Renal Carcinomas Flashcards
MC primary renal malignancy
renal cell carcinoma
MC age and gender a/w renal cell carcinoma
6th-8th decade, ~64 avg
M>W
Risk factors for renal cell carcinoma
SMOKING!!! HTN Obesity chronic dialysis toxic exposures heavy aspirin, NSAIDS genetics
MC type of renal cell carcinoma? What is the genetic mutation?
Clear cell
deletion of chromosome 3p
What are the usual sx of renal cell carcinoma?
usually asymptomatic until advanced disease
- hematuria
- abdominal mass
- flank pain
Others:
weight loss
scrotal varicocele
What is the usual diagnostic scan for renal cell carcinoma?
CT abd w/ & w/o contrast
What must be done w/ all solid renal masses and why?
tissue biopsy
even smaller masses may by malignant
In what type/stage of RCC is surgery curative?
localized RCC (stages I, II, III)
What is considered a small renal mass?
why is increasing size important?
< 4 cm
the larger the mass, the more likely it is high-grade or advanced RCC
What studies/management is indicated w/ a small renal mass?
- urology
- dedicated renal CT or MRI w/o and then w/ contrast
- CMP and BMP- paraneoplastic syndrome
- renal fxn to eval for CKD
- chest imaging for mets
- biopsy
When is surveillance an option with small renal masses?
if the mass is < 1 cm
MC type of renal tumor in children?
Wilms tumor
MC presentation of pt w/ Wilms tumor?
Other sx?
Abdominal mass= MC
others:
- abd pain
- hematuria
- fever
- hypertension
What is the initial study done in pts done w/ possible Wilms tumor?
What is done for definitive dx?
initially= abd U/S
Definitive= histologic confirmation (surgical excision or biopsy)
What is tx for Wilms tumor? Prognosis?
chemo and surgical excision
good, 5-year survival 90%
What does renovascular disease cause?
Secondary HTN
What is gold standard for diagnosing renovascular diseases?
But… what is more commonly done?
Duplex Doppler US= gold standard
CTA = MC
What is the cause of atherosclerotic renal artery disease?
reduced blood flow to kidney
usually involves aortic orifice or proximal main renal artery
What are Risk factors for atherosclerotic renal artery stenosis?
- hyperlipidemia
- cigarette smoking
- age > 50
What result is needed for dx of atherosclerotic renal artery stenosis?
how do you treat?
luminal occlusion of at least 60-75%
Tx:
tx HTN, monitor CKD, revascularization
What age group/gender is most at risk for fibromuscular dysplasia?
women < 50 yo
What is fibromuscular dysplasia?
noninflammatory, nonatherosclerotic disorder leading to arterial stenosis, occlusion, aneurysm, dissection, and arterial tortuosity
What are clinical signs of fibromuscular dysplasia?
- HA, pulsatile tinnitus, neck pain, flank pain, abd pain
- HTN, cervical or abdominal bruit, TIA, stroke
How do you manage fibromuscular dysplasia?
- ACE or ARB
- Surgical= angioplasty
