Quiz 2

Question 1

Sx of Diabetic Nephropathy

Answer 1

Albuminuria
Occult hematuria
Diabetic symptoms

Question 2

2 key things to monitor w Diabetic Nephropathy

Answer 2

1. Microalbumin (random am sample or 24hr collection) N=0-30mg/d
   - microalbuminuria: “high” 30-300mg/d
   - macroalbuminuria: “very high” >300mg/d
2. HbA1c levels (>6.5% diagnostic for DM)

Question 3

Risk factors for Diabetic Nephropathy

Answer 3

FMHx, advanced age, HTN, poor glycemic control, minorities, obesity, smoking, OCP

Question 4

Tx for Diabetic Nephropathy

Answer 4

1 treat diabetes; guidelines recommend drug therapy be initiated immediately

• Gingko (protect glomerulus)
• Flax and pumpkin seeds
• Curcumin (renal protective)
• Guggul
• Chromium
• ALA

Question 5

Causes of Hypertensive Nephropathy

Answer 5

1: Atherosclerosis (deposition of hyaline-like material on arteriole wall)

• Fibromuscular dysplasias
• Polyarteritis nodosa
• AV fistula
• Aortic aneurism
• Coarctation of aorta
• Embolism

Question 6

Pathogenesis of Hypertensive Nephropathy

Answer 6

Decreased blood flow causes kidney to secrete renin, retain NaCl and H2O –> inc BP

Renin secretion also caused by Na depletion, hemorrhage, shock, CHF, renal artery stenosis

Question 7

Sx of Hypertensive Nephropathy

Answer 7

Mb asx
HA, fatigue, confusion, vision changes, angina, HF, hematuria, epistaxis, irregular heartbeat, ear buzzing, pulmonary edema, uncontrollable HTN, L ventricular hypertrophy, HTN retinopathy, abdominal bruit

Question 8

Labs (ish) for Hypertensive Nephropathy

Answer 8

Diastolic >120, HTN refractory to therapy. CBC, electrolytes, glucose, BUN, creatinine, UA, EKG, PLASMA RENIN, Captopril challenge test

Question 9

Tx for Hypertensive Nephropathy

Answer 9

• Control BP
• Surgical reconstruction of damaged artery or bypass in case of hyperplasia
• Tx atherosclerosis (guggal, garlic, EFA, B vit)
• Vascular protectants (bioflavonoids, vaccinium)

Question 10

Cx of Hypertensive Nephropathy

Answer 10

Early death
Hypertensive heart disease
MI
CHF
Kidney damage
KI failure
Stroke
Loss of vision

Question 11

What population is Nephroptosis most common?

Answer 11

Females, young and thin, more common the right side. 64% of those w fibromuscular dysplasia of renal artery have this

Question 12

What is happening with Nephroptosis?

Answer 12

Kidney drops >5cm upon moving from supine to standing. Theorized o be dt lack of perirenal fat and fascial support and/or longer renal vascular pedicle

Question 13

Risk factors of Nephroptosis

Answer 13

Excessive weight loss

Frequent intense physical activity

Question 14

Sx of Nephroptosis

Answer 14

Severe abdominal, CVA, flank pain and vomitting in upright position dt

1. acute hydronephorosis kinked proximal ureter
2. renal vessel lumen narrowing and ischemia
3. visceral nerve stimulation from traction

Question 15

Nephroptosis Crisis sx

Answer 15

Severe pain, N/V, chills, tachycardia, oliguria, hematuria, proteinuria.

Pain relieved w upward movement of kidney/supine position

Question 16

PE of Nephroptosis

Answer 16

kidney palpable in ipsilateral lower abdomen

Question 17

DDX of Nephroptosis

Answer 17

Urolithiasis, cholecystitis, spastic bowel, PN, ovarian cyst, appendicitis, divertilucitis

Question 18

Workup for Nephroptosis

Answer 18

renal US, IV urography

Question 19

Tx for Nephroptosis

Answer 19

• Surgical nephropexy for symptomatic its w flank pain >1yr

- Laparoscopic nephropexy (newer tx)

Question 20

3 Cystic diseases of the kidney

Answer 20

1. Simple or solitary cyst
2. Autosomal Dominant Polycystic Kidney Disease (ADPKD)
3. Acquired Renal Cystic Disease

Question 21

Presentation of Simple cysts

Answer 21

Flank/back intermittent dull back pain, fever and malaise if infect. Abdominal mass, may be tender if infected

Question 22

Diagnosis of Simple cysts

Answer 22

Labs: Normal UA
US: Sharply demarcated w smooth walls, enhanced back wall
CT: Smooth thin wall, sharply demarcated, should not enhance w contrast media

Question 23

Tx of Simple cysts

Answer 23

Leave alone if simple
Const. hydrotherapy
Drainage or antimicrobial tx if infected
Surgery if obstruction

Question 24

Dx of ADPKD

Answer 24

15-39yo w at least 3 cysts in BOTH kidneys, 40-59yo at least 2 cysts, AND positive FHx

Question 25

Sx of ADPKD

Answer 25

Pain over both kidneys, gross hematuria, HTN, nocturne, palpable nodular kidney Renal insufficiency: HA, N/V, weight loss Infected: fever, chills, tender kidneys

Question 26

Labs for ADPKD

Answer 26

- Incr. erythropoietin leads to inc HCB and HCT - Anemia from blood loss - Proteinuria, hematuria, pyuria, bacteriuria - Uremia from renal insufficiency (inc BUN and creatinine)

Question 27

Imaging for ADPKD

Answer 27

KUB: enlarged renal shadows up to 5x size CT: 95% accurate, can detect from 0.5cm US: Most cost effective, can detect 1-1.5cm MRI: Differentiate Renal Cell Carcinoma

Question 28

Cx of ADPKD

Answer 28

1. Gross Hematuria: rupture of cysts, mb CA 2. Nephrolithiasis: Ca oxalate 3. HTN 4. ESRF: 50% leads to renal failure 5. Pain: from enlarging cysts 6. Other: Cerebral aneurysm, MVP, aortic aneurysm, colonic diverticula

Question 29

Tx of ADPKD

Answer 29

1. Low protein diet (0.5-0.75g/kg/d) 2. 3000ml or more fluids 3. Restrict caffeine 4. Flax oil 5. Avoid strenuous activity 6. Treat uremia, stones, infection 7. Tx HTN 8. Constitutional HP 9. Somatostatin, everolius

Question 30

Dx of ADPKD

Answer 30

Kids: poor | 35-40 or older: 5-10 year life expectancy

Question 31

5 types of Renal Parenchymal Neoplasms

Answer 31

1. Beingin Tumors 2. Adenocarcinoma or Renal Cell Carcinoma 3. Nephroblastoma (Wilms' Tumor) 4. Sarcoma of the kidney 5. Secondary renal tumor

Question 32

MC type of benign tumor

Answer 32

Renal Adenomas: small, well differentiate glandular tumors of renal cortex. Asx -identified at autopsy

Question 33

Population most effected by RCC/RCA

Answer 33

Males in 50-70's, blacks and hispanics

Question 34

Risk factors for RCC/RCA

Answer 34

Smoking, analgesics, ADPKD, obesity, toxins, coffee, animal fat, dialysis, hysterectomy, contrast IVU, Von Hippel-Landau dz

Question 35

Pathogenesis of RCC/RCA

Answer 35

Originates from proximal renal tubular epithelium. Spreads via direct invasion through capsule or extension into renal vein.

Question 36

Most common site of metastasis of RCC/RCA

Answer 36

Lung

Question 37

RCC/RCA can cause paraneoplastic syndromes, which top 4 does this include?

Answer 37

Erythrocytosis Hypercalcemia HTN Non-metastatic hepatic dysfunction

Question 38

Sx of RCC/RCA

Answer 38

"Great masquerader" Triad: gross hematuria, flank pain, palpable and mass Fever, weight loss, HTN Males: L varicocele from blockage of L testicular vein

Question 39

Sx of metastasis of RCC/RCA

Answer 39

Dyspnea, cough, seizure, bone pain

Question 40

Labs for RCC/RCA

Answer 40

Hematuria (gross or microscopic) Elevated ESR; anemia Abnormal LFT from toxin build up (inc alk phase, dec albumin) Maybe inc alpha-fetoprotein or beta-hCG

Question 41

Procedures for RCC/RCA for diagnosis

Answer 41

Renal bx and fine needle aspiration

Question 42

Imaging for RCC/RCA

Answer 42

US: simple cysts, thrombus CT: method of choice for staging and extent of brain mets CXR: useful for mets PET: monitor response to systemic therapy

Question 43

Tx of RCC/RCA

Answer 43

1. Nephrectomy for localized stage 1 &2 2. Chemo/radiation (not proven effective) 3. Biologic response modulators 4. Molecularly targeted therapies (Inhibitors of VEGF or mTOR)

Question 44

Population most effected by Wilms' Tumor

Answer 44

~3.5 yo

Question 45

Sx of Wilms' Tumor

Answer 45

Abd mass and pain, HTN, hematuria, anemia

Question 46

Dx of WIlms' Tumor

Answer 46

Found on US or CT

Question 47

Tx of Wilms' Tumor

Answer 47

Surgical removal, mb chemo

Question 48

Population most effected by Sarcoma of the Kidney

Answer 48

patients >50yo

Question 49

Sx of Sarcoma of the kidney

Answer 49

Flank/abd pain, weight loss

Question 50

Types of Sarcomas of the kidney

Answer 50

``` Leiomyosarcoma (females) Fibrosarcoma Liposarcoma Hemangiopericytomas Osteogenic sarcoma Malignant schwannomas ```

Question 51

Tx of Sarcomas of the kidney

Answer 51

Radical nephrectomy for localized disease is the only effective therapy.

Question 52

Top four cancers most likely to metastasize to kidneys?

Answer 52

Lung 20% Breast 12% Stomach 11% Contralateral renal 9%

Question 53

2 lab findings found with secondary renal tumors

Answer 53

Albuminuria and hematuria

Question 54

Are pain and renal insufficiency common with secondary renal tumors?

Answer 54

No, they are rare.