Urology for the MRCS part A Flashcards
(320 cards)
1
Q
Enumerate types of renal stones with their percentage of occurrence starting with the most common to the less common
A
Mnemonic;CC/US/C
(1) Calcium oxalate(85%)
(2) Calcium phosphate stones(10%)
(3) Uric acid stones(5-10%)
(4) Struvite stones(2-20%)
(5) Cystine stones(1%)
2
Q
Discuss calcium oxalate stones
A
Percentage =85%
Aetiology
(1)Hypercalciuria
(2)Hyperoxaluria
(3)Hyperuricosuria-may cause uric acid stones to which calcium oxalate binds
(4)Hypocitraturia-increases risk because citrate forms complexes with calcium
making it more soluble
Opacity = Radio-opaque(though less than calcium phosphate stones)
Urine acidity = variable
Urine PH = 6
3
Q
Enumerate causes of calcium oxalate stones
A
(1)Hypercalciuria
(2)Hyperoxaluria
(3)Hyperuricosuria-may cause uric acid stones to which calcium oxalate binds
(4)Hypocitraturia-increases risk because citrate forms complexes with calcium
making it more soluble
4
Q
Comment on opacity of calcium oxalate stones
A
Radio-opaque(though less than calcium phosphate stones)
5
Q
Comment on urine acidity of calcium oxalate stones
A
Variable
6
Q
What is the urine PH of calcium oxalate stones?
A
6
7
Q
Why hyperuricosuria causes calcium oxalate stones?
A
May cause uric acid stones to which calcium oxalate binds
8
Q
Why hypocitraturia causes calcium oxalate stones?
A
Increases risk because citrate forms complexes with calcium making it more soluble
9
Q
Discuss calcium phosphate stones
A
Incidence = 10%
Aetiology-the following increases supersaturation of urine with calcium and phosphate causing calcium phosphate stones:-
(1)Renal tubular acidosis types 1 and 3(types 2 and 4 do not)
(2)High urinary PH
Opacity = radio-opaque (composition similar to bone)
Urine acidity = Normal/Alkaline
Urine PH > 5.5
10
Q
What is the incidence of calcium phosphate stones?
A
10%
11
Q
What is the aetiology of calcium phosphate stones ?
A
the following increases supersaturation of urine with calcium and phosphate causing calcium phosphate stones:-
(1)Renal tubular acidosis types 1 and 3(types 2 and 4 do not)
(2)High urinary PH
12
Q
What increases supersaturation of urine with calcium and phosphate causing calcium phosphate stones?
A
(1)Renal tubular acidosis types 1 and 3(types 2 and 4 do not)
(2)High urinary PH
13
Q
Comment on opacity of calcium phosphate stones
A
radio-opaque (composition similar to bone)
14
Q
Comment on urine acidity of calcium phosphate stones
A
Normal/Alkaline
15
Q
What is the urine PH of calcium phosphate stones?
A
> 5.5
16
Q
How does uric acid form?
A
A product of purine metabolism
17
Q
Discuss uric acid stones
A
Incidence = 5-10%
Aetiology
Mnemonic;TIP
(1)extensive (T)issue breakdown e.g.,malignancy
(2)in children with (I)nborn errors of metabolism
(3)low (P)H-increases uric acid precipitation
(4)Thiazide diuretics
(5)In primary polycythaemia
(6)chemotherapy and cell death can increase uric acid levels.
(7)dehydration
Opacity =radiolucent(unless they have calcium contained within them)
If uric acid stones are unlikely to be coated with calcium therefore will be radiolucent
Urine acidity = acid
Urine PH = 5.5
18
Q
What is the incidence of uric acid stones?
A
5-10%
19
Q
What is the aetiology of uric acid stones?
A
Mnemonic;TIP
(1)extensive (T)issue breakdown e.g.,malignancy
(2)thiazide diuretics
(3)in children with (I)nborn errors of metabolism
(4)In 1ry polycythaemia
(5)low (P)H-increases uric acid
precipitation
(6)chemotherapy and cell death can increase uric acid levels
(7)Dehydration
20
Q
Comment on opacity of uric acid stones
A
Radiolucent (unless they have calcium contained within them)
If uric acid stones are unlikely to be coated with calcium therefore will be radiolucent
21
Q
Comment on urine acidity in uric acid stones
A
Acid
22
Q
What is the urine PH in uric acid stones?
A
5.5
23
Q
Discuss struvite stones
A
Incidence = 2-20%
Aetiology
chronic infections with urease producing bacteria e.g.,proteus mirabilis
Infection with proteus mirabilis accounts for 90% of all proteus infections.
It has a urease producing enzyme.This will tend to favour urinary
Alkalinisation which is a relative prerequisite for the formation of
staghorn calculi.
Composition
(1)Magnesium
(2)Ammonium
(3)Phosphate
(4)Crystals-precipitate under alkaline conditions
Opacity = slightly radio-opaque
Urine acidity = Alkaline
Urine PH = >7.2
24
Q
What is the incidence of struvite stones?
A
2-20%
25
What is the aetiology of struvite stones?
Chronic infection with protease producing bacteria e.g.,proteus mirabilis
Infection with proteus mirabilis accounts for 90% of all proteus infections.
It has a urease producing enzyme.This will tend to favour urinary
Alkalinisation which is a relative prerequisite for the formation of
staghorn calculi.
26
What is the composition of struvite stones?
(1)Magnesium
(2)Ammonium
(3)Phosphate
(4)Crystals-precipitate under alkaline conditions
27
Comment on opacity of struvite stones
Slightly radio-opaque
28
Comment on urine acidity in struvite stones
Alkaline
29
What is the urine PH in struvite stones?
>7.2
30
Discuss cystine stones
Incidence = 1%
Aetiology
Inherited-recessive disorder of transmembrane cystine transport leading to decreased absorption of cystine from intestines and renal tubules
Feature = multiple stones may form
Opacity = because they contain sulphur,they may have the following appearance
(1)radiosense or
(2)semi-opaque
(3)ground glass
Urine acidity = normal
Urine PH = 6.5
31
Why the urine PH is measured?
32
What is the incidence of cystine stones?
1%
33
What is the aetiology of cystine stones?
Inherited-recessive disorder of transmembrane cystine transport leading to decreased absorption of cystine from intestines and renal tubules
34
What is the feature of cystine stones?
multiple stones may form
35
Comment on opacity of cystine stones
because they contain sulphur,they may have the following appearance
(1)radiosense or
(2)semi-opaque
(3)ground glass
36
Comment on urine acidity in cystine stones
Normal
37
What is the urine PH in cystine stones?
6.5
38
Summarise types of renal stones for the exam
39
Classify renal stones
40
Discuss therapeutic selections for renal stones
41
How do you manage a ureteric calculi <5mm?
Expectantly
42
How do you manage a stone burden <2cm?
(1)Lithotripsy or
(2)Ureteroscopy-if pregnant or impacted
43
How do you manage complex renal calculi?
Percutaneous nephrolithotomy(PCNL)
44
How do you manage staghorn calculi?
Percutaneous nephrolithotomy(PCNL)
45
How do you manage stone of any size+obstructed and infected system ?
Urgent decompression(ureteroscopy or nephrostomy)
46
How do you manage an obstructed stone or a stone causing obstruction?
Urgent decompression(ureteroscopy or nephrostomy)
47
How do you manage a stone causing infected system?
Urgent decompression(ureteroscopy,nephrostomy)
48
Discuss staghorn renal calculi
Definition
(1)Involve the renal pelvis hence the stag horn shape
(2)Extend into at least 2 calyces
Aetiology = Recurrent Urinary Tract Infection(UTI)with urea plasma producing bacteria
(1)Ureaplasma urealyticum
(2)Proteus mirabilis
Infection with proteus mirabilis accounts for 90% of all proteus infections.
It has a urease producing enzyme.This will tend to favour urinary
Alkalinisation which is a relative prerequisite for the formation of
staghorn calculi.
(3)Klebsiella
(4)Pseudomonas
(5)Enterobacter
Composition
1st/struvite which is composed of(Mnemonic;MAP/T)
(1)magnesium
(2)ammonium
(3)Phosphate
(4)triple phosphate
2nd/Calcium carbonate appatite
Type of stone
(1)Struvite(magnesium,ammonium,phosphate,triple phosphate) or
(2)Calcium carbonate appatite
Opacity=radio-opaque
49
Define staghorn renal calculi
(1)Involve the renal pelvis
(2)Extend into at least 2 calyces
50
What is the aetiology of staghorn renal calculi?
Recurrent Urinary Tract Infection with urea producing bacteria
(1)Ureaplasma urealyticum
(2)Proteus mirabilis
Infection with proteus mirabilis accounts for 90% of all proteus infections.
It has a urease producing enzyme.This will tend to favour urinary
Alkalinisation which is a relative prerequisite for the formation of
staghorn calculi.
(3)Klebseila
(4)Pseudomonas
(5)Enterobacter
51
What is the composition of staghorn renal calculi?
1st/struvite which is composed of(Mnemonic;MAP/T)
(1)magnesium
(2)ammonium
(3)Phosphate
(4)triple phosphate
2nd/Calcium carbonate appatite
52
Discuss renal stones appearance on imaging
53
What is the effect of urinary PH on stone formation?
54
What is the incidence of urolithiasis?
15%
55
What are the clinical features of urolithiasis?
Abdominal pain which is
(1)the classic feature in history
(2)loin to groin
(3)sudden onset
(4)almost always associated with haematuria
56
How to diagnose urolithiasis?
Helical non contrast CT(CT KUB)-the most sensitive and specific diagnostic test
57
Discuss shock wave lithotripsy
Also known as = extracorporial shock wave lithotripsy(ESWL)
Definition
(1)a shock wave is generated external to the patient
(2)internally,cavitation bubbles and mechanical stress lead to stone fragmentation
Side effects
(1)fragmentation of larger stones results in the development ureteric obstruction
(2)the passage of shock waves results in solid organ injury
(3)the procedure is uncomfortable and requires analgesia during and after the procedure
Indications and contraindications
58
What is the other name for shock wave lithotripsy?
extracorporial shock wave lithotripsy(ESWL)
59
Define shock wave lithotripsy
(1)a shock wave is generated external to the patient
(2)internally,cavitation bubbles and mechanical stress lead to stone fragmentation
60
Draw a schematic diagram illustrating cavitation bubbles in ESWL
61
Real picture of cavitation bubbles in ESWL
62
What are the side effects of shock wave lithotripsy(ESWL)
(1)fragmentation of larger stones results in the development ureteric obstruction
(2)the passage of shock waves results in solid organ injury
(3)the procedure is uncomfortable and requires analgesia during and after the procedure
63
What are the indications and contraindications of shock wave lithotripsy (ESWL)?
64
What are the indications of shock wave lithotripsy (ESWL)?
65
What are the contraindications of shock wave lithotripsy (ESWL)?
66
Discuss ureteroscopy
Indications
(1)where lithotripsy is contraindicated(e.g.,pregnant)
(2)complex stone disease
(3)stone burden of less than 2cm in pregnants
Technique
(1)passes retrograde
-through the ureter
-into the renal pelvis
(2)left in situ for 4 weeks after the procedure
67
What are the indications of ureteroscopy?
(1)where lithotripsy is contraindicated(e.g.,pregnant)
(2)complex stone disease
(3)stone burden of less than 2cm in pregnants
68
What is the technique for ureteroscopy?
(1)passes retrograde
-through the ureter
-into the renal pelvis
(2)left in situ for 4 weeks after the procedure
69
What do(left in situ) mean for ureteroscopy?
Left in the renal pelvis
70
For how long the ureteroscopy is left in situ inside the renal pelvis?
4 weeks
71
Discuss percutaneous nephrolithotomy(PCNL)
Indications
(1)Staghorn stones
(2)Large stones(mostly > 2 cm)-It should be considered 1st line for stones>20mm
(3)Multiple stones
(4)complicated stones(e.g.,upper UTI,obstruction by a stone of whatever the size)
(5)Lower pole calyx or region stones,two options
->1cm do percutaneous nephrolithotomy (PCNL)
-<1cm do flexible ureteroscopy
(6)PCNL is a safe treatment for stones in a transplant kidney but it should be done in a specialist centre
(7)PCNL is often considered in patients with kidney stones that have undergone urinary diversion.
A retrograde approach can also be considered if access to the ureters can be gained
Contraindications
(1)Uncorrected bleeding disorders or coagulopathy
(2)Uncooperative patient
(3)Severe hyperkalemia (>7 mEq/L); this should be corrected with hemodialysis before the procedure
Technique
(1)Access is gained to the renal collecting system
(2)Intracorporial lithotripsy or stone fragmentation is performed
(3)Stone fragments removed
72
What are the indications of percutaneous nephrolithotomy(PCNL)?
(1)Staghorn stones
(2)Large stones(mostly > 2 cm)-It should be considered 1st line for stones>20mm
(3)Multiple stones
(4)complicated stones(e.g.,upper UTI,obstruction by a stone of whatever the size)
(5)Lower pole calyx or region stones,two options
->1cm do percutaneous nephrolithotomy (PCNL)
-<1cm do flexible ureteroscopy
(6)PCNL is a safe treatment for stones in a transplant kidney but it should be done in a specialist centre
(7)PCNL is often considered in patients with kidney stones that have undergone urinary diversion.
A retrograde approach can also be considered if access to the ureters can be gained
73
What is the technique used for percutaneous nephrolithotomy(PCNL)?
(1)Access is gained to the renal collecting system
(2)Intracorporial lithotripsy or stone fragmentation is performed
(3)Stone fragments removed
74
What does radiosense for renal stones mean?
Radio-opaque
75
What does radio-opaque for renal stones mean?
Radiosense
76
Discuss nephrostomy
77
What is the difference between stent(down)and nephrostomy(above)?
78
Define nephrostomy
Opening in the kidney
79
What are the indications of nephrostomy?
(1)pyelonephritis
(2)signs of obstruction(especially,distal obstruction)
-RF
-sepsis
-solitary kidney
-continuing obstruction
(3)fever
80
What is the technique used for renal stents?
Placed from the urethra down so you are not coming from the kidney above
81
What is the indication of nephrectomy?
If kidney function <15%
82
Discuss management of renal stones in general
1st/According to the urgency of the case
[I]NON EMERGENCY CASES
#Options
(1)Conservative treatment for 2 weeks
For stones<5mm;90% pass through urine within 4 weeks of symptoms onset
(2)Extracorporial shock wave lithotripsy(ESWL)
(3)Percutaneous nephrolithotomy(PCNL)
(4)Flexible ureteroscopy
(5)Open surgery for selected cases-minimally invasive options are the most popular first line treatment
[II]MORE INTENSIVE AND URGENT TREATMENT
#Indications
(1)Ureteric obstruction
Ureteric obstruction due to stones together
with infection is a surgical emergency and
the system must be decompressed
(2)Renal developmental abnormalities such as horseshoe kidney
(3)Renal transplant
#Options
(1)Nephrostomy tube placement
(2)Ureteric cathetre insertion
(3)Ureteric stent placement
2nd/According to the stone size
83
What is the management of renal stones according to the urgency of the case?
1st/According to the urgency of the case
[I]NON EMERGENCY CASES
#Options
(1)Conservative treatment for 2 weeks
For stones<5mm;90% pass through urine within 4 weeks of symptoms onset
(2)Extracorporial shock wave lithotripsy(ESWL)
(3)Percutaneous nephrolithotomy(PCNL)
(4)Flexible ureteroscopy
(5)Open surgery for selected cases-minimally invasive options are the most popular first line treatment
[II]MORE INTENSIVE AND URGENT TREATMENT
#Indications
(1)Ureteric obstruction
Ureteric obstruction due to stones together
with infection is a surgical emergency and
the system must be decompressed
(2)Renal developmental abnormalities such as horseshoe kidney
(3)Renal transplant
#Options
(1)Nephrostomy tube placement
(2)Ureteric cathetre insertion
(3)Ureteric stent placement
84
What are the options of management of renal stones of non emergency cases?
(1)Conservative treatment for 2 weeks
For stones<5mm;90% pass through urine within 4 weeks of symptoms onset
(2)Extracorporial shock wave lithotripsy(ESWL)
(3)Percutaneous nephrolithotomy(PCNL)
(4)Flexible ureteroscopy
(5)Open surgery for selected cases-minimally invasive options are the most popular first line treatment
85
What are the indications of more intensive and urgent treatment for renal stones?
(1)Ureteric obstruction
Ureteric obstruction due to stones together
with infection is a surgical emergency and
the system must be decompressed
(2)Renal developmental abnormalities such as horseshoe kidney
(3)Renal transplant
86
What are the options of more intensive and urgent treatment for renal stones?
(1)Nephrostomy tube placement
(2)Ureteric cathetre insertion
(3)Ureteric stent placement
87
What is the treatment of renal stones according to the stone size?
88
What is the treatment of renal stones according to the symptoms ?
89
What is the complication of instrumentation of renal tract and what is the treatment?
90
What is the complication of instrumentation of renal tract?
91
What are the organisms causing sepsis during instrumentation of renal tract as part of management of renal stones?
Gm(-)ve sepsis caused by organisms such as
(1)E.coli
(2)Bacteroides
92
What is the treatment of the organisms causing sepsis during instrumentation of renal tract as part of management of renal stones?
93
What is the indication of conservative management of renal stones?
(1)Conservative treatment for 2 weeks for stones<5mm
(Salah stated < 0.5cm in MRCS but in reality<1 cm)
without obstruction features ;
90% pass through urine within 4 weeks
of symptoms onset
(2)Conservative treatment is not for patients with solitary kidney and a chance of obstructing this kidney
94
What is the treatment of renal stones <5mm size?
Conservative treatment for 2 weeks for stones<5mm;90% pass through urine within 4 weeks of symptoms onset
95
For how long the conservative treatment of renal stones lasts?
2 weeks
96
How long do renal stones need to pass out if treated conservatively?
4 weeks
97
What is the percentage of renal stones passing through the urine if treated conservatively?
90%
98
What is the way through which renal stone pass out if treated conservatively?
Urine
99
What is the treatment of renal stones > 5mm?
100
What are the features of obstruction of renal tract by stones?
(1)RF
(2)Sepsis
(3)Solitary kidney
(4)Continuing obstruction
101
What is the treatment of renal stones > 5mm with obstruction features?
Nephrostomy
If no nephrostomy option in answer key,then ureteric stent option
102
What is the treatment of renal stones > 5mm with obstruction features and no nephrostomy in answer key?
ureteric stent option
103
What is the treatment of renal stones > 5mm with no obstruction features?
104
What is the treatment of renal stones > 5mm in the renal pelvis with no obstruction features?
(1)Extracorporial shock wave lithotripsy(ESWL)1st line treatment
(2)Percutaneous nephrolithotomyPCNL) if staghorn or large stone > 2cm
105
What is the treatment of simple renal stones > 5mm with no obstruction features?
Extracorporial shock wave lithotripsy(ESWL) 1st line treatment
106
What is the treatment of staghorn renal stones with no obstruction features?
Percutaneous nephrolithotomy (PCNL)
107
What is the treatment of large renal stones > 2cm with no obstruction features?
Percutaneous nephrolithotomy (PCNL)
108
What is the treatment of renal stones > 5 mm and ≤ 2cm in the upper pole calyx with no obstruction features?
Extracorporial shock wave lithotripsy (ESWL)
109
What is the treatment of renal stones > 1cm in the lower pole calyx with no obstruction features?
Percutaneous nephrolithotomy (PCNL) if > 1cm otherwise ESWL
110
What is the treatment of renal stones > 5 mm in the upper 1/3rd ureter with no obstruction features?
Push-Bang or ESWL in situ
111
What is the treatment of renal stones > 5 mm in the middle 1/3rd ureter with no obstruction features?
Mnemonic;PULLL
(1)Push-Bang 1st line treatment or
(2)USG or
(3)Laser or
(4)Lithoclast or
(5)Lithotripsy(if not considering surgery)
112
What is the treatment of renal stones > 5 mm in the lower 1/3rd ureter with no obstruction features?
Mnemonic;DJU
(1)Dormia Basket &
(2)JJ stent(Ureteroscopic removal if mild obstruction)
113
What is the treatment of renal stone <2cm with no obstruction features?
114
What is the treatment of small stone at the collecting system?
Flexible ureter-Renoscopy+Laser+Lithotripsy but never ESWL
115
What is the treatment bladder stone ?
Lithoclast fragmentation but required surgery if >5cm
116
What is the treatment of cystine calculi?
Dissolves by alkaline diuresis
117
What is the management of stones according to the symptoms?
118
What are the symptoms of bladder instability?
H/o
(1)urgency
(2)frequency
(3)nocturia
(4)uroflowmetry flow rate>15ml
119
What is the treatment of bladder instability?
Antimuscarinic drug like Tolterodine
120
What is the 1st line analgesia for renal colic?
NSAID
121
What is the 2nd line treatment for renal colic?
Strong opiates
122
Discuss diabetic nephropathy very briefly?
123
How is the diabetic nephropathy detected early?
By Micro-albuminaemia
124
What are the histological features of diabetic nephropathy?
Diffuse and nodular glomeruloscelerosis
125
What do we mean by antegrade and retrograde?
126
Discuss ureteric colic
127
Discuss rate of stones passage
128
Discuss over active bladder
129
Define the following terms
Urinary urgency,urge incontinence,urinary frequency and nocturia
130
Define urinary urgency
Inability to defer voiding
131
Define urge incontinence
Urgency causing non-voluntary urinary incontinence
132
Define urinary frequency
8 or more voids per 24hrs
133
Define nocturia
Awakening to void >1 instance per night
134
Discuss indinavir stones
135
What type of renal stones produced by indinavir could be seen on imaging?
Radiolucent stones
136
Discuss risk factors for stone disease
137
What is the effect of corticosteroids on stones formation?
138
Are urine cultures necessary in stone disease?
139
How to briefly manage urosepsis according to Pastest?
140
What are the sites of narrowing in the renal tract and what is its importance?
The following are the sites where the renal stones dislodge:
(1)Ureteropelvic junction(UPJ) or pelviureteric junction(PUJ)
(2)Ureteral crossing of the iliac vessels
(3)Ureterovesical junction(UVJ) or vesicoureteric junction(VUJ)
141
What is the duration required for complete renal obstruction to cause permanent renal dysfunction?
28 days
142
Enumerate causes of hydronephrosis
143
Enumerate causes of bilateral hydronephrosis
144
Enumerate causes of unilateral hydronephrosis
145
What is the sequele of pelvic ureteric junction obstruction?
Dietl’s crisis
146
Discuss Dietl’s crisis
Definition
Intermittent hydronephrosis
Aetiology
Pelvis Ureteral junction (PUJ) obstruction
Clinical features
Swelling in the loin
(1)appears after an attack of acute renal colic
(2)disappears after passage of urine
147
Define Dietl’s crisis
Intermittent hydronephrosis
148
What is the clinical feature of Dietl’s crisis?
Swelling in the loin
(1)appears after an attack of acute renal colic
(2)disappears after passage of urine
149
What is the aetiology of Dietl’s crisis?
Pelvic ureter junction(PUJ) obstruction
150
What are the investigations of hydronephrosis?
151
What is the role of USS in hydronephrosis?
(1)Identifies hydronephrosis
(2)Assess kidneys
152
What is the role of IVU in hydronephrosis?
Assess the position of the obstruction
153
What is the role of Antegrade and retrograde pyelography in hydronephrosis?
Allows treatment
154
What is the role of CT scan in hydronephrosis?
CT scan is done if suspect renal colic as the majority of stones are detected this way
155
What is the management or treatment of hydronephrosis?
Mnemonic;CAR
156
What is the treatment of acute urinary tract obstruction as part of management of hydronephrosis?
Nephrostomy tube placement
157
What is the treatment of chronic urinary tract obstruction as part of management of hydronephrosis?
(1)Ureteric stent placement or
(2)Pyeloplasty
158
What is the importance of proteus mirabilis infection in the renal stones formation?
Infection with proteus mirabilis accounts for 90% of all proteus infections.
It has a urease producing enzyme.This will tend to favour urinary alkalinisation which is a relative prerequisite for the formation of staghorn calculi.
159
What is the clinical picture of pelvic ureteric junction(PUJ)obstruction?
160
What is the cardinal feature of pelvic ureteric junction(PUJ)obstruction?
Back and flank pain correlates with periods of increased fluids intake and food ingestion with diuretics properties
161
What is the other name for ureteropelvic junction(UPJ)?
Pelviureteric junction
162
What is the other name for ureterovesical junction?
Vesicoureteric junction(VUJ)
163
What is the other name for renal cell carcinoma?
(1)Renal cell carcinoma of the renal cortex
(2)Renal adenocarcinoma
(3)Adenocarcinoma of the kidney
(4)Hypernephroma
(5)Grawtis tumour
(6)Clear cell carcinoma
164
What are the other names for renal cell carcinoma?
(1)Renal cell carcinoma of the renal cortex
(2)Renal adenocarcinoma
(3)Adenocarcinoma of the kidney
(4)Hypernephroma
(5)Grawit’s tumour
(6)Clear cell carcinoma
165
Discuss the incidence of the renal cell carcinoma
166
What is the general incidence of renal cell carcinoma?
Renal cell carcinoma are the most common renal tumour comprising 75-85% of all renal malignancies
167
What is the sex incidence of renal cell carcinoma?
M>F
168
What is the age incidence of renal cell carcinoma?
Sporadic tumours affect patients in their 6th decade.
169
Discuss manifestations of renal cell carcinoma
170
Discuss the asymptomatic presentation of the renal cell carcinoma
-Incidence:50%
-most commonly present as asymptomatic unilateral tumour in adults not in children
171
What is the percentage of asymptomatic presentation of renal cell carcinoma?
50%
172
Fill the blanks:
Renal cell carcinoma most commonly present as———,———-,in ———- not in ———
Renal cell carcinoma most commonly present as ASYMPTOMATIC,BILATERAL TUMOUR,in ADULTS not in CHILDREN
173
Discuss the unilateral presentation of renal cell carcinoma
-most commonly present as asymptomatic,unilateral tumour in adult not in children
-sometimes bilateral multicentric but not often
174
Discuss the triad of renal cell carcinoma
Incidence
10%
Presentation
(1)Haematuria(50%)
1)Microscopic-most commonly discovered during diagnostic work up
2)Macroscopic-the patient may develop frank haematuria and have episodes
of clot colic
(2)Renal colic(40%)
sometimes;it would be painless
(3)Renal mass(30%)
-RCCs typically affect the renal parenchyma
-Benign renal tumours are rare,so renal masses should be investigated with
multisliced CT scanning.
Some units will add an arterial or venous phase to the scan to demonstrate
1.vascularity
2.evidence of caval growth
175
What is the incidence of renal cell carcinoma triad?
10%
176
Discuss Haematuria in renal cell carcinoma
Incidence
50%
Presentation
1)Microscopic-most commonly discovered during diagnostic work up
2)Macroscopic(frank)-the patient may develop frank haematuria and have episodes of
clot colic
177
Discuss presentation of renal cell carcinoma triad
(1)Haematuria(50%)
1)Microscopic-most commonly discovered during diagnostic work up
2)Macroscopic-the patient may develop frank haematuria and have episodes
of clot colic
(2)Renal colic(40%)
sometimes;it would be painless
(3)Renal mass(30%)
-RCCs typically affect the renal parenchyma
-Benign renal tumours are rare,so renal masses should be investigated with
multisliced CT scanning.
Some units will add an arterial or venous phase to the scan to demonstrate
1.vascularity
2.evidence of caval growth
178
Discuss renal colic as a presentation of renal cell carcinoma triad
Incidence
40%
Presentation
sometimes;it would be painless
179
What is the incidence of renal colic as a presentation of renal cell carcinoma?
40%
180
What is the presentation of renal colic as part of the renal cell carcinoma triad?
Sometimes,it would be painless
181
Discuss renal mass as part of the renal cell carcinoma triad
Incidence
30%
Presentation
-RCCs typically affect the renal parenchyma
-Benign renal tumours are rare,so renal masses should be investigated with
multisliced CT scanning.
Some units will add an arterial or venous phase to the scan to demonstrate
1.vascularity
2.evidence of caval growth
182
What is the incidence of renal mass as part of renal cell carcinoma triad?
30%
183
What is the presentation of renal mass as part of renal cell carcinoma triad?
-RCCs typically affect the renal parenchyma
-Benign renal tumours are rare,so renal masses should be investigated with
multisliced CT scanning.
Some units will add an arterial or venous phase to the scan to demonstrate
1.vascularity
2.evidence of caval growth
184
Discuss left varicocle as part of the presentation of renal cell carcinoma
Due to compression of the left testicular vein as it joins the renal vein
185
What is the cause of left varicocele in renal cell carcinoma?
Due to compression of the left testicular vein as it joins the renal vein
186
What is the site of left testicular vein drainage?
Left renal vein
187
Why should we do an U/S to left vericocle in renal cell carcinoma
188
Discuss paraneoplastic syndrome as part of presentation of renal cell carcinoma
Aetiology in renal cell carcinoma
Paraneoplastic syndromes are due to ectopic secretion of hormones by the RCCs
Presentation
189
What is the aetiology of paraneoplastic syndromes as part of presentation of renal cell carcinoma?
Paraneoplastic syndromes are due to ectopic secretion of hormones by the RCCs
190
What are the paraneoplastic syndromes as part of presentation of renal cell carcinoma?
191
What is the most common paraneoplastic syndromes in general?
Endocrinopathies
192
What is the most common endocrinopathies in paraneoplastic syndromes?
Cushing syndrome(50%)
193
What is the most common paraneoplastic syndromes in general?
Cushing syndrome
194
What is the most common paraneoplastic syndromes in renal cell carcinoma?
Hypercalcaemia(20%)
195
What is the cause of hypercalcaemia in renal cell carcinoma?
(1)Parathyroid hormone
It leads to increased bone resorption and decreased
renal clearance of calcium
(2)TGF-alpha
(3)TNF
(4)IL-1
196
What is the incidence of hypercalcaemia in renal cell carcinoma?
20%
197
What is the presentation of hypercalcaemia in renal cell carcinoma?
(1)Depression
(2)Lethargy
(3)Constipation
(4)Abdominal pain
(5)Vomiting
198
What is the effect of parathyroid hormone in hypercalcaemia as a presentation of renal cell carcinoma?
(1)Increased bone resorption
(2)Decreased renal clearance of calcium
199
What is the importance of hyponatraemia in renal cell carcinoma?
Although not caused by renal cell carcinoma,it may be considered as poor prognostic indicator
200
What is the importance of hypocalcaemia in renal cell carcinoma?
Not seen in renal cell carcinoma
201
What is the most common malignancy associated with hypercalcaemia?
Squamous cell carcinoma of the lung
202
What is the importance of lymphopaenia in renal cell carcinoma?
203
What is the importance of polycythaemia in renal cell carcinoma?
204
What is the incidence of symptoms of metastasis in renal cell carcinoma?
25%
205
What are the symptoms of metastasis in renal cell carcinoma?
206
What are the routes of spread of renal cell carcinoma?
207
Discuss the direct route of spread to the metastasis of renal cell carcinoma
208
What is the most common route of spread to the metastasis of renal cell carcinoma?
Heamatogenous spread
209
Discuss the haematogenous route of spread to the metastasis of renal cell carcinoma
210
What are the organs to which the renal cell carcinoma directly metastasise?
211
What are the organs to which the renal cell carcinoma haematogenously metastasise?
212
Discuss the histological features of renal cell carcinoma
213
What is the origin of renal cell carcinoma?
Proximal convoluted tubules(PCT)
214
Discuss role of 20% in renal cell carcinoma
215
What is the appearance of renal cell carcinoma
216
What are the investigations of renal cell carcinoma?
217
What is the reason for which multisliced CT scan is done for renal cell carcinoma?
Benign tumours are rare,so renal masses should be investigated with multisliced CT scanning.
Some units will add an arterial or venous phase to demonstrate
(1)Vascularity
(2)Evidence of caval growth
218
What is the reason for which CT scan of the chest and abdomen is done for renal cell carcinoma?
To detect distant disease
219
What is the reason for which routine bone scan is done for renal cell carcinoma?
Not indicated in the absence of symptoms
220
What is the reason for which biopsy is done for renal cell carcinoma?
221
What is the indication of renal biopsy in renal cell carcinoma?
Before any ablative therapies
222
What are the contraindications of renal biopsy in renal carcinoma?
Post nephrectomy
223
What is the reason for which renal biopsy is contraindicated post nephrectomy?
Most cases of malignancy can be accurately classified on imaging
224
What multisliced CT scan show in renal cell carcinoma?
A mass with small cystic centre
225
What is the differential diagnosis of renal cell carcinoma?
226
What is the importance of oncocytoma as a differential diagnosis of renal cell carcinoma?
227
Discuss TNM staging and grading of renal cell carcinoma
228
What is the importance of renal cell carcinoma staging and grading?
Prognosis
229
Describe primary tumour (T) category of renal cell carcinoma staging?
230
Describe regional lymph nodes (N) category of renal cell carcinoma staging?
231
Describe distant metastasis (M) category of renal cell carcinoma staging?
232
Describe prognostic stage groups of renal cell carcinoma staging?
233
What is Tx stage of renal cell carcinoma mean?
Primary tumour can not be assessed
234
What is T0 stage of renal cell carcinoma mean?
No evidence of primary tumour
235
What is T1 stage of renal cell carcinoma mean?
236
What is T1a stage of renal cell carcinoma mean?
Tumour ≤4 cm in greatest dimension,limited to the kidney
237
What is T1b stage of renal cell carcinoma mean?
Tumor >4 cm but ≤7 cm in greatest dimension, limited to the kidney
238
What is T2 stage of renal cell carcinoma mean?
239
What T2a means in staging of renal cell carcinoma?
Tumor >7 cm but <10 cm in greatest dimension, limited to the kidney
240
What T2b means in staging of renal cell carcinoma?
Tumor >10 cm, limited to the kidney
241
What T3 means in staging of renal cell carcinoma?
Tumor extends into major veins or perinephric tissues, but not into the ipsilateral adrenal gland and not beyond Gerota's fascia
242
What T3a means in staging of renal cell carcinoma?
243
What T3b means in staging of renal cell carcinoma?
Tumor extends into the vena cava below the diaphragm
244
What T3c means in staging of renal cell carcinoma?
Tumor extends into the vena cava above the diaphragm or invades the wall of the vena cava
245
What T4 means in staging of renal cell carcinoma?
Tumor invades beyond Gerota's fascia (including contiguous extension into the ipsilateral adrenal gland)
246
What Nx means in staging of renal cell carcinoma?
Regional lymph nodes cannot be assessed
247
What N0 means in staging of renal cell carcinoma?
No regional lymph node metastasis
248
What N1 means in staging of renal cell carcinoma?
Metastasis in regional lymph node(s)=1 node
249
What N2 means in staging of renal cell carcinoma?
Metastasis in regional lymph node(s)=2 nodes
250
What M0 means in staging of renal cell carcinoma?
No distant metastasis
251
What M1 means in staging of renal cell carcinoma?
Distant metastasis
252
What stage I means in the grading of renal cell carcinoma?
T1N0M0
253
What stage II means in the grading of renal cell carcinoma?
T2N0M0
254
What stage III means in the grading of renal cell carcinoma?
(1)T1N1M0
(2)T2N1M0
(3)T3NxM0
(4)T3N0M0
(5)T3N1M0
255
What stage IV means in the grading of renal cell carcinoma?
(1)T4,any N,M0
(2)Any T,any N,M1
256
Discuss management of renal cell carcinoma
257
Discuss management of T1 stage of renal cell carcinoma
258
What is the main procedure to treat T1 stage in renal cell carcinoma?
Partial nephrectomy
259
What is the indication of partial nephrectomy in the treatment of T1 stage in renal cell carcinoma?
Inadequate reserve in the remaining kidney
260
What is the advantage of partial nephrectomy in the treatment of T1 stage in renal cell carcinoma?
Gives equivalent oncological results to total radical nephrectomy
261
Discuss treatment of T2 stage or above of renal cell carcinoma
262
Discuss total radical nephrectomy as an option for treatment of T1 stage or above of renal cell carcinoma
263
What is the standard practice for treatment of T1 stage or above of renal cell carcinoma
Total radical nephrectomy
264
What is the technique for total radical nephrectomy as an option for treatment of T1 stage or above of renal cell carcinoma
265
What is the technique for total radical nephrectomy as an option for treatment of T1 stage or above of renal cell carcinoma if performed via the open approach?
266
What is the reason that early venous control is mandatory during surgery of total radical nephrectomy for treatment of T1 stage or above of renal cell carcinoma?
To avoid shedding of tumour cells into the circulation
267
What is not indicated in total radical nephrectomy for treatment of T1 stage or above of renal cell carcinoma?
268
What is the treatment of stages 1-4 of renal cell carcinoma?
269
Discuss adjuvant therapy as an option for treatment of T2 stage or above of renal cell carcinoma
270
What is the treatment of stage 1 renal cell carcinoma?
Partial nephrectomy
271
What is the treatment of stage 2,3 and 4 of renal cell carcinoma?
Total radical nephrectomy
272
What is the other name for Wilm’s tumour?
(1)Wilm’s nephroblastoma
(2)Nephroblastoma
273
Discuss incidence of Wilm’s tumour
(1)Rare childhood tumour
(2)It accounts for 80% of all genitourinary malignancies in
pre-school children <15 years
(3)They are the commonest intra-abdominal tumours in
children under 10 years of age
(4)Occurs in children <5 years of life
(5)Usually presents in the first 4 years of life
274
What are the manifestations of Wilm’s tumour?
275
What is the chance of a patient with Wilm’s tumour to have a renal mass?
90%
276
Discuss renal mass in a patient with Wilm’s tumour?
277
What is the chance of a patient with Wilm’s tumour to have bilateral or multi-centric renal mass?
10%
278
What is the chance of a patient with Wilm’s tumour to have haematuria ?
Renal mass in Wilm’s tumour is rarely associated with haematuria(1/3rd of the patients)
279
What is the number of patients with Wilm’s tumour to have haematuria?
1/3rd of the patients
280
What is the chance of a patient with Wilm’s tumour to have fever?
50%
281
What is the chance of a patient with Wilm’s tumour to have hypertension?
50%
282
At which side the varicocele usually presents in patients with Wilm’s tumour?
Left side
283
Discuss WAGR syndrome in patients with Wilm’s tumour?
(1)Wilm’s tumour
(2)Aniridia
(3)Genitourinary
(4)Mental Retardation
284
What are the symptoms of metastasis in patients with Wilm’s tumour?
285
What is the characteristic feature of children with Wilm’s tumour?
Failure to thrive
286
What are the investigations of Wilm’s tumour?
287
What does XRs show in Wilm’s tumour?
Non calcified lesion
288
What does CT show in Wilm’s tumour?
Non calcified lesion
289
Discuss differential diagnosis of Wilm’s tumour
290
What is the difference between Wilm’s tumour and neuroblastoma?
291
What is the histological feature of Wilm’s tumour?
Undifferentiated embryonic tumour
292
What is the management of Wilm’s tumour?
293
What is the VAD regime for the management of Wilm’s tumour?
It is a chemotherapy regime combined with nephrectomy and includes
294
What is the prognosis of Wilm’s tumour?
295
Define neuroblastoma
296
What is the origin of neuroblastoma?
297
What is the incidence of neuroblastoma?
298
What are the manifestations of neuroblastoma?
299
What is the name of the syndrome associated with neuroblastoma?
Opsoclonus-myoclonus syndrome
300
What are the investigations of neuroblastoma?
301
What are the catecholamines secreted by neuroblastoma?
(1)Vanillylmandelic acid
(2)Homovanillic acid
302
What does the urine test for in neuroblastoma?
Catecholamines
303
What is the diagnostic test of neuroblastoma and what does it show?
Meta-Iodophor-Benzyl-Guanidine(MIBG) is diagnostic and shows calcified tumour
304
What does Meta-Iodo-Benzyl-Guanidine(MIBG) show in neuroblastoma?
Calcified tumour
305
What is the reason for doing a CT scan in neuroblastoma?
For staging
306
What is the management of neuroblastoma?
307
Discuss pathology of Wilm’s tumour
308
Discuss complications and ways of spread of Wilm’s tumour
309
What is the difference between Wilm’s tumour and Hypernephroma(renal cell carcinoma)?
310
What is the other name for renal transitional cell carcinoma?
Transitional cell carcinoma of the kidney
311
What is the incidence of renal transitional cell carcinoma?
312
What is the incidence of renal transitional cell carcinoma for or compared to the upper urinary tract tumours?
90%
313
What is the incidence of renal transitional cell carcinoma for or compared to all renal tumours?
Rare,approximately 7-10% of all renal tumours
314
What is the sex incidence of renal transitional cell carcinoma?
M 3x > F
315
What is the incidence of renal transitional cell carcinoma in males?
M 3x > F
316
What is the incidence of renal transitional cell carcinoma in females?
M 3x > F
317
What are the risk factors for renal transitional cell carcinoma?
318
What is the significance of smoking in renal transitional cell carcinoma?
319
What is the significance of smoking in urology ?
Renal transitional cell carcinoma
320
What is the significance of the occupation in renal?
