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Nayla Foundations Exam 5 > Renal Feirstein > Flashcards

Renal Feirstein Flashcards

1
Q

What is the epidemiology of RCC

A

M>W
avg onset 64 y/o
73% have a 5 year survival

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2
Q

What are the RF for RCC

A

SMOKING

HTN, obesity, chronic dialysis, increased ASA, NSAID, or APAP use, genetics, toxin exposures

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3
Q

What is the pathology of RCC

A

MC* clear cell: 3p deletion
Papillary/chromophilic (type 1 good prog, type 2 aggressive)
Chromophobe (oncocytic)

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4
Q

What is the triad associated with RCC

A

Hematuria
Flank pain
Abdominal mass

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5
Q

What are other symptoms of RCC

A 
scrotal varicocele 
weight loss 
ascites 
pulmonary emboli (IVC) 
mets to lungs, lymph, bone, liver, brain
paraneoplastic syndrome
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6
Q

How do you diagnose RCC

A

**abdominal CT w/ wo contrast
but can also use MRI
Tissue biopsy
to eval mets: bone scan, CT chest, MRI w/ contrast, or PET

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7
Q

How do you treat RCC

A

Localized (stage I-III): surgery is curative

Advanced (stage IV): systemic Tx, surgery, and radiation

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8
Q

What is a “small renal mass”

A

<4cm and enhances on contrast imaging
<2cm: usually benign (10% RCC)
4+cm: small% benign, 20-30% RCC

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9
Q

What are predictors of malignancy in a small renal mass

A

Male

increasing tumor size

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10
Q

What can be used to diagnose small renal masses

A 
renal CT/MRI w/wo
CMp
CBC
renal function tests 
chest imaging (mets?) 
\+/- biopsy 
**involve urology!
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11
Q

How do you manage a small renal mass

A

surgery!
<3cm: thermal ablation w/ biopsy
<2cm: imaging q 3-6 months for 2 yrs, then q 6-12 months
<1cm: surveillance

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12
Q

What is the MC primary pediatric renal tumor

A 
Wilms Tumor (<15 y/o) 
-abnormal renal development and loss of tumor suppressor gene function
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13
Q

What does Wilms look like

A

Solitary
surrounded by enhancing pseudocapsule
made of blastemal, stromal, and epithelial cells

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14
Q

Wilms tumor usually presents with

A

Abdominal mass, otherwise asymptomatic

rarely: abd pain, fever, HTN, hematuria

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15
Q

What is needed to definitively diagnose Wilms tumor

A

Biopsy (need histologic confirmation)
but, start w/ US, then CT or MRI before invasive biopsy
**check the other kidney!!

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16
Q

Labs done for Wilms tumor include

A

renal and liver function tests
UA, calcium, CBC, coags
refer to peds and get chest imaging for mets

17
Q

Why check coags in Wilms tumor

A

because many have associated Von Willebrand factor bleeding disorder

18
Q

What is the outcome of Wilms tumor

A

90% 5 year survival rate with chemo and surgical excision

BUT, increased risk for premature death as adult d/t chemo and radiation

19
Q

What should we do for surveillance in Wilms tumor patients

A

CXR, abd US, CT
q 6-8 weeks during treatment
q3 months for 2 years
q 6 months for 2 years after that

20
Q

What is renal vascular disease

A

a cause of secondary HTN (due to atherosclerotic disease* or fibromuscular dysplasia) associated with target organ injury (LVH, renal fibrosis)

21
Q

What are important Ddx for renal vascular disease

A

thromboembolic renal disease (in old and hypercoagulable, w/ flank pain, leukocytosis, n/v, HTN, renal decline)
Microvascular injury 2/2 HTN (hypertensive nephrosclerosis, arteriolonephrosclerosis)

22
Q

When should you consider renal vascular disease as a diagnosis

A 
Young onset, severe/resistant HTN, acute rise in BP 
SrCr increase >30% s/p ACE/ARB 
mod-severe HTN w/ flash pulm edema 
New onset Stage II HTN >55 y/o 
abdominal bruits
23
Q

What do renal vascular disease labs show

A

increased BUN/Cr

24
Q

How do you diagnose renal vascular disease

A

**renal arteriograph
also doppler, CTA
MRA last resort d/t complications with gandolinium

25
Q

When do you order diagnostic testing

A

only if intervention will be completed!

26
Q

What is atherosclerotic RAS

A

atherosclerosis leading to decreased renal blood flow involving the aorta or proximal main renal artery

  • it is a cardiac risk equivalent!
  • onset usually >45 y/o
27
Q

What are RF for atherosclerotis RAS

A

HLD
smoking
50+ y/o
comorbid CAD/PAD

28
Q

How do you diagnose atherosclerotic renal artery stenosis

A

60-75% luminal occlusion

29
Q

How do you treat ARAS

A

treat HTn
monitor CKD
secondary prevention (STATINS! ASA, stop smoking)

30
Q

What is fibromuscular dysplasia

A

non-inflammatory, non-atherosclerotic disorder leading to arterial stenosis, occlusion, aneurysm, dissection, or tortuosity AKA decreased renal blood flow

31
Q

What does FMD involve

A

distal main renal artery (unlike atherosclerotic which involves proximal) or intrarenal branches

32
Q

What does FMD show on angiography

A

multifocal (string of beads) vs focal (circumferential stenosis)

33
Q

What is the clinical presentation of FMD

A 
HA
pulsatile tinnitus 
neck pain
flank/abd pain
HTN
TIA
bruits
34
Q

How do you treat FMD

A

ACE/ARB (need SrCr q6 mo, and duplex q6-12 mo)

*Angioplasty (need duplex and SrCr @ 1st post-op, q6 mo for 2 years, then every year)

35
Q

Why are ACE/ARB contraindicated in RAS

A

normally, stenosis decreases renal perfusion and autoregulation (mediated by angiotensin II) maintains GFR
If you block angiotensin II, you stop autoregulation and decrease GFR= AKI
BUT, stenosis is what causes renal vascular disease (stenosis) SO
be cautious, but ACE/ARB are 1st line for RAS

36
Q

What must you monitor in RAS patient on ACE/ARB

A

SrCr, to ensure it doesnt rise above 30%

37
Q

What are complications of renovascular disease

A

renal artery dissection
hemorrhage (capsular perforation)
atheroembolic disease leading to HTN and kidney failure

38
Q

Who most likely benefits from surgery

A

Short duration of BP prior to diagnosis
meds dont control BP (intolerant to meds)
recurrent flash pulmonary edema/HF

Nayla Foundations Exam 5 (7 decks)

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