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Foundations-Nephro > Renal cell carcinoma/Wilms/Renovascular dz/Renal Cyst > Flashcards

Renal cell carcinoma/Wilms/Renovascular dz/Renal Cyst Flashcards

1
Q

What is the mean age of renal cell carcinoma? Gender?

A

64 y.o.

Males

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2
Q

What is the biggest risk factor for renal cell carcinoma?

A

Smoking!!

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3
Q

What is the MC renal cell carcinoma?

A

Clear cell= 75-85%

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4
Q

What is the genetic mutation of clear cell?

A

Deletion of chromosome 3p

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5
Q

What is the second MC RCC?

A

Papillary= 10-15%

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6
Q

What is the classic triad of sx’s we see in RCC in ADVANCED disease?

A
  1. Hematuria
  2. Abdominal Mass
  3. Flank pain
    * Most are ASYMPTOMATIC I in early dz
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7
Q

What are the MC sites of RCC metastasis

A
  1. Lungs
  2. Lymph nodes
  3. Bone
  4. Liver
  5. Brain
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8
Q

What syndrome is RCC associated with?

A

Paraneoplastic Syndrome:

  1. Anemia
  2. Fever, cachexia
  3. Thrombocytosis
  4. Polymalgia reumatica
  5. Erythrocytosis
  6. Hypercalcemia
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9
Q

What is the best diagnostic tool to evaluate RCC?

A

Abdominal CT with/without contrast

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10
Q

Treatment for RCC- Stage I, II and III

A

Surgery is curative

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11
Q

Advanced RCC (stage IV) treatment

A
  1. Surgery
  2. Radiation
  3. Systemic therapy
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12
Q

What are the predictors of malignancy in RCC

A
  1. Male sex

2. Increasing tumor size: <2 cm=20-40% benign, >4 cm= 20-30% high grade

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13
Q

Why would we order a CMP and CBC in the evaluation of RCC?

A

Check for paraneoplastic syndrome

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14
Q

If the tumor is <3 cm, what treatment option can we consider?

A

Thermal ablation

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15
Q

If the tumor is <2 cm, what treatment option can we consider?

A

Surveillance

  • Imaging q 3-6 months x2 yrs
  • Then q 6-12 months
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16
Q

If the tumor is <1 cm, what treatment option can we consider?

A

surveillance

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17
Q

If the tumor is <4 cm, what treatment option can we consider?

A

Surgery: Partial Nephrectomy

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18
Q

What makes up 95% of primary renal malignancies in children <15 y.o.?

A

Wilms Tumor

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19
Q

What is the MC clinical presentation in Wilms Tumor

A

Abdominal mass

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20
Q

What is the definitive dx for Wilms tumor?

A

Histological confirmation

-Surgical excision or biopsy

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21
Q

What is the INITIAL STUDY for evaluation of a Wilms Tumor

A

Abdominal U/S

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22
Q

Why would we order coags in Wilms Tumor?

A

look for bleeding disorder that is commonly seen in this cancer=Von Willebrand dz

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23
Q

What is the 5-year survival for Wilms?

24
Q

Wilms Tummor treatment

A

Chemotherapy and surgical excision

25
What makes up the majority of secondary hypertension causes?
Atherosclerotic Renal Artery Stenosis= 80-90%
26
What is the other cause of secondary hypertension ?
Fibromusclar dysplasia=10-15%
27
When do we want to consider renovascular disease as cause for secondary hypertension?
1. Young onset 2. Severe or resistant HTN 3. Acute rise over stable value
28
What is your best INITIAL test in renovascular dz?
CT angiogram
29
atherosclerotic renal artery stenosis treatment
1. Tx HTN 2. Monitor CKD 3. Secondary CV prevention: STATINS! 4. Revascularization: Angioplasty w/ or w/o stenting or bypass
30
What population does fibromusclar dysplasia MCly occur in?
Women <50 y.o.
31
What is the clinical presentation of fibromusclar dysplasia?
1. HA 2. Pulsatile tinnitus 3. Neck pain 4. Flank or abdominal pain 5. HTN 6. TIA/Stroke 7. Cervical/abdominal bruit
32
fibromusclar dysplasia medical management
ACE-1 or ARB
33
fibromusclar dysplasia surgical intervention?
Angioplasty
34
What is the MC clinical presentation of Simple renal cyst?
usually ASYMPTOMATIC | MC incidental findings
35
U/S criteria for simple cyst
1. Sharply demarcated with smooth thin walls | 2. No echoes (anechoic) w/in the mass
36
U/S characteristics of complex cyst
1. Thick walls and/or septations 2. Calcifications 3. Solid components 4. Mixed echogenicity 5. Vascularity
37
What is the MC reason for acquired renal cysts?
Chronic renal failure
38
acquired renal cysts dx criteria
1. Bilateral involvement 2. > 4 cysts 3. Diameter range <0.5 cm up to 2 – 3 cm
39
Treatment for acquired renal cyst if persistent pain and cyst >5 cm
1. Percutaneous aspiration | 2. Laparoscopic unroofing
40
What mutation is the most aggressive form of Autosomal Dominant Polycystic Kidney Disease (ADPKD)?
PKD1 mutation=85-90%
41
What is the slow growing ADPKD?
PKD2 mutation
42
What would you expect to see in 75% of cases of ADPKD?
Family history
43
Peak age of ADPKD?
30-40's
44
Clinical presentation in ADPKD
1. PAIN: Abdominal, flank or back pain 2. HTN= 50% of patients 3. Abdominal mass 4. Hematuria
45
What is an early indicator of ADPKD that is often overlooked?
1. Frequent UTI's | 2. Recurrent nephrolithiasis
46
What is the best initial diagnostic test for ADPKD?
US
47
ADPKD treatment
1. Manage HTN: ACE-1 or ARB, low sodium 2. Pain management 3. Avoid nephrotoxic agents 4. Avoid contact sports
48
Medullary Sponge kidney etiology
Congenital disorder 1. Most sporadic w/ no family hx 2. Familial autosomal dominant= RARE
49
Medullary Sponge kidney etiology presentation
Usually ASYMPTOMATIC | -Found incidentally
50
What would you expect to see on a CT in Medullary Sponge kidney
Cystic dilated of the distal collecting tubules
51
If hypercalciruria is present in Medullary Sponge kidney, how can we treat this?
Thiazide diuretic
52
Complication of Thiazide diuretic
Recurrent UTI’s or nephrolithiasis can lead to decline
53
Medullary Cystic Disease (Nephronophthisis) etiology
Autosomal recessive inheritance
54
What is the major complication of Medullary Cystic Disease (Nephronophthisis)?
Progression to ESRD before age 20
55
Clinical presentation of Medullary Cystic Disease (Nephronophthisis)
1. Polyuria 2. Polydipsia 3. Bland urinary sediment 4. Thirsty
56
What is associated with Medullary Cystic Disease (Nephronophthisis)?
Retinitis pigmentosa
57
Definitive dx of Retinitis pigmentosa
Genetic testing

Foundations-Nephro (2 decks)

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