Flashcards in Genitourinary Deck (378)
What does haematuria and dysuria and frequency suggest?
What does haematuria and bilate loin pain suggest?
What does haematuria and uteteric colic suggest?
What investigations should be done in haematuria?
urine analysis, urine cytolody, abdomen US, abdomen CT, cytoscopy, renal biopsy
Rare causes of haematuria?
sport, renal artery embolism, renal vein thrombosis, loin pain haematuria syndrome, idiopathic
What do negative urological tests in haematuria suggest?
In who is renal cell carcinoma most common?
male, ages >60
Risk factors for renal cell carcinoma?
smoking, obesity, hypertension, asbestos
Signs and symptoms of renal cell carcinoma?
haematuria (40%), flank pain, paraneoplastic, weight loss, fever, malaise
Causes of renal cell carcinoma?
Von Hippel Lindau disease, dialysis, familial traits, smoking, heavy meals, obesity
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
How willVon Hippel Lindau syndrome present?
phaeochromocytoma, renal and pancreatic cysts, cerebellar haemangioblastoma
Treatment of renal cell carcinoma?
nephrectomy, exploration is IVC is involved, mutli-tyrosine kinaseinhibitors eg. sumirtinab and sarefinib
How do multi-tyrosine kinase inhibitors treat renal cell carcinoma?
block kinase that usually phosphorylates proteins and cause proliferation
What will investigations show in renal cell carcinoma?
liver dysfunction, abnormal LFTs, cholestasis, nephrogenic hepatomegaly
What is the difference between a simple and a complex cyst?
simple is benign, complex can be benign or cancer
What classification is used in cystic lesions?
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
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
What are the histological subtypes in renal cell carcinoma?
clear cell (80-90%)
What is involved in small renal mass surveillance?
can progress to cancer so should be managed with serial imaging to follow progression
What is involved in cryotherapy?
2 freeze cycles using helium and argon,
What is involved in radiofrequency ablation?
heating, percutaneously or laparoscopically
When is cryotherapy and radiofrequency ablation used?
in small cystic lesions, in patients with VHL, solitary kidneys, unsuitable for partial/full nephrectomy
When is surgery used for renal cell carcinoma treatment?
preferably nephron sparing, T1 and
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
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.
What is the multiple drug resistance protein expressed in high levels in renal cell carcinoma?
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