Renal Cell Carcinoma Flashcards
ddx for hematuria
- Nephritic syndrome
- UTI
- stones
- trauma
- BPN
- malignancy
def microscopic hematuria
def macroscopic hematuria
causes of false positives for blood in urine analysis
myoglobinuria, beets, drugs (pyridium, phenytoin, rifampin, nitrofurantoin), or menstruation
talk to me about the shape of RBCs we may find in urine
Glomerular causes → dysmorphic RBCs +/- RBC casts
Extraglomerular causes → isomorphic RBCs w/no casts
isomorphic RBCs is malignancy until proven otherwise!
def renal cell carcinoma
adenocarcinoma
RF for RCC
- older
- African American
- comorbidities: obesity, HTN, sickle cell, and kidney disease
- hereditary diseases like tuberous sclerosis, von Hippel-Lindau syndrome
- occupational exposure: asbestos, herbicide
tell me about the epi of RCC
most common kidney cancer in adults
most commonly dx in males 50-70Y
tell me about sporadic vs hereditary RCC
sporadic is a nonhereditary type of RCC
hereditary is when there is some sort of genetic mutation that results in the dev of RCC that is passed down from generation to generation
- von Hippel Lindau syndrome ➔ ~40% dev RCC
- Hereditary papillary renal carcinoma
- Hereditary renal carcinoma
what s/s does RCC typically present with?
incidental discovery is common – with urine analysis that is indicated for other reasons
often is asymptomatic until later stages of disease
classic triad: hematuria, flank pain, and flank mass
other s/s:
- fever of unknown origin
- palpable flank mass
- polycythemia ➔ increased EPO
- hypercalcemia
what is a paraneoplastic syndrome?
malignant cells generate autoantibodies, cytokines, hormones, or peptides that affect multiple organ systems
what paraneoplastic syndromes might we see in RCC?
- Cushing syndrome
- gynecomastia
- hypercalcemia – PTHrP
- HTN - renin
- polycythemia - EPO
- Systemic amyloidosis
- Polyneuromyopathy
common met locations for RCC
Common met sites: LN, lungs, adrenals, liver, brain, and bone
how is the prognosis for RCC?
usually it’s pretty good, but it depends on the subtype
it is typically a slow growing cancer
what ix for suspected RCC?
- urine analysis: dipstick, microscopy, culture and sensitivty
- bloodwork: cbc, lytes, extended lytes, cr, urea, alt/alp, bilirubin
- imaging: U/S KUB then progress to CT w/ contrast or MRI for dx
consider other imaging for other mets based on s/s
