Renal / Genitourinary Flashcards
1
Q
Def of AKI
A
rapid decline in renal funciton w/ increase in Cr(relatively increase of 50% or absolute 0.5-1)
2
Q
Types of AKI (2)
A
Prerenal - decreas in renal blood flow (6–70%)
Intrinsic - damage to renal parenchyma 925040%)
Postobstructive - outflow obst (5%)
3
Q
AKI per RIFLE criteria
A
RISK = 1.5 fold increase in serum Cr of DFR decrease bu 25% or output<0.5 mL/kg/hr for 24 hrs or anuria 12hrs
Loss - dialysis 4 wks
ESRD - dialysis 3 months
4
Q
Weight gain and edema in AKI 2/2
A
positive water and Na balance
5
Q
Azotemia
A
elevated BUN and Cr
- BUN elv in catabolic drugs (steriods), GI/soft tissue bleeds and dietary protein intake
-Cr elv in muslce breakdowna nd drugs
6
Q
Pre renal causes of AKI(5)
A
low flow -> decreased clearance
Volume loss/sequestered- dehydration, diuretics, poor PO intake, vomitting. diarrhea, hemorrhage
Low CO- CHF
Hypotension - Sepsis, HTN meds
Cirrosis, hepatorenal syndrome
NSAID and ACEi use w. low renal perfusion
7
Q
Monitor w/ AKI (5)
A
I/Os and weight BO serum electolytes Hb and Hct for anemia infeciton
8
Q
Prerenal vs intrinsic
UA
BUN/cr
FENa
Urine osm
Urine NA
A
Prerenal
- few Hyaline casts
- > 20:1 ratio
- 500mOSm
- Na 2/3% FENa (loss of retainment)
- 250-300 mOsm
- > 40 Na
9
Q
Intrinsic renal failure(5)
A
kidneys can’t concentrate
Tubular disease (ATN) - ischemia and nephrotoxin
->prerenal progressing to intrinsic w/ ischemia (ATN)
Glomerular disease - acute glomerulonephtitis, Goodpastures, Wegeners, post step GN, lupus)
Vascular disease - Renal occlusion, TTP, HUS
Interstitial disease (AIN) - allergic, hypersensitivity to meds (NSAID etc)
10
Q
Rhabdomyolisis and the kidneys
A
myoglobin released post trauma and crush injuries -> toxic to kidneys
Labs - elv Creatine phosphokinase, hyperkalemia, hypocalcemia, hyperuricemia
Tx w/ IV fluids, mannitol, bicarb (drives K into cell)
11
Q
ATN causes (2)
A
Ischemic AKI
- severe decline in renal blood flow - shock, hemorrhage, sepsis, DIC, HF
- > death of tubular cells
Nephrotoxic AKI - direct injury 2/2 substances - Abx(aminoglycosides, vancomycin) -radiocontrast -NSAIDs in CHF - poisons myoglobinuria - chemotherapy (cisplatin) -kappa/gamma light chains
12
Q
Post renal AKI
A
obstruction of any segment of urinary tract -> retrograde tubular pressure -> Decrease GFR
Both Kidneys for Cr to rise
Large prostate -most common nephrolithasis neoplasm retroperitoneal fibrosis uretral obstruction uncommon (need both)
13
Q
Test for post renal
A
PE of the bladder
US of kidneys
Catheter for volume
14
Q
Course of ATN(3)
A
insult->
oliguric phase - azotemia and uremia (10-14days), output osmotic dousers
Recovery phase
15
Q
Dehydration triggers the release of what
A
ADH 0> water reabsorption
ATN the tubules are damaged and cannot reabsorb leading to low osmolarity urine
16
Q
Tests for AKI
A
UA Urine Chme BMP Bladder Cath renal US
17
Q
AKI and Muddy brown casts, renal tubular casinos UA
A
ATN
18
Q
AKI and RBC casts and RBCs on UA
A
glomerular disease
19
Q
AKI and WBC casts and WBCs on UA
A
Pyelonephritis
Acute interstitial nephritis
20
Q
AKI and benign UA
A
prerenal causes,
Look at BUN/Cr, FENa and Urine OSM
-> either prerenal or intrinsic ARF
21
Q
Urine Sediment
Hyaline Casts
RBC casts
WBC Casts
Fatty casts
A
Hyaline - prerenal, decide of contents
OBC - glomerular disease
WBC - renal parenchymal inflammation
Fatty - nephrotic syndrome
22
Q
FENa calculation
A
UNa/PNa x UCr/PCr) x 100
2-3% ATN
Useful if oliguria (<500mL/day)
23
Q
Complications of AKI(4)
K?
acid/base?
A
ECF volume expansion and pulm edema (Tx w. diuretic)
Metabolically
- Hyperkalemia (less exchange to retain Na -> excess K + movement from ICF -> ECF w/ cell destruction
- Metabolic Acidosis - w/ anion gap - less H excreted (w/K) (tx bicarb)
- hypocacemia - loss active Vit D
- Hyponatremia if > fluids
- hyperphosphatemia
- hyperuricemia
Uremia- toxic accum
Infection
24
Q
Tx of AKI general
A
Avoid Drug insult (NSAIDS, contrast, aminoglycosides)
Change med doage
Correct fluids IV or duiures
Correct electrolyte disturb
Optimize BP
Dialysis if remix, academia, hyperkalemia, volume overload
25
Pre renal AKI TX
treat disorder
NS -> euvolemia and BP; NOT if edema or ascots
No ACEi or NSAIDs
26
Intrinsic AKI Tx
Supportive if ATN, eliminate cause
fursimide if oliguric
-
27
Elv Cr look at what?
Baseline Cr
detemine AKI, CKD or superimposed acute on chronic disease
28
Uremia Def?
signs and symptoms of elv BUN, usually > 60
pericarditis, Neuro (lethargy, somnolence, confusion, seizures, weakness) platelet dysfunction
29
CKD definition(2)
Causes- 5
decreased kidney function GFP <60
Structural damage for 3 months
```
DM**(30%)
HTN ** (25%)
Chronic GN
Interstitial nephritis
polycystic kidney disease
```
30
2 most common causes of CKD
DM
| HTN
31
chronic renal insufficency
perm elv Cr but not failed kidneys
| >1.5-3
32
Features of CKD(7 systems )
Cardio
- HTN 2/2 Na and H20, (most common 2ry cause)
- CHF
- Pericarditis (uremic)
GI - N/V, anorexia
Neuro - lethargy/confusion/weak
Hematologic- low EPO-> anemia, platelet dysfunction (uremia)
Endocrine- hyperphosphatemia and hypocalcemia, infertility, puritis
Fluid/lytes -
Immunologic- uremia lowers immunity (pneumonia, UTI etc)
33
Phos and Ca in CKD
results in? (2)
Hypocalcemia and elv Phos
decreased renal clearance of phos -> less Vitamin D 1,25 made -> low Ca retained from GI
--> secondary hyperparathyroidism
renal osteodystophy
hyperphos may precipitate w/ Ca -> vascular calcifications calciphyaxis
34
CKD electrolyte abnormalities
Volume overload
hyperkalemia
hypermagnesia
hyperphosphatemia -> hypocacemia
Metabolic acidosis - loss of renal mass -> decreased ammonia production, less H excreted
35
Secondary hyperparathyroidism in CKD
Hyperphosphatemia w/ decreased excretion 2/2 loss of ability to excrete
- > less Vit D 1,25
- > less Ca in blood
- > increase in PTH release which is unresponsive kidneys
36
CKD Tx
Diet - low protein 0.7g/kg/day; low Na; low K phos and mag
ACEi - dilate efferent arterioles, caution w/ hyperkalemia
```
BP control
Glycemic control
Stop smoking
Fix electrolytes (bicarb for acidosis; oral Ca and Vit D; Ca Citrate for hyperphosphatemia)
EPO for anemia
```
37
Indications for dialysis
| AEIOU
Acidoisis
Electrolytes - severe hyperkalemia
Intoxication - methanol, ethylene glycol, lithium , ASA
Overload - hypervolemia
Uremia - clinical presentation rather than values
38
Proteinuria def
4 classes
urinary excretion > 150mg protein/24hrs
Glomerular - increased perm w/ GN, more severe-> nephrotic syndrome
Tubular - small proteins normally absorbed are not b/c abnormal - sickle cell, oust, interstial nephritis
Overflow proteinuria - overwhelms tubules, mtpl myeloma
Other - UTI, fever, Pregancy, orthostatic proteinuria (self limited)
39
Nephrotic syndrome key features(6)
* Urine protein>3.5g/24hrs
* hypoalbuminemia - albumin synth can't keep up
* Edema
* Hyperlipidemia - hepatic synth of LDL and VLDLD in effort to get more albumin
- hypercoag w/ loss of anticoags in urine
- infection risk w/ loss of immunoglobins
40
Causes of nephrotic syndrome
Primary
- membranous nephropathy (40%)
- FSGS(35%)
- membranoproliferative
- minimal change in kids
Systemic - DM, Collagen vasc, SLE, RA, henoch schonlein purpura, PAN, wegeners
```
Amylodosis,
Drugs- caporal, heroin, metals, NSAIDs, pencillaime
Infection
Mtpl Myeloma
Malignant HTN
```
41
Dx of nephrotic syndrome
Urine dipstick - Albumin concentration 30mg/dL or higher
UA - initial test post dipistick looking for casts - RBC (GN), WBC (pyelo or interstitial) Fatty (nephrotic)
42
Symptomatic proteinuria Tx
Tx underlying disease - SLE, DM, Mtpl myeloma, etc,
ACEi or ARB
Diuretics if edema
Limit Protein and Na
vaccinate influenza and pneumococcus
43
Gross painless hematuria worry of ?
Renal cell carcinoma or Bladder CA
until proven otherwise
44
Hematuria def
if Gross vs microscopic?
>3 WBC on HPF of UA
Microscopic - commonly glomerular origin,
Gross- nonglomerular
infection can cause both
45
Causes of hematuria
```
Stones
infection - UTI, urethritis, pyelonephritis
Bladder/Kidney CA
glomerular disease IgA nephropathy
Truama
Strenuous exercise
Systemic disease - SLE, rheumatic fever, henoch-schlonlein purpura, Wegeners, Goodpastures
Bleeding disorder
Sickle cell
Meds - cyclophosphamids, antocoags, sulfonamides,
Analgesic nephropathy
Polycystic kidney disease
BPH - rare
```
46
Diostick positive for blood but no RBCs on microscope
hemoglobinuria or myoglobinuria most likely
47
If suspicions high for bladder malignancy and cytology is negative do what?
Still do a cystoscope
48
Dx of hematuria
Urine dipstic
UA - Cast analysis
Urine specimen for cytology if CA concerns
24 hr urine - Cr and protein
Blood tests
IVP, CT, US if no causes above find anything
Renal biopsy if suspicious
49
Glomerular disease is either(2)
Characterized by
primary -intrinsic renal path
Secondary -systemic disease
proteinuria, hematuria, or both
Get UA, renal function tests and needle biopsy of kidney
50
Nephritic syndrome
Causes
Labs(3)
Clinical(2)
inflamed glomeruli
Poststrep glomerulonephritis most common
Hematuria, AKI (azotemia, oliguria), Minimal proteinuria
HTN and Edema
51
Nephrotic Syndrome
Causes
Labs (3)
Clinical (3)
Abdnormal glomerular permeability
Membranous glomerulonephritis most common
DM, SLE, infection, Focal Segmental glomerulosclerosis
Urine protein >3/5g/day
Hypoabumniema
hyperlipidemia, fatty casts
Edema, Hypercoaguable, infection risk
52
Steroids used in glomerular disease or tubular
glomerular
also immune suppressants
53
Primary glomerular disorders (5)
Minimal change - nephrotic, kids. Associated w/ hodgkins+nonhodgkins; no hiso abnormalities, fusion of foot processes on election microscope
Focal Segmental glomerulosclerosis - nephrotic, blacks, hematuria, HTN
Membranous glomerulonephritis - nephrotic, glomerular capillary walls thick
IgA nephropathy(bergers) - hematuria, post URI (dif from post strep), renal function normal
Hereditary nephritis (alports) - X linked/Auto Dom, hematuria, pyuria, proteinuria, hearing loss
54
Fusion of foot processes on electron microscope
No histological change on light microscope?
Tx
minimal change disease
Tx w/ steriods 4-8wks, excellent prognosis
55
Tx of focal segmental glomerulonephritis?
more common in?
See?
Black people
See hematuria and HTN
poor prognosis and Tx w/ steroids, immune suppressor and ACEi/ARBs
56
Thick capillary walls seen on kidney biopsy
Tx?
Membranous glomerulonephritis - can be primary or secondary (if 2/2 infection (HepC/B, syphilis, malaria, HIV,) Drugs (gold, captopril, pencillamine) neoplasm or lupes
Steroids does not change survival rate, remission is common and prognosis is fair -common
57
Mesangial deposition of IgA and C3 on electron microscope
Clinical picture
Tx?
IgA nephropathy
see gross hematuria after and upper respiratory infection (or exercise)
prognosis good though no therapy proven effective, Steroids?
58
Most common cause of glomerular hematuria
IgA nephropathy
59
hereditary nephritis - Alborts
Presentation and Tx?
X linked or Auto domw/ variable prentrance
Hematuria, pyuria, proteinuria and hearing loss
No Tx
60
Secondary glomerular disease(7)
```
DM nephropathy- most common
HTN nephtopathy
Lupus
Membranoproliferative - Hep C
Poststreptococcal GN - after group A, beta hemolytic infection (URT or skin)
Goodpastues -antiglomerular basemsnt Ig
Dysproteinemias - amylodisosis
Sickle cell nephropathy
HIV nephropathy
Wegenrrs
Polyarteritis nodosa
```
61
secondary glomerular disease due to Hep C
Membranoproliferative glomerulonephritis
other causes too - hep B, syphilis, lupus
Associated w/ cryoglobulinemia
Can be primary
62
hematuria after upper respiratory infection of skin(impetigo) roughly 10-14 days after
Poststrep GN - Group A beta hemolytis
most common cause of nephritic syndrome
Hematuria, edema, HTN, low complement, protenuria
ASO elv?
Self limited
63
Proliferative Gn - crescentic
renal biopsy linear immunoflorescence
Goodpastures syndrome
Triad - proliferative CN, pulmonary hemorrhage and IgG antiglomerular basement antibody
rapidy progressive renal failure, hemoptysis and cough
Lung disease before kidney
T: plasmapheresis and cyclophosphamide/steriods
64
HIV nephropathy
Histologically similar too?
peroteinuria, edema and hematuria
Histo- collapsing form of FSGS
Tx prednisone, ACEi, ARV
65
Acute Interstitial Nephritis Causes (4)
Inflammatory response
-Acute allergic rxn to meds*(pencillins, cephalsporins, sufa drugs, diuretics, anticoag, phenytoin, rifampin, allopurinol, PPI)
Infection-(kids) Strep spp and legionella
Collagen vascular disease - sarcoidosis
Autoimmune - SLE, Sjogrens
66
Diagnosing AIN look for
recent infection
new medication
fever/rash/aches/AKI
67
Features of AIN(4)
AIN -> AKI
Rash, fever, esosinphilia,
Maybe: pyuria and hematuria
68
Esosinophils in UA think of?
Acute interstitial nephritis
69
Analgesic nephropathy
form of toxic injury w. excessive NSAID or ASA use
Seen as interstitial nephritis of renal papillary necrosis
-> acute/chronic renal failure
70
Renal papillary necrosis
Causes?
Dx by
Most common associated w/ analgesic nephropathy, DM nephropathy, sickle cell disease, obstruction, UTI, alcoholism and transplant reject
Dx - excretory urigram (change in papilla or medulla)
sloughed necrotic papillae -> uretral obstriction
Stop offending agetn
71
RTA in general is?
3 Types?
tubule disorder -> non-anion gap hyperchloremic metabolic acidosis
Normal glomerular function
Seen as decrease of H excreted in urine -> acidemia and urine alkalosis
Type 1 distal
Type 2 proximal
Type 4
72
Type 1 distal RTA
Defect?
See
defect = inability to secrete H at DISTAL tubule -> new bicarb cannot be regenerated
metabolic acidosis,
alkaline urine can't be lower than 6
SEE - increased excretion of ions ->
- Lower ECF volume
- HYPOKALEMIA*
- Renal stones/nephrocalcinosis* (increased Ca and phos excretes)
**hypokalemic, hyperchloremic, metabolic acidosis w/ stones
73
Causes of Type 1 RTA (distal) (7)
Tx?(2)
```
congenital
multiple myeloma
nephrocalcinosis
nephrotoxicity (amphotericin B); auoimmune (SLE, sjogrens)
medullary sponge kidney
analgesic nephropathy
```
Correct acidosis w/ Na bicarb. (helps w/stones)
Admin phosphate salts (excrete titratable acid)
74
Type 2 proximal RTA
Defect?
See?
inability to resorb bicarb at proximal tubule -> increased EXCRETION OF BICARB* (alkaline urine)
**hypokalemic hyeprchloremic non-anion gap metabolic acidosis (~type1)
NO Stones
75
Causes of RTA type 2(7)
Tx(2)
```
Fanconis syndrome-kids
Cystinosis,
Wilsons
lead toxicity
mutiple myeloma
nephrotic syndrome
amyloidosis
```
Always r/o mtpl myeloma for commonly see monoclonal light chain excretion
Do NOT give bicarb, just excreted
Tx the cause
Na restriction -> Na reabsorbtion (and bicarb)
76
Type 4 RTN
Defect?
See?
Decreased Na reabsorption and decreased H and K secretion in the distal tubule
HYPERkalemia and acidic urine w/ non aniongap metabolic acidois
NO stones
77
Causes og Type 4 RTN
hypoaldosteronism or increased renal resistance to aldosteronism
Common w/ interstitial renal disease and DM nephropathy
78
Harnup syndrome
Defect?
Clinically see?
Auto recessive defect in AA transporter
-> decreased intestinal and renal reabsorption of neutral AA (tryptophan ) -> nictinamide fe
Clincal: pellagra- dermatitis, diarrhea, ataxia and psychiatric disturbances
Tx w. nicotinamide supplement
79
Fanconi Syndrome
See?
hereditary/aquired proximal tubule dysfunction -> defective transport of : Glucose, AA, Na, K, phos, uric acid, bicarb
->spilling in the urine and associated problems
(skeletal and rickets, impaired growth, osteomalacia, dehydration, type 2 RTA)
Tx w/ phos, K, alkali, salt supplementation
Hydration
80
ADPKD
features
Recurrent?(2)
Auto dom
most common cause of CKD
ESRD by 50s -60s in 50%
Recurrent pyelonephritis and nephrolithiasis
81
Features of ADPKD
```
hematuria
ab pain
HTN
Palpable kidneys
Stones
Infection
```
berry aneurisms*
82
Tx for ADPKD
none - drain cysts cymptomatically
Tx HTN
83
Auto recessive polycystic kidney disease
features (50
cysts in renal collecting ducts and hepatic fibrosis
less common
Liver involvement*-> hepatic complications
Kidneys increased in size
HTN
Pum insufficency 2/2 pulm hypoplasia and large kidneys
Potter syndrome if severe- -> low amniotic fluid, hypo plastic lungs, limb abnormalitis, weird fascies
84
Meduallry sponge Kidney
cystic dilation of collecting ducts
Presents w/ hematuria UTIs, nephrolithiasus, asymptomatic
Dx w/ IVP
no Tx
85
Simple renal cysts
common - 1/2 of Pts >50
no Tx, incidental US
86
Most common cause of secondary HTN
renal artery stenosis
87
Causes of renal artery stenosis (2)
Dx?
Athersclerosis (2/3), maybe bilateral
Fibromuscular dysplasia - young female, bilateral 50%
Renal arteriogram gold standard, MRA new test that is not nephrotoxic
88
Use what drug w/ caution in renal stenosis
ACEi
89
Tx of Renal stenosis
revascularization w/ percutaneous transluminal renal angioplasty
Surgery (bypass) if fails
may also include ACEi, CCBs
90
HTN nephrosclerosis
HTN -> increased capillary hydrostatic pressure in glomerulo -> benign/malignant slcerosis
2nd most common cause of 2ry HTN
if malignant -> rapid decrease in renal function and accelerated HTN -> internal vascular injury
African americans
91
Sickle cell nephropathy
microvascular infarction
- renal papillae -> necrosis, renal failure and increased UTIs
nephrotic syndrome
-> dehydration -> sickling crisis
ACEi help
92
Hypercalciuria causes(7)
- increased intestinal absorbtion
- decreased renal reabsorbtion -> increased excretion
- increased bone reabsorption
- primary hyperparathyroidsims
- sarcoidosis
- malignancy
- Vit D excess
Increased stone risk
93
Hyperoxaluria causes(3)
severe steatorrhea -> Ca oxylate stones 2/2 absorption of oxalate)
small bowel disease, Crohns
pytidoxine deficiency
94
Types of nephrolithiasis
Ca - most common
- Ca Oxylate or Ca phosphate
- Radiodense
Uric acid stones (2nd 10%)
- persistent acidic urine promotes stones
- assoc w/ hyperuricemia (gout, chemo)
- flat square plates
- LUcent *** (need US or CT)
Struvite stones
- radiodense
- UTIs - Proteusm klebsiella, serratia, enterbacter)
- alkaline urine forms
- urea split -> ammonia combines w/Mg and phos -> stones
Cystine stones
- genetic
- hexagon crystal poorly visualized)
95
Size of kidney stone to pass
1cm do NOT
96
Flank pain that radiates anterior to the groin, sudden onset
N/V
hematuria -90%
stones
also can have concurrent UTIs
97
Dx of kidney Stones
US - hematuria, maybe associated UTI, get pH (alkaline -> protease bugs; acidic -> uric acid stones)
Urine culture
BMP w/ Ca
98
kidney stones seen on X- ray (2)
Calcium stones and struvite stones
Uric acid and cysteine are hard to visualize
99
Gold standard for diagnosis of kidney stones
CT scan w/o contrast- sees all stines
US good but high false negative rate early on , but useful if pregnant
100
Prevetion of stones
high fluid intake
limit animal protein if uric stones
Pharmacologic measure - Thiazides reduce Ca excretion
Allopurinol for uric stones
101
Extracorpreal shock wave lithotripsy indicated for stones if>
ongoing obstruction, stones >5mm but less than 2cm
use percutaneous lithotomy if lithotripsy fails and stones >2cm
102
Lower vs upper uretral tract obstruction
Causes of each
lower - below utererovesicular junction > urination troubles
- BPH, prostate CA, urethral sctircute, ston, neurogenic bladder (MS or DM), trauma, bladder CA
upper (above) - causes renal colic
- (intrinsic) kidney stones, blood clots, sloughed apillia, crystal, tumors, strictues, uteropelvic/uterovesical junction dysfunction
- (extrinsic) - pregnancy, tumors, abdominal aortic aneurism, fretroperitoneal fibrosis, endoemtriosis, prolpse, hematomas)
103
1st test w/ renal obstruction concerns
US**
KUB -> radiograph looking for stones
UA
Intravenous urogram (IVP) gold standard
104
Prostate CA risks(5)
age, African american, high fat diet, + family Hx, herbicide/pesticide esposure
105
Features of prostate CA
| early, late and later
Early - asymptomatic, peripheral -> central for obstruction, often met by that time
Later - obstruction, difficulty voiding, dysuria, frequency
Late - bone pain from METS, vertebral bodies, pelvis, long bones
106
DRE
if abnormal get a biopsy regardless of PSA, esp over 45yrs
TRUS and biopsy indicated
107
Indications for TRUS w/ biosy for prostate CA
PSA >10
PSA velocity >0.75/yr
Abnormal DRE
108
Localized prostate Tx?
locally invasive?
METS?
radical prstatectomy
local invasion -> radiation + androgen deprivation therapy, not curative but lower spread
METS
- reduce testosterone w/ ochiectomy,
- antiandrogens,
- lutenizing hormone releasing hormone agonists (leuprolide)
- GnRH antagonist - suppresses testosterone binding to pituitary w/o causing transient surge of LH and FSH (Degarelix)
109
Renal cell Carcinoma
M>W
89% of primary renal cell CA (transitional cell 2nd)
sporadic but some auto dom Von hip Lindau association
METs to lung, liver, brain and bone
110
Risks for renalc ell CA
```
Cigarrettes
Phencetin analgesid
ADPKD
Chronic dialysis
Heavy metal exposure
HTN
```
111
Paraneoplastic in renal cell carcinoma
RARE
maybe- EPO, PTHr(hypercalcemia), renin (HTN), cortisol(cushing), gonadotropin)
112
Dx of Renal cell CA
Tx?
Renal US
Abdominal CT - w. and w.o contrast -> staging and diagnosis
Radical nephrectomy
113
Bladder CA
most common type of CA of genitourinary tract- 90% transitional cell CA (anywhere from kidney -> bladder)
Most common rout of spread is local extension
RECURS** after removal
114
Risk factors for Bladder CA
Cigarette Smoking**
industrial carcinogens - aniline dye, azo dyes
Cyclophsophamide Tx - long term
115
Dx of Bladder Ca
painless hematuria in older age concerning
```
Get UA, Urine culture r/oinfection
Urine cytology
IVP
Cystoscope** And biopsy
CT for staging
```
116
Testicular CA
2 categoreis w/ 2 types
Common in men 20-35 but any age
high cure rate
Germ cell tumors (95%)
- Seminomas (35%) - slow growth, late invasion, radiosensitive
- Nonseminomas (65%) additional 4 types, usually mixed - embryonal CA, Choricarconoma, teratoma, yolk sac carcinoma
Non germ cell tumors (5%)
- leydig cell tumors - hormonally active, benign and surgical, Secrete estrogen and androgens (precocious puberty)
- Sertoli cell tumors : benign
117
Nonseminomatous testicular CA
Embryonal carcinoma - high malignant potential, hemorrhage and necrosis common - Early METS
Choriocarcinoma - most aggressive, rare, mets before Dx- beta hCG
Teratoma - rarely mets
yolk sac carcinomas - usually young boys
118
Risk factors for testicualr CA (20
cryptorchidsm , surgery not eliminate risk
| Klinefelters
119
Tumor markers in testicular CA
beta hCG
AFP
beta hCG - choricarcinoma, maybe elv in nonseminomatous CA
AFP - embryonal tumors, NEVER choriocarinoma or seminoma
120
DDX for testicular CA(6)
Varicocelle - dialtaed tortuous vein
```
Testicular torsion
spermatocele - testicular cyst
hydrocele- fluid in teste
epidydymitis
lymphoma
```
121
acute severe testicular pain w/ swollen and tender scrotum, elv testicle
Get what?
Timeline?
renal US for testicular torsion
Surgical emergency, surgery(orchioplexy) w/in 6 hrs otherwise may not be salvageable
122
Epididymitis
infection seen in children and elderly - E coli
Sexually active - gonorrhea and chlaydia
Swollen tender testicle w/ dysuria, fever chills and scrotal pin
Admin abx
Fever and not acute separates from torsion
