Flashcards in Genitourinary Deck (378)
Loading flashcards...
91
What does haematuria and dysuria and frequency suggest?
UTI
92
What does haematuria and bilate loin pain suggest?
glomerulonephritis
93
What does haematuria and uteteric colic suggest?
stone disease
94
What investigations should be done in haematuria?
urine analysis, urine cytolody, abdomen US, abdomen CT, cytoscopy, renal biopsy
95
Rare causes of haematuria?
sport, renal artery embolism, renal vein thrombosis, loin pain haematuria syndrome, idiopathic
96
What do negative urological tests in haematuria suggest?
nephrological cuase
97
In who is renal cell carcinoma most common?
male, ages >60
98
Risk factors for renal cell carcinoma?
smoking, obesity, hypertension, asbestos
99
Signs and symptoms of renal cell carcinoma?
haematuria (40%), flank pain, paraneoplastic, weight loss, fever, malaise
100
Causes of renal cell carcinoma?
Von Hippel Lindau disease, dialysis, familial traits, smoking, heavy meals, obesity
101
What is the mutation in Von Hippel Lindau disease that causes renal cell carcinoma?
lose short arm of chromosome 3, causing inactivation of VHL gene which is a tumour suppressor gene, and then there is over expression of VEGF antagonist
102
How willVon Hippel Lindau syndrome present?
phaeochromocytoma, renal and pancreatic cysts, cerebellar haemangioblastoma
103
Treatment of renal cell carcinoma?
nephrectomy, exploration is IVC is involved, mutli-tyrosine kinaseinhibitors eg. sumirtinab and sarefinib
104
How do multi-tyrosine kinase inhibitors treat renal cell carcinoma?
block kinase that usually phosphorylates proteins and cause proliferation
105
What will investigations show in renal cell carcinoma?
liver dysfunction, abnormal LFTs, cholestasis, nephrogenic hepatomegaly
106
What is the difference between a simple and a complex cyst?
simple is benign, complex can be benign or cancer
107
What classification is used in cystic lesions?
Bozniak Classification
108
What is the Bozniak classification?
1-simple septations, thin wall
2-irregular wall, no enhancement
3-thick, irregular wall enhancement
4-irregular walls, ca and enhancement
109
What investigations are done in a cystic lesion?
classification, spatial observation, renal biopsy, surgery, bone scan if raised Ca, DMSA renogram if concerned about renal fucntion, CT chest and abdo with contrast, MRI if other organs/IVC affected or poor renal function
110
What are the histological subtypes in renal cell carcinoma?
clear cell (80-90%)
papillary (10-15%)
chromophobe (4-5%)
sarcomatoid
111
What is involved in small renal mass surveillance?
can progress to cancer so should be managed with serial imaging to follow progression
112
What is involved in cryotherapy?
2 freeze cycles using helium and argon,
113
What is involved in radiofrequency ablation?
heating, percutaneously or laparoscopically
114
When is cryotherapy and radiofrequency ablation used?
in small cystic lesions, in patients with VHL, solitary kidneys, unsuitable for partial/full nephrectomy
115
When is surgery used for renal cell carcinoma treatment?
preferably nephron sparing, T1 and
116
Treatment of metastatic renal cell carcinoma?
palliative nephrectomy, surgical resection if can do complete resection and has good performance status, radiotherapy to symptomatic bone and brain metastases
117
Where does metastatic renal cell carcinoma develop from and what do they have high levels of?
proximal tubules, high levels of expression of the mulitiple drug resistance protein, so resistant to chemo.
118
What is the multiple drug resistance protein expressed in high levels in renal cell carcinoma?
P-glycoprotein
119
How does sporadic clear cell renal cell carcinoma cause neoangiogenesis?
hypoxia inducible factor accumulation from VHL inactivation causes increased VEGF and PDGF to promote neoangiogenesis
120
