nausea and vomiting are also signs
pain in the flank area are also signs
gross hematuria can be present in any stone location and occurs in 95% of patients
UROLITHIASIS:
Management: What is the test of choice for imaging?
A CT scan is a quick noninvasive imaging modality with high sensitivity
Diagnostic modality of choice if noncontrast, stone survey CT scan
UROLITHIASIS:
Management: What kind of stones pass spontaneously?
50% of stones less than 5 mm pass spontaneously
UROLITHIASIS:
Management: When is surgical intervention necessary?
Surgical intervention is required when a stone is greater than 10 mm
surgical intervention is required if stones does not pass after four to six weeks
Hydronephrosis: What is it and when does it occur?
hydronephrosis or swelling of the kidneys occurs when urine flow is blocked allowing urine to accumulate in the kidneys
Potential sites of urinary calculi:
Kidneys
Ureters
Bladder
Extracorporeal Shock-Wave Lithotripsy (E S W L):
What is it used for?
To crush kidney stones
Extracorporeal Shock-Wave Lithotripsy (E S W L):
What can occur with this procedure (symptom wise)
nausea and vomiting can be expected as well as UTI signs such as fever
What is a ureteroscopy used for?
ureteroscopy is used for mid/ distal stones
Ureteroscopy- What is the procedure for this?
Under general anesthesia a flexible scope is inserted through the urethra and a bladder to identify and remove the stone
INCONTINENCE:
Pathophysiology and clinical manifestations
Involuntary or uncontrolled loss of urine in any amount
INCONTINENCE:
Pathophysiology and clinical manifestations
What are the types of incontinence
Stress incontinence,
urge incontinence,
mixed,
overflow incontinence, or
functional incontinence
INCONTINENCE:
Pathophysiology and clinical manifestations
What is stress incontinence?
stress incontinent refers to the leaking of urine when an individual laughs, coughs, exercises or lifts something.
INCONTINENCE:
Pathophysiology and clinical manifestations
What is urge incontinence?
urgent continence is the strong urge to urinate following an uncontrolled leakage
INCONTINENCE:
Pathophysiology and clinical manifestations
What is overflow incontinence?
overflow incontinence refers to as frequent urination
INCONTINENCE:
Pathophysiology and clinical manifestations
What is functional/consonant incontinence?
functional incontinence refers to the fact that the individual might be continent or is continent but environmental factors lead to the loss of urine at inappropriate times and areas
INCONTINENCE
Management: How is diagnosis made?
Diagnosis with history and laboratory tests
INCONTINENCE
Management: WHat is the goal of treatment?
Goal of treatment is to prevent or stop urinary leakage
INCONTINENCE
Management: What kind of exercise is done?
Strengthen the pelvic floor such as Kegel exercises
INCONTINENCE
What are complications? What is it related to?
Complications include skin changes
Related to exposure to a moist environment
Incontinence:
What group of medications are there?
medications such as anticholinergics calm the overactive bladder by blocking nerve stimulation.
alpha adrenergic blockers
Incontinence:
What do anticholinergics do?
Calm the overactive bladder by blocking nerve stimulation.
Incontinence:
What are types of anticholinergics?
Oxybutynin,
Incontinence:
What do alpha adrenergic blockers do? What is an example?
alpha adrenergic blockers promotes urethral relaxation and relaxation of the bladder neck and muscles these include
Flomax
4th most common cancer among men- what is it?
BLADDER CANCER
BLADDER CANCER: What is the most important risk factor?
Smoking is the most important risk factor
BLADDER CANCER: What are other risk factors to this?
other risk factors include:
occupational hazards from rubber,
chemical, coal
As well as environmental factors such as drinking arsenic containing well water and being exposed to pesticides
BLADDER CANCER: How is bladder cancer classified?
Classified as non- muscle invasive or muscle invasive cancer
BLADDER CANCER:
Pathophysiology and clinical manifestations
What is tumor formation attributed to?
Tumor formation is attributed to genetic changes in target cells
BLADDER CANCER:
What is the most common symptom?
Painless hematuria is the most common
BLADDER CANCER
Management include?
Thorough history and physical
Early detection and treatment increase survival rates
BLADDER CANCER
What do Superficial or low-grade bladder cancers
consist of?
Consist of excision or removal through fulguration or laser ablation
BLADDER CANCER
Management:
Invasive bladder cancer- what needs to be done?
Radical cystectomy
Combined with neoadjuvant or adjuvant chemotherapy
