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English 2 > Renal / Genitourinary > Flashcards

Renal / Genitourinary Flashcards

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1
Q

Hypernatremia (etiologies, PE)

A

Na >145
Esp free water loss (not Na+ gain)
6 D’s: Diuresis, Dehydr, Db insip, Docs (iatrog), Diarrh, Disease (kidn, SCD)

Thirst, neuro sympt (alt mental stat, weak, focal def, hyporefl, seiz)

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2
Q

Hypernatremia (dg)

A 
Urin osmol
<100 central DI
100-300 nephro DI
300-600 osmotic diuresis
>600 extrarenal loss (vomit, diarr, ... with Na+ur <25) or Na+ gain (hypertonic saline w/ Na+ur >100)
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3
Q

Hypernatremia (ttt)

A

ttt: hypoVol + unstable vitals give isotonic 0.9% NaCl
If Nl vitals + asympt give D5W

Determine water deficit: replace w/ D5W, 0.45% NaCl or enteral water
!!! rate of replacement (48-72h if chronic hyperNa)

EuVol and hyperVol hyperNa: diuretics + D5W

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4
Q

Hyponatremia (PE, dg)

A

Na <135
Esp ↑ADH
Asympt or confus, lethargy, M cramps, hyporefl, nausea
Seiz, coma, brainstem herniat

Dg: calculate serum osmol (#1 is hypotonic hypoNa) then check volume (usually for hypotonic; hypoVol isoVol hyperVol) then measure urine Na and urine osmol

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5
Q

Hyponatremia (ttt)

A 
Underl cause
HyperVol + euVol: water restrict* +/- diuretics
HypoVol: Nl saline
Sev hypoNa (Na <120): hypertonic saline
Chron hypoNa (>72h): correct slowly
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6
Q

Hyperkalemia (etiologies)

A

K >5

  • Spurious: hemolysis, delay in analysis, extreme ↑WBCs or ↑plts
  • ↓excret*: renal insuff, drugs, hypoaldost, T4 RTA
  • Cellular shift: rhabdomyolysis, tumor lysis sd, insulin def, acidosis, drugs, exo, bld resorpt*
  • ↑intake: fruits, potatoes, iatrog
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7
Q

Hyperkalemia (PE, dg)

A

Asympt; N/V, intest colic, areflexia, weak, arrhythm, paresthesia

Dg: repeat bld draw, ECG (tall + peak T, wide QRS, ↑PR, loss P), sine waves, VFib, card arrest

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8
Q

Hyperkalemia (ttt)

A 
K >6.5 or ECG changes: emergent ttt
#1 Calcium gluconate (if sev)
Bicar +/or insulin + glucose
Beta⊕ helps
Stop diet/fluid K+
Kayexalate removes K+ but !!! CI
Loop diuretics
Dialysis: if renal failure or sev refractory
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9
Q

Hypokalemia (etiologies)

A

K <3.6

  • Transcellular shifts: insulin, B2⊕, alkalosis
  • GI loss: diarrh, laxative abuse, vomit, NG
  • Renal loss: diuretics (loop, thiazid), hypoMg2+, 1* mineralocort excess, 2* hyperaldost, ↓vol, Bartter sd, Gitelman sd, drugs, DKA, T1-2 RTA, polyuria
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10
Q

Hypokalemia (PE, dg, ttt)

A

Fatigue, weak, M cramps, ileus, hyporeflex, paresthesia, rhabdomyol, ascend paralysis

Dg: 24h or spot urine K+ (GI vs renal loss); ECG (flat T, U wave, ST depress*), AV block, cardiac arrest
ttt: underl cause, oral +/or IV K+ (not >20mEq/L/hr)
Replace Mg2+

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11
Q

Hypercalcemia (etiologies, PE)

A

Ca >10.2 (corrected for albumin)
By hyperparathyr, cancer (breast, SCC, MM), Ca supplem, iatrog, immobil, Milk-alkali sd, Paget ds, adren insuff, acromeg, hyperthyr, Zollinger-Ellison sd, ↑vitA, ↑vitD, granulomatous ds (sarcoid, …)

Asympt; osteopenia, fx, kidn stones, anorex, constip, weak, fatig, alt ment status

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12
Q

Hypercalcemia (dg, ttt)

A

Dg: total/ionized Ca, album, P, PTH
If suspic*: PTHrP (cancer), prot electrophor (MM), vit D (sarc, TB), ECG (short QT)

ttt: IV hydrat*, avoid thiazides; steroids for granulom ds
If Ca>14: IV fluids + calcitonin + bisphosph

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13
Q

Hypocalcemia (etiologies, PE)

A 
Ca <8.5
By hypoparath (post-surg, idiop), 2* hyperparath (CKD), malnutrit*, hypoMg2+, acute pancreatitis, vitD def, citrate chelat*, pseudohypoparath, DiGeorge sd

Abdo M cramps, dyspn, tetany, perioral/acral paresth, convuls*; Chvostek, Trousseau

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14
Q

Hypocalcemia (dg, ttt)

A

Dg: ionized Ca + PTH (#1); Hx of thyroidect; Mg2+, album, vitD (25 + 1,25), ECG (prolong QT)

ttt: underl cause, Mg2+ replet*, PO Ca2+ supplem (IV if severe)

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15
Q

Hypomagnesemia (etiologies, PE)

A

Mg <1.5
↓intake (malnutrit*, malabs, short bowel sd, TPN, PPIs)
↑loss (diuret, diarrh, vomit, hyperCa, alcoholism+++)
Miscellan: DKA, pancreatitis, ↑extracell volume

If sev: hyperreflexia, tetany, paresth, irritab, confus*, lethargy, seiz, arrhyth

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16
Q

Hypomagnesemia (dg, ttt)

A

Dg: concurrent hypoCa and hypoK; ECG (prolong PR + QT)

ttt: IV/PO Mg supplem, !!! correct Mg first (before hypoCa and hypoK)

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17
Q

Respiratory acidosis

A

Hypoventilat*

  • Airway obstruct*
  • Acute lung ds
  • Chronic lung ds
  • Opioids, narcotics, sedatives
  • Weak respiratory muscles
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18
Q

Metabolic acidosis with compensation (hyperventilation) + normal AG

A
  • Diarrhea
  • Glur sniffing
  • Renal tubular acidosis
  • Hyperchloremia
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19
Q

Metabolic acidosis with compensation (hyperventilation) + ↑ AG

A

MUDPILES:

Methanol; Uremia; DKA; Paraldehyde; Iron/INH; Lactic acidosis; Ethylene glycol; Salicylates (late)

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20
Q

Respiratory alkalosis

A

Hyperventilat*

  • Early high altitude expo
  • Aspirin (early)
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21
Q

Metabolic alkalosis with compensat* (hypoventilation)

A

Chloride sensitive (hypochloremic, saline responsive, urine Cl <20):

  • Vomiting
  • Diuretic
Chloride resistant (saline resistant, urine Cl >20):
-Hyperaldosteronism
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22
Q

Renal tubular acidosis

A

Net ↓tubular H+ secret* or HCO3- reabsorpt*
Non-AG metabolic acidosis
Types: I; II; IV (#1 fqt)

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23
Q

Renal tubular acidosis type I

A 
Def H+ secret* (distal)
HypoK
Urin pH >5.3
Autoimmune dso; hypercalciuria; ifosfamide
ttt: replace bicarb
Compl: nephrolithiasis
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24
Q

Renal tubular acidosis type II

A 
Def HCO3- reabsorpt* (proximal)
HypoK
Urin pH 5.3 (then <5.3)
MM; amyloidosis; Fanconi; cystinosis; ifosfamide
ttt: thiazides, volume deplet*
Compl: Rickets, osteomalacia
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25
Q

Renal tubular acidosis type IV

A 
Aldost def or resistance (distal)
HyperK
Urin pH <5.3
Hyporeninemic hypoaldost (renal insuff); ACEIs/ARBs; heparin
ttt: furosemide, replace mineralocortic
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26
Q

Acute kidney injury (complications)

A

= Acute renal failure
Abrupt ↓fct; retent of creat+BUN
Oliguria (<500mL/d) not required

Compl: metabolic acidosis, e- abNl, volume overload; CKD!!!

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27
Q

Prerenal acute kidney injury (etiologies, PE, ttt)

A

↓renal perfus*
Hypovol, shock, cirrhosis, nephrot sd, renal art stenosis, hepatorenal sd, drugs (NSAIDs, ACEIs), CHF

Tachycard, hypoTN, other sympt (of liv failure, nephrot sd)
ttt: fluids, avoid nephrotoxic drugs; dialysis if AEIOU criteria

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28
Q

Prerenal acute kidney injury (labs)

A 
BUN/Creat >20:1
FeNa <1%
Urin Na <20
Urin osm >500
Hyaline casts in urine
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29
Q

Intrinsic acute kidney injury (etiologies, PE, ttt)

A

Nephron injury
ATN (isch or toxin), AIN, glomerulonephritis, emboli, rhabdomyolysis

Hx drug expo (aminogl, NSAIDs, peni), contrast media
Creat spikes in 5-10d (drugs) or 24h (contrast)
ttt: IVF if contrast needed; nonionic contrast; stop meds

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30
Q

Intrinsic acute kidney injury (labs)

A 
BUN/Creat <15:1
FeNa >2%
Urin Na >40
Urin osm <350
RBC casts (glomerulonephritis); WBC/eosino (AIN); muddy-brown cast (ATN); WBC (pyelonephritis); fatty (nephrot sd)
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31
Q

Postrenal acute kidney injury (etiologies, PE, ttt)

A

Urin outflow obstruct*
Prostat ds, pelvic tumor, intratubul obstruct* (crystalluria), bilat stones

↓urin output, suprapub pain, distend bladder, scan w/ postvoid residual >50mL
ttt: bladder cath

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32
Q

Postrenal acute kidney injury (labs)

A

BUN/Creat varies
FeNa >1-2%
Urin Na >40
Urin osm <350

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33
Q

Chronic kidney disease (etiologies, PE, dg)

A

> 3mo of GFR <60 or kidney damage
Esp by DM, HTN, glomerulonephritis, PKD

Asympt until GFR <30; gradual signs of uremia (anorex, N/V, pericarditis, “frost”, delirium, seiz, coma)

Dg: azotemia, fluid retent, metab acidosis, hyperK, anemia, abNl hemostasis, hypoCa, hyperP, 2 hyperparath, urin (waxy casts), osteodystrophy

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34
Q

Chronic kidney disease (ttt, complications)

A

ttt: ACEIs/ARBs, HTN control, DDAVP (if abNl bleed), EPO, fluid restrict*, ↓Na/K/P intake, P binders/calcitriol (Osteodystr), hemodialysis, peritoneal dialysis, renal transplant

Compl: acquired renal cystic ds (if long-term dialys), CV (MI, sudden card death)

35
Q

Carbonic anhydrase inhibitors

A

Acetazolamide
In proximal conv tubule
Inhib CA, ↑H reabs, block Na/H exchange

Side eff: hyperchlor metab acidosis, sulfa allergy

36
Q

Osmotic diuretics

A

Mannitol, urea
In entire tubule
↑tub fluid osmolarity

Side eff: pulm edema (CHF + anuria)

37
Q

Loop diuretics

A

Furosemide, ethacrynic acid, bumetanide, torsemide
In ascend loop of Henle
Inhib Na/K/2Cl transporter

Side eff: water loss, metab alkal, ↓K/Ca/Mg, ototoxicity, sulfa allergy, hyperuricemia

38
Q

Thiazide diuretics

A

HCTZ, chlorothiazide
In distal conv tubule
Inhib Na/Cl transport

Side eff: water loss, metab alkal, ↓Na/K, ↑glu/Ca/uric acid, sulfa allergy, pancreatitis

39
Q

K+-sparing diuretics

A

Spironolactone, triamterene, amiloride
In cortical coll tub
Aldost recep antag (spirono); block Na channel (triam/amil)

Side eff: metab acid, ↑K, antiandrogenic (gynecom; spironol)

40
Q

Nephritic syndrome

A

Glomerular inflamm (glomerulonephritis)
Proteinuria <1.5g/d
Oliguria, macro/micro hematuria, HTN, edema (also pulm)

Dg: UA, ↓GFR, ↑BUN+crea, renal biopsy
ttt: salt+water restrict*+diuretics (HTN, fluid overload, uremia) +/- dialysis; sometimes CS

41
Q

Postinfectious glomerulonephritis

A 
Nephritic sd w/ immune complex
Recent (2-6wks) GAS inf; or any inf
Oliguria, cola-urin, HTN, edema
Low C3 (then Nl in 6-8wks); ↑ASO, ↑anti-DNase
Lumpy-bumpy imm.fluoresc
ttt: diuretics
42
Q

IgA nephropathy (Berger ds)

A 
Nephritic sd w/ immune complex
After URI or GI inf
Esp young men
Gross hematuria
Normal C3
ttt: GC; ACEIs (if proteinuria)
!!! Progress to ESRD
43
Q

Henoch-Schonlein purpura

A 
Nephritic sd w/ immune complex
Small Vx vasculitis; esp child
Triad: palpable purpura, arthralgia, abdo pain
Normal C3
ttt: GC
44
Q

Granulomatosis with polyangiitis (Wegener ds)

A

Nephritic sd w/o Ig deposit
Granulom in nasopharyng + kidney w/ necrotizing vasculitis
Resp/sinus sympt; hemoptysis
c-ANCA; segmental necrotizing glomerulonephritis
ttt: ↑dose CS, cytotoxic agent, rituximab

45
Q

Microscopic polyangiitis

A 
Nephritic sd w/o Ig deposit
Small Vx vasculitis (kidney, lung); No granulomas
Resp sympt; hemoptysis; No nasophar
p-ANCA; necrotizing glomerulonephritis
ttt: GC, cyclophosphamide, rituximab
46
Q

Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)

A 
Nephritic sd w/o Ig deposit
Small Vx vasculitis
Asthma, sinusitis, skin nodules/purpura, periph neurop
p-ANCA, ↑Ig-E
ttt: GC
47
Q

Goodpasture syndrome

A

Nephritic sd w/ anti-GBM ds
Rapidly progress glomerulonephritis + pulm hge
Esp men in mid-20s
Hemoptysis, dyspn, +/-resp failure, No upper resp
Linear anti-GBM deposits (IF), iron def anem, macroph (sputum), pulm infiltr (CXR)
ttt: plasma exchange, pulse steroids
!!! ESRD progress*

48
Q

Alport syndrome

A 
Nephritic sd w/ anti-GBM ds
Heredit glomerulonephritis
Esp boys 5-20yo
Asympt hematuria, sensorineural deafness
GBM splitting (EM)
!!! progr renal failure; may recurr after transplant
49
Q

Nephritic syndrome with low C3 (#dg)

A
  • Postinfectious
  • Membranoproliferative glomerulonephritis (and mixed cryoglobulinemia: purpura, arthralgia, nephrit sd, ↓C3, ⊕HCV)
  • Lupus nephritis
50
Q

Nephrotic syndrome (causes, PE)

A

Esp from systemic ds (DM, SLE, amyloidosis)
Proteinuria ≥3.5g/d; general edema, hypoalbuminemia (<3), hyperlipidemia, foamy urine, lipiduria

↑R inf, hypercoag (↑venous thromb/PE; loss antithromb3, prot C/S)

51
Q

Nephrotic syndrome (dg, ttt)

A

Dg: spot prot/creat ratio, albu, lipid, …; renal biopsy

ttt: prot+salt restrict*, diuretics, antihyperlipidemics
Imm.suppressant (sometimes); ACEIs; Strep pneumo vaccine (PPV23)

52
Q

Minimal-change disease

A 
#1 in child
Idiop; NSAIDs, hemato malign (Hodgkin)
↑R inf, thrombosis; sudden edema
Normal (light micro); fus* epith foot process + lipid-laden (EM)
ttt: steroids; excellent pg
53
Q

Focal segmental glomerulosclerosis

A

1 in adult; Idiop; IVDU, HIV, obes

Esp Afric/Amer man w/ uncontrolled HTN
Microsc hematuria; biopsy (sclerosis in capill tuft)
ttt: prednisone, cytotoxic ttt, ACEIs/ARBs

54
Q

Membranous nephropathy

A

Ass w/ solid cancers, inf (HBV, malaria), autoimm (SLE), meds (NSAIDs, gold)
Spike+dome (granular deposits IgG+C3 at basement memb)
ttt: prednisone, cytotoxic ttt

55
Q

Diabetic nephropathy

A

2 forms: diffuse hyalinizat* or nodular glomerulosclerosis (Kimmelstiel-Wilson)
Long-standing poorly controlled DM + retinop/neuropathy
Thick GBM, ↑mesangial matrix
ttt: tight glycem control, ACEIs/ARBs

56
Q

Lupus nephritis

A 
Nephrotic or nephritic sd
Severity of renal ds → overall pg
UA (prot or RBC)
Mesangial prolif; subendoth or subepith imm complex deposit*
ttt: prednison and cytotoxic med
57
Q

Renal amyloidosis

A

1* (plasma cell dyscrasia); 2* (inf or inflamm)
MM or chronic infl ds (rheum arth, TB)
Nodular glomerulosclerosis; EM (amyloid fibrils); apple-green biref w/ Congo red stain
ttt: prednisone, melphalan; BMT in MM

58
Q

Membranoproliferative nephropathy

A

Nephritic/nephrotic sd; ttt w/ CS and cytotoxic meds

T I: ass w/ HBV, HCV, cryoglob, SLE, subacute bact endocarditis
Tram-track, double BM, subendoth + mesangial deposits
Low C3

T II/III: esp idiop
Intramembran dense deposits

59
Q

Nephrolithiasis (RF, PE)

A

RF: ⊕fam Hx, ↓fluid intake, gout, meds (allop, chemoth, loop diur), post-colectomy/ileostomy, enz def, RTA T1, hyperparath; esp older men

Acute severe colicky flank pain; radiat* testes/vulva; N/V
Shift posit*/uncomfort

60
Q

Nephrolithiasis (dg, ttt)

A

Dg: UA (macro/micro hematuria), alter urin pH
Noncontrast abdo CT (#1) or AXR; US (#1 in child, pgnt)
KUB (if opaque stone)

ttt: hydrat* + analgesia (#1); <0.5cm pass; 0.5-3cm ttt w/ ESWL or percut nephrolithotomy or retrogr ureteroscopy;
alpha⊖ or CCB (facilitate passage)
Prevent: ↑fluid, ↑Ca intake, ↓prot/oxalate, ↓Na intake

61
Q

Calcium oxalate / Calcium phosphate nephrolithiasis

A

1 kidney stone

Esp idiopathic hypercalciuria, 1* hyperparath, fat malabs, alkaline urine
Urine: ↑pH (Ca-P) or ↓pH (Ca-Oxal); Radiopaque
ttt: hydrat*, ↓Na/prot intake, thiazide
Do Not ↓Ca intake

62
Q

Struvite nephrolithiasis

A

Mg-NH4-PO4
Ass w/ urease-prod org (Proteus); Staghorn calculi
Urine: ↑pH; Radiopaque
ttt: hydrat*, AB if UTI, surg removal

63
Q

Uric acid nephrolithiasis

A

Ass w/ gout, xanthine oxidase def, ↑purine turnover
Urine: ↓pH; Radiolucent
ttt: hydrat*, alkalinize urin w/ citrate, ↓diet purine/allopur

64
Q

Cystine

A

Def in renal transport of aa (Cystine, Ornithine, Lysine, Arginine)
Hexagonal crystals, ⊕urin cyanide nitroprusside test
Urine: ↓pH; Radiopaque
ttt: hydrat*, ↓Na intake, alkalinize urine, penicillamine

65
Q

Polycystic kidney disease (types)

A

Cystic dilat* of renal tubules
Cysts in spleen, liver, pancreas

ADPKD: #1, asympt until >30yo, 50% will have ESRD then dialysis by 60yo, ↑R cerebral aneurysm

ARPKD: more severe, infants/young child, renal failure, liver fibrosis, portal HTN; death in few years

66
Q

Polycystic kidney disease (PE, dg, ttt)

A

Pain, hematuria +/- HTN, hepat cysts, cereb aneur, divertic, MVP
If cyst ruptur/inf: sharp local pain

Dg: US (#1) or CT; genetic test (ADPKD1, ADPKD2)
ttt: Prevent compl + ↓progr to ESRD
Early UTI ttt; BP control (ACEIs/ARBs)
When ESRD: dialysis; renal transplant

67
Q

Hydronephrosis (etiologies, PE)

A

Dilat* of renal calyces
2* to obstruct: ureteropelvic junct (child), if adult BPH, neurogenic bladder, tumor, …
2* to ↑output urinary flow and vesicoureteral reflux

Asympt; flank pain, ↓urin output, abdo pain, UTIs

68
Q

Hydronephrosis (dg, ttt, complications)

A

Dg: US or CT; ↑BUN+crea
ttt: surg if anatomic obstruct*; laser/sound wave if calcul; ureteral stent; nephrostomy; Foley/suprapub cath (if low UT obstr)

Compl: if unttt, HTN, acute/chronic renal failure, sepsis, poor pg

69
Q

Scrotal swelling (etiologies, PE)

A
  • Painless: hydrocele, varicocele
  • Painful: epididymitis, testic tors*

“Bag of worms” (varicoc; esp left side)
Prehn sign: ⊕ in epididymitis; ⊖ in tors*

70
Q

Scrotal swelling (dg, ttt)

A

Dg: transilluminat* on US (⊕ in hydroc; ⊖ in varicoc)
Doppler (↑flow in inf; ↓flow in tors*); UA+Cx (gono, Ecoli, chlam)

ttt: hydroc (none); varicoc (surg if larg/sympt); inf (AB tetracycl/fluoroq; NSAIDs for pain); tors* (immed surg in <6h; orchiopexy bilateral!!!)

71
Q

Erectile dysfunction (etiologies, RF)

A
  • Initiate: psychol, endocrin, neuro
  • Fill: arteriogenic
  • Store: veno-occlusive dysfct*

RF: DM, atheroscl, meds (B⊖, SSRI, TCA, diuretics), HTN, heart ds, surg/radiat* prostate cancer, spinal cord injury

72
Q

Erectile dysfunction (PE, dg, ttt)

A 
Psy # organic: ⊕ nocturnal/early-morning erect* so nonorganic; situat* dependence
Neuro eval (anal tone, LE); hypogonadism eval

Dg: clinic; testosterone, gonadotropin, prolactin
ttt: psychotherapy; PDE5 inhib; testosterone (if hypogonadism)
If PDE5 inhib fails: pump, prostag inj, surg implant

73
Q

Benign prostatic hyperplasia (PE)

A

Nl aging process; in >80% of men 80yo
Esp periurethral zone

  • Obstruct sympt: hesitant, weak/intermitt stream, incompl empty, urin retent*
  • Irritative sympt: nocturia, daytime fqcy, urge incont, hematuria
74
Q

Benign prostatic hyperplasia (dg, ttt)

A

Dg: DRE (uniform enlarged, rubbery), UA+Cx, PSA
Creat (r/o obstr uropathy, renal insuff)

ttt: alpha⊖, 5 alpha-reductase inhib
TURP if mod-sev sympt/complic (renal insuff, recurr UTIs, bladd stones)

75
Q

Prostate cancer (RF, PE, prevention)

A

In men: #1 cancer; #2 cause of cancer death
RF: adv age, ⊕fam Hx

Asympt, obstr urin sympt, lymphedema (obstr meta), back pain (bone meta)
DRE (palpable nodule, indurat*) (tender prost = prostatitis)

Prevent: annual DRE +/or PSA starting 50yo, earlier in Afr/Am or w/ 1st degree fam cancer

76
Q

Prostate cancer (dg, ttt)

A

Dg: clinic, ↑PSA>4, transrectal biopsy (under US, defin dg)
Grade (Gleason); CT abdo/pelv + bone scan (meta; osteoblastic, ↑BMD)

ttt: watchful waiting (elder + low-grade); radical prostatectomy (ass w/ ↑R of incontinence or erect dysfct)
Radiat* (ass w/ ↑R of proctitis, GI sympt); PSA (follow-up)
If meta: androgen ablat* (GnRH agonist, orchiectomy, flutamide) + chemotherapy

77
Q

Bladder cancer (RF, PE)

A

1 fqt cancer of UT; esp men 60-70yo

Esp transitional cell carcinoma
RF: smok, ↑meat/fat, schistos, chronic cyclophosph, expo to aniline dye

Gross hematuria, other urin sympt (irritat)

78
Q

Bladder cancer (dg, ttt)

A

Dg: cystoscopy w/ biopsy (#1), UA (hematuria), cytology, MRI/CT/bone scan (invas* + meta)

ttt: intravesicular chemoth (carcinoma in situ or large high-grade recurrent); resect* or intravesic BCG/mitomycin-C (superficial cancer); radical cystectomy or radiat* (invasive w/o meta or unresectable); chemoth alone (invasive + meta)

79
Q

Renal cell carcinoma (RF, PE)

A

AdenoK from tubular epith cells
Spread: renal vein, IVC then meta lung and bone
RF: male, smok, obes, acquir cystic kidney ds in ESRD, vonHippel-Lindau

Triad: hematuria, flank pain, palpable mass
+/- ↓weight, mal, fever, varicocele, anemia or polycythemia

80
Q

Renal cell carcinoma (dg, ttt)

A

Dg: CT (dg+stage); histo on nephrectomy piece (confirm)

ttt: surg resect* (cure if local); metastasectomy
Tyrosine kinase inhib (↓angiogenesis, cell prolif)

81
Q

Testicular cancer (RF, PE, dg)

A

Esp men 15-34yo; but seminoma esp 40-50yo
Germ cells (95%)
RF: cryptorchidism, Klinefelter sd

Painless enlarged testes
Dg: testic US; CXR + CT abdo/pelv (meta); tumor markers

82
Q

Testicular cancer (ttt)

A

ttt: radical orchiectomy
Platinum-chemoth for nonseminomatous
Radioth +/- chemoth: if seminoma

83
Q

Testicular cancer (tumor markers)

A

Germ cell: seminoma (↑placental ALP); yolk sac (↑AFP), choriocarcinoma (↑B-hCG); teratoma (AFP, B-hCG)

Non-germ cell: leydig cell (↑testosterone, estrogen); sertoli cell (none); testicular lymphoma (none)

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