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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?

A

90%

24
Q

Wilms Tummor treatment

A

Chemotherapy and surgical excision

25
Q

What makes up the majority of secondary hypertension causes?

A

Atherosclerotic Renal Artery Stenosis= 80-90%

26
Q

What is the other cause of secondary hypertension ?

A

Fibromusclar dysplasia=10-15%

27
Q

When do we want to consider renovascular disease as cause for secondary hypertension?

A
  1. Young onset
  2. Severe or resistant HTN
  3. Acute rise over stable value
28
Q

What is your best INITIAL test in renovascular dz?

A

CT angiogram

29
Q

atherosclerotic renal artery stenosis treatment

A
  1. Tx HTN
  2. Monitor CKD
  3. Secondary CV prevention: STATINS!
  4. Revascularization: Angioplasty w/ or w/o stenting or bypass
30
Q

What population does fibromusclar dysplasia MCly occur in?

A

Women <50 y.o.

31
Q

What is the clinical presentation of fibromusclar dysplasia?

A
  1. HA
  2. Pulsatile tinnitus
  3. Neck pain
  4. Flank or abdominal pain
  5. HTN
  6. TIA/Stroke
  7. Cervical/abdominal bruit
32
Q

fibromusclar dysplasia medical management

A

ACE-1 or ARB

33
Q

fibromusclar dysplasia surgical intervention?

A

Angioplasty

34
Q

What is the MC clinical presentation of Simple renal cyst?

A

usually ASYMPTOMATIC

MC incidental findings

35
Q

U/S criteria for simple cyst

A
  1. Sharply demarcated with smooth thin walls

2. No echoes (anechoic) w/in the mass

36
Q

U/S characteristics of complex cyst

A
  1. Thick walls and/or septations
  2. Calcifications
  3. Solid components
  4. Mixed echogenicity
  5. Vascularity
37
Q

What is the MC reason for acquired renal cysts?

A

Chronic renal failure

38
Q

acquired renal cysts dx criteria

A
  1. Bilateral involvement
  2. > 4 cysts
  3. Diameter range <0.5 cm up to 2 – 3 cm
39
Q

Treatment for acquired renal cyst if persistent pain and cyst >5 cm

A
  1. Percutaneous aspiration

2. Laparoscopic unroofing

40
Q

What mutation is the most aggressive form of Autosomal Dominant Polycystic Kidney Disease (ADPKD)?

A

PKD1 mutation=85-90%

41
Q

What is the slow growing ADPKD?

A

PKD2 mutation

42
Q

What would you expect to see in 75% of cases of ADPKD?

A

Family history

43
Q

Peak age of ADPKD?

A

30-40’s

44
Q

Clinical presentation in ADPKD

A
  1. PAIN: Abdominal, flank or back pain
  2. HTN= 50% of patients
  3. Abdominal mass
  4. Hematuria
45
Q

What is an early indicator of ADPKD that is often overlooked?

A
  1. Frequent UTI’s

2. Recurrent nephrolithiasis

46
Q

What is the best initial diagnostic test for ADPKD?

A

US

47
Q

ADPKD treatment

A
  1. Manage HTN: ACE-1 or ARB, low sodium
  2. Pain management
  3. Avoid nephrotoxic agents
  4. Avoid contact sports
48
Q

Medullary Sponge kidney etiology

A

Congenital disorder

  1. Most sporadic w/ no family hx
  2. Familial autosomal dominant= RARE
49
Q

Medullary Sponge kidney etiology presentation

A

Usually ASYMPTOMATIC

-Found incidentally

50
Q

What would you expect to see on a CT in Medullary Sponge kidney

A

Cystic dilated of the distal collecting tubules

51
Q

If hypercalciruria is present in Medullary Sponge kidney, how can we treat this?

A

Thiazide diuretic

52
Q

Complication of Thiazide diuretic

A

Recurrent UTI’s or nephrolithiasis can lead to decline

53
Q

Medullary Cystic Disease (Nephronophthisis) etiology

A

Autosomal recessive inheritance

54
Q

What is the major complication of Medullary Cystic Disease (Nephronophthisis)?

A

Progression to ESRD before age 20

55
Q

Clinical presentation of Medullary Cystic Disease (Nephronophthisis)

A
  1. Polyuria
  2. Polydipsia
  3. Bland urinary sediment
  4. Thirsty
56
Q

What is associated with Medullary Cystic Disease (Nephronophthisis)?

A

Retinitis pigmentosa

57
Q

Definitive dx of Retinitis pigmentosa

A

Genetic testing

Foundations-Nephro (2 decks)

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