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Med 1 > Renal / Genitourinary > Flashcards

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)

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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%)

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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

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4
Q

Weight gain and edema in AKI 2/2

A

positive water and Na balance

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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

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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

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7
Q

Monitor w/ AKI (5)

A 
I/Os and weight
BO
serum electolytes
Hb and Hct for anemia
infeciton
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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
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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)

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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)

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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
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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)
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13
Q

Test for post renal

A

PE of the bladder
US of kidneys
Catheter for volume

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14
Q

Course of ATN(3)

A

insult->

oliguric phase - azotemia and uremia (10-14days), output osmotic dousers

Recovery phase

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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

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16
Q

Tests for AKI

A 
UA
Urine Chme
BMP
Bladder Cath
renal US
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17
Q

AKI and Muddy brown casts, renal tubular casinos UA

A

ATN

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18
Q

AKI and RBC casts and RBCs on UA

A

glomerular disease

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19
Q

AKI and WBC casts and WBCs on UA

A

Pyelonephritis

Acute interstitial nephritis

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20
Q

AKI and benign UA

A

prerenal causes,

Look at BUN/Cr, FENa and Urine OSM
-> either prerenal or intrinsic ARF

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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

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22
Q

FENa calculation

A

UNa/PNa x UCr/PCr) x 100

2-3% ATN

Useful if oliguria (<500mL/day)

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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

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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

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25
Q

Pre renal AKI TX

A

treat disorder
NS -> euvolemia and BP; NOT if edema or ascots

No ACEi or NSAIDs

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26
Q

Intrinsic AKI Tx

A

Supportive if ATN, eliminate cause
fursimide if oliguric
-

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27
Q

Elv Cr look at what?

A

Baseline Cr

detemine AKI, CKD or superimposed acute on chronic disease

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28
Q

Uremia Def?

A

signs and symptoms of elv BUN, usually > 60

pericarditis, Neuro (lethargy, somnolence, confusion, seizures, weakness) platelet dysfunction

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29
Q

CKD definition(2)

Causes- 5

A

decreased kidney function GFP <60

Structural damage for 3 months

DM**(30%)
HTN ** (25%)
Chronic GN
Interstitial nephritis
 polycystic kidney disease
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30
Q

2 most common causes of CKD

A

DM

HTN

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31
Q

chronic renal insufficency

A

perm elv Cr but not failed kidneys

>1.5-3

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32
Q

Features of CKD(7 systems )

A

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)

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33
Q

Phos and Ca in CKD

results in? (2)

A

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

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34
Q

CKD electrolyte abnormalities

A

Volume overload
hyperkalemia
hypermagnesia
hyperphosphatemia -> hypocacemia

Metabolic acidosis - loss of renal mass -> decreased ammonia production, less H excreted

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35
Q

Secondary hyperparathyroidism in CKD

A

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
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36
Q

CKD Tx

A

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
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37
Q

Indications for dialysis

AEIOU

A

Acidoisis

Electrolytes - severe hyperkalemia

Intoxication - methanol, ethylene glycol, lithium , ASA

Overload - hypervolemia

Uremia - clinical presentation rather than values

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38
Q

Proteinuria def

4 classes

A

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)

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39
Q

Nephrotic syndrome key features(6)

A
  • 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
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40
Q

Causes of nephrotic syndrome

A

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
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41
Q

Dx of nephrotic syndrome

A

Urine dipstick - Albumin concentration 30mg/dL or higher

UA - initial test post dipistick looking for casts - RBC (GN), WBC (pyelo or interstitial) Fatty (nephrotic)

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42
Q

Symptomatic proteinuria Tx

A

Tx underlying disease - SLE, DM, Mtpl myeloma, etc,

ACEi or ARB

Diuretics if edema
Limit Protein and Na
vaccinate influenza and pneumococcus

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43
Q

Gross painless hematuria worry of ?

A

Renal cell carcinoma or Bladder CA

until proven otherwise

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44
Q

Hematuria def

if Gross vs microscopic?

A

> 3 WBC on HPF of UA

Microscopic - commonly glomerular origin,
Gross- nonglomerular

infection can cause both

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45
Q

Causes of hematuria

A 
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
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46
Q

Diostick positive for blood but no RBCs on microscope

A

hemoglobinuria or myoglobinuria most likely

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47
Q

If suspicions high for bladder malignancy and cytology is negative do what?

A

Still do a cystoscope

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48
Q

Dx of hematuria

A

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

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49
Q

Glomerular disease is either(2)

Characterized by

A

primary -intrinsic renal path
Secondary -systemic disease

proteinuria, hematuria, or both

Get UA, renal function tests and needle biopsy of kidney

50
Q

Nephritic syndrome

Causes

Labs(3)
Clinical(2)

A

inflamed glomeruli

Poststrep glomerulonephritis most common

Hematuria, AKI (azotemia, oliguria), Minimal proteinuria

HTN and Edema

51
Q

Nephrotic Syndrome

Causes

Labs (3)
Clinical (3)

A

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
Q

Steroids used in glomerular disease or tubular

A

glomerular

also immune suppressants

53
Q

Primary glomerular disorders (5)

A

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
Q

Fusion of foot processes on electron microscope
No histological change on light microscope?

Tx

A

minimal change disease

Tx w/ steriods 4-8wks, excellent prognosis

55
Q

Tx of focal segmental glomerulonephritis?

more common in?

See?

A

Black people

See hematuria and HTN

poor prognosis and Tx w/ steroids, immune suppressor and ACEi/ARBs

56
Q

Thick capillary walls seen on kidney biopsy

Tx?

A

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
Q

Mesangial deposition of IgA and C3 on electron microscope

Clinical picture

Tx?

A

IgA nephropathy

see gross hematuria after and upper respiratory infection (or exercise)

prognosis good though no therapy proven effective, Steroids?

58
Q

Most common cause of glomerular hematuria

A

IgA nephropathy

59
Q

hereditary nephritis - Alborts

Presentation and Tx?

A

X linked or Auto domw/ variable prentrance

Hematuria, pyuria, proteinuria and hearing loss

No Tx

60
Q

Secondary glomerular disease(7)

A 
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
Q

secondary glomerular disease due to Hep C

A

Membranoproliferative glomerulonephritis

other causes too - hep B, syphilis, lupus

Associated w/ cryoglobulinemia

Can be primary

62
Q

hematuria after upper respiratory infection of skin(impetigo) roughly 10-14 days after

A

Poststrep GN - Group A beta hemolytis

most common cause of nephritic syndrome

Hematuria, edema, HTN, low complement, protenuria

ASO elv?

Self limited

63
Q

Proliferative Gn - crescentic

renal biopsy linear immunoflorescence

A

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
Q

HIV nephropathy

Histologically similar too?

A

peroteinuria, edema and hematuria

Histo- collapsing form of FSGS

Tx prednisone, ACEi, ARV

65
Q

Acute Interstitial Nephritis Causes (4)

A

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
Q

Diagnosing AIN look for

A

recent infection
new medication
fever/rash/aches/AKI

67
Q

Features of AIN(4)

A

AIN -> AKI

Rash, fever, esosinphilia,

Maybe: pyuria and hematuria

68
Q

Esosinophils in UA think of?

A

Acute interstitial nephritis

69
Q

Analgesic nephropathy

A

form of toxic injury w. excessive NSAID or ASA use

Seen as interstitial nephritis of renal papillary necrosis

-> acute/chronic renal failure

70
Q

Renal papillary necrosis

Causes?

Dx by

A

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
Q

RTA in general is?

3 Types?

A

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
Q

Type 1 distal RTA

Defect?

See

A

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
Q

Causes of Type 1 RTA (distal) (7)

Tx?(2)

A 
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
Q

Type 2 proximal RTA

Defect?

See?

A

inability to resorb bicarb at proximal tubule -> increased EXCRETION OF BICARB* (alkaline urine)

**hypokalemic hyeprchloremic non-anion gap metabolic acidosis (~type1)

NO Stones

75
Q

Causes of RTA type 2(7)

Tx(2)

A 
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
Q

Type 4 RTN

Defect?

See?

A

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
Q

Causes og Type 4 RTN

A

hypoaldosteronism or increased renal resistance to aldosteronism

Common w/ interstitial renal disease and DM nephropathy

78
Q

Harnup syndrome

Defect?

Clinically see?

A

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
Q

Fanconi Syndrome

See?

A

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
Q

ADPKD

features

Recurrent?(2)

A

Auto dom
most common cause of CKD

ESRD by 50s -60s in 50%
Recurrent pyelonephritis and nephrolithiasis

81
Q

Features of ADPKD

A 
hematuria
ab pain
HTN
Palpable kidneys
Stones
Infection

berry aneurisms*

82
Q

Tx for ADPKD

A

none - drain cysts cymptomatically

Tx HTN

83
Q

Auto recessive polycystic kidney disease

features (50

A

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
Q

Meduallry sponge Kidney

A

cystic dilation of collecting ducts

Presents w/ hematuria UTIs, nephrolithiasus, asymptomatic

Dx w/ IVP

no Tx

85
Q

Simple renal cysts

A

common - 1/2 of Pts >50

no Tx, incidental US

86
Q

Most common cause of secondary HTN

A

renal artery stenosis

87
Q

Causes of renal artery stenosis (2)

Dx?

A

Athersclerosis (2/3), maybe bilateral

Fibromuscular dysplasia - young female, bilateral 50%

Renal arteriogram gold standard, MRA new test that is not nephrotoxic

88
Q

Use what drug w/ caution in renal stenosis

A

ACEi

89
Q

Tx of Renal stenosis

A

revascularization w/ percutaneous transluminal renal angioplasty
Surgery (bypass) if fails

may also include ACEi, CCBs

90
Q

HTN nephrosclerosis

A

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
Q

Sickle cell nephropathy

A

microvascular infarction
- renal papillae -> necrosis, renal failure and increased UTIs

nephrotic syndrome
-> dehydration -> sickling crisis

ACEi help

92
Q

Hypercalciuria causes(7)

A
  • increased intestinal absorbtion
  • decreased renal reabsorbtion -> increased excretion
  • increased bone reabsorption
  • primary hyperparathyroidsims
  • sarcoidosis
  • malignancy
  • Vit D excess

Increased stone risk

93
Q

Hyperoxaluria causes(3)

A

severe steatorrhea -> Ca oxylate stones 2/2 absorption of oxalate)

small bowel disease, Crohns

pytidoxine deficiency

94
Q

Types of nephrolithiasis

A

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
Q

Size of kidney stone to pass

A

1cm do NOT

96
Q

Flank pain that radiates anterior to the groin, sudden onset

N/V
hematuria -90%

A

stones

also can have concurrent UTIs

97
Q

Dx of kidney Stones

A

US - hematuria, maybe associated UTI, get pH (alkaline -> protease bugs; acidic -> uric acid stones)

Urine culture
BMP w/ Ca

98
Q

kidney stones seen on X- ray (2)

A

Calcium stones and struvite stones

Uric acid and cysteine are hard to visualize

99
Q

Gold standard for diagnosis of kidney stones

A

CT scan w/o contrast- sees all stines

US good but high false negative rate early on , but useful if pregnant

100
Q

Prevetion of stones

A

high fluid intake
limit animal protein if uric stones

Pharmacologic measure - Thiazides reduce Ca excretion
Allopurinol for uric stones

101
Q

Extracorpreal shock wave lithotripsy indicated for stones if>

A

ongoing obstruction, stones >5mm but less than 2cm

use percutaneous lithotomy if lithotripsy fails and stones >2cm

102
Q

Lower vs upper uretral tract obstruction

Causes of each

A

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
Q

1st test w/ renal obstruction concerns

A

US**

KUB -> radiograph looking for stones
UA
Intravenous urogram (IVP) gold standard

104
Q

Prostate CA risks(5)

A

age, African american, high fat diet, + family Hx, herbicide/pesticide esposure

105
Q

Features of prostate CA

early, late and later

A

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
Q

DRE

A

if abnormal get a biopsy regardless of PSA, esp over 45yrs

TRUS and biopsy indicated

107
Q

Indications for TRUS w/ biosy for prostate CA

A

PSA >10
PSA velocity >0.75/yr
Abnormal DRE

108
Q

Localized prostate Tx?

locally invasive?

METS?

A

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
Q

Renal cell Carcinoma

A

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
Q

Risks for renalc ell CA

A 
Cigarrettes
Phencetin analgesid
ADPKD
Chronic dialysis
Heavy metal exposure
HTN
111
Q

Paraneoplastic in renal cell carcinoma

A

RARE

maybe- EPO, PTHr(hypercalcemia), renin (HTN), cortisol(cushing), gonadotropin)

112
Q

Dx of Renal cell CA

Tx?

A

Renal US

Abdominal CT - w. and w.o contrast -> staging and diagnosis

Radical nephrectomy

113
Q

Bladder CA

A

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
Q

Risk factors for Bladder CA

A

Cigarette Smoking**
industrial carcinogens - aniline dye, azo dyes
Cyclophsophamide Tx - long term

115
Q

Dx of Bladder Ca

A

painless hematuria in older age concerning

Get UA, Urine culture r/oinfection
Urine cytology
IVP
Cystoscope** And biopsy
CT for staging
116
Q

Testicular CA

2 categoreis w/ 2 types

A

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
Q

Nonseminomatous testicular CA

A

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
Q

Risk factors for testicualr CA (20

A

cryptorchidsm , surgery not eliminate risk

Klinefelters

119
Q

Tumor markers in testicular CA

beta hCG

AFP

A

beta hCG - choricarcinoma, maybe elv in nonseminomatous CA

AFP - embryonal tumors, NEVER choriocarinoma or seminoma

120
Q

DDX for testicular CA(6)

A

Varicocelle - dialtaed tortuous vein

Testicular torsion
spermatocele - testicular cyst
hydrocele- fluid in teste
epidydymitis
lymphoma
121
Q

acute severe testicular pain w/ swollen and tender scrotum, elv testicle

Get what?

Timeline?

A

renal US for testicular torsion

Surgical emergency, surgery(orchioplexy) w/in 6 hrs otherwise may not be salvageable

122
Q

Epididymitis

A

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

Med 1 (11 decks)

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