Renal cell carcinoma/Wilms/Renovascular dz/Renal Cyst Flashcards Preview

Foundations-Nephro > Renal cell carcinoma/Wilms/Renovascular dz/Renal Cyst > Flashcards

Flashcards in Renal cell carcinoma/Wilms/Renovascular dz/Renal Cyst Deck (57):
1

What is the mean age of renal cell carcinoma? Gender?

64 y.o.
Males

2

What is the biggest risk factor for renal cell carcinoma?

Smoking!!

3

What is the MC renal cell carcinoma?

Clear cell= 75-85%

4

What is the genetic mutation of clear cell?

Deletion of chromosome 3p

5

What is the second MC RCC?

Papillary= 10-15%

6

What is the classic triad of sx's we see in RCC in ADVANCED disease?

1. Hematuria
2. Abdominal Mass
3. Flank pain
*Most are ASYMPTOMATIC I in early dz

7

What are the MC sites of RCC metastasis

1. Lungs
2. Lymph nodes
3. Bone
4. Liver
5. Brain

8

What syndrome is RCC associated with?

Paraneoplastic Syndrome:
1. Anemia
2. Fever, cachexia
3. Thrombocytosis
4. Polymalgia reumatica
5. Erythrocytosis
6. Hypercalcemia

9

What is the best diagnostic tool to evaluate RCC?

Abdominal CT with/without contrast

10

Treatment for RCC- Stage I, II and III

Surgery is curative

11

Advanced RCC (stage IV) treatment

1. Surgery
2. Radiation
3. Systemic therapy

12

What are the predictors of malignancy in RCC

1. Male sex
2. Increasing tumor size: <2 cm=20-40% benign, >4 cm= 20-30% high grade

13

Why would we order a CMP and CBC in the evaluation of RCC?

Check for paraneoplastic syndrome

14

If the tumor is <3 cm, what treatment option can we consider?

Thermal ablation

15

If the tumor is <2 cm, what treatment option can we consider?

Surveillance
-Imaging q 3-6 months x2 yrs
-Then q 6-12 months

16

If the tumor is <1 cm, what treatment option can we consider?

surveillance

17

If the tumor is <4 cm, what treatment option can we consider?

Surgery: Partial Nephrectomy

18

What makes up 95% of primary renal malignancies in children <15 y.o.?

Wilms Tumor

19

What is the MC clinical presentation in Wilms Tumor

Abdominal mass

20

What is the definitive dx for Wilms tumor?

Histological confirmation
-Surgical excision or biopsy

21

What is the INITIAL STUDY for evaluation of a Wilms Tumor

Abdominal U/S

22

Why would we order coags in Wilms Tumor?

look for bleeding disorder that is commonly seen in this cancer=Von Willebrand dz

23

What is the 5-year survival for Wilms?

90%

24

Wilms Tummor treatment

Chemotherapy and surgical excision

25

What makes up the majority of secondary hypertension causes?

Atherosclerotic Renal Artery Stenosis= 80-90%

26

What is the other cause of secondary hypertension ?

Fibromusclar dysplasia=10-15%

27

When do we want to consider renovascular disease as cause for secondary hypertension?

1. Young onset
2. Severe or resistant HTN
3. Acute rise over stable value

28

What is your best INITIAL test in renovascular dz?

CT angiogram

29

atherosclerotic renal artery stenosis treatment

1. Tx HTN
2. Monitor CKD
3. Secondary CV prevention: STATINS!
4. Revascularization: Angioplasty w/ or w/o stenting or bypass

30

What population does fibromusclar dysplasia MCly occur in?

Women <50 y.o.

31

What is the clinical presentation of fibromusclar dysplasia?

1. HA
2. Pulsatile tinnitus
3. Neck pain
4. Flank or abdominal pain
5. HTN
6. TIA/Stroke
7. Cervical/abdominal bruit

32

fibromusclar dysplasia medical management

ACE-1 or ARB

33

fibromusclar dysplasia surgical intervention?

Angioplasty

34

What is the MC clinical presentation of Simple renal cyst?

usually ASYMPTOMATIC
MC incidental findings

35

U/S criteria for simple cyst

1. Sharply demarcated with smooth thin walls
2. No echoes (anechoic) w/in the mass

36

U/S characteristics of complex cyst

1. Thick walls and/or septations
2. Calcifications
3. Solid components
4. Mixed echogenicity
5. Vascularity

37

What is the MC reason for acquired renal cysts?

Chronic renal failure

38

acquired renal cysts dx criteria

1. Bilateral involvement
2. > 4 cysts
3. Diameter range <0.5 cm up to 2 – 3 cm

39

Treatment for acquired renal cyst if persistent pain and cyst >5 cm

1. Percutaneous aspiration
2. Laparoscopic unroofing

40

What mutation is the most aggressive form of Autosomal Dominant Polycystic Kidney Disease (ADPKD)?

PKD1 mutation=85-90%

41

What is the slow growing ADPKD?

PKD2 mutation

42

What would you expect to see in 75% of cases of ADPKD?

Family history

43

Peak age of ADPKD?

30-40's

44

Clinical presentation in ADPKD

1. PAIN: Abdominal, flank or back pain
2. HTN= 50% of patients
3. Abdominal mass
4. Hematuria

45

What is an early indicator of ADPKD that is often overlooked?

1. Frequent UTI's
2. Recurrent nephrolithiasis

46

What is the best initial diagnostic test for ADPKD?

US

47

ADPKD treatment

1. Manage HTN: ACE-1 or ARB, low sodium
2. Pain management
3. Avoid nephrotoxic agents
4. Avoid contact sports

48

Medullary Sponge kidney etiology

Congenital disorder
1. Most sporadic w/ no family hx
2. Familial autosomal dominant= RARE

49

Medullary Sponge kidney etiology presentation

Usually ASYMPTOMATIC
-Found incidentally

50

What would you expect to see on a CT in Medullary Sponge kidney

Cystic dilated of the distal collecting tubules

51

If hypercalciruria is present in Medullary Sponge kidney, how can we treat this?

Thiazide diuretic

52

Complication of Thiazide diuretic

Recurrent UTI’s or nephrolithiasis can lead to decline

53

Medullary Cystic Disease (Nephronophthisis) etiology

Autosomal recessive inheritance

54

What is the major complication of Medullary Cystic Disease (Nephronophthisis)?

Progression to ESRD before age 20

55

Clinical presentation of Medullary Cystic Disease (Nephronophthisis)

1. Polyuria
2. Polydipsia
3. Bland urinary sediment
4. Thirsty

56

What is associated with Medullary Cystic Disease (Nephronophthisis)?

Retinitis pigmentosa

57

Definitive dx of Retinitis pigmentosa

Genetic testing