Flashcards in Renal cell carcinoma/Wilms/Renovascular dz/Renal Cyst Deck (57):
What is the mean age of renal cell carcinoma? Gender?
What is the biggest risk factor for renal cell carcinoma?
What is the MC renal cell carcinoma?
Clear cell= 75-85%
What is the genetic mutation of clear cell?
Deletion of chromosome 3p
What is the second MC RCC?
What is the classic triad of sx's we see in RCC in ADVANCED disease?
2. Abdominal Mass
3. Flank pain
*Most are ASYMPTOMATIC I in early dz
What are the MC sites of RCC metastasis
2. Lymph nodes
What syndrome is RCC associated with?
2. Fever, cachexia
4. Polymalgia reumatica
What is the best diagnostic tool to evaluate RCC?
Abdominal CT with/without contrast
Treatment for RCC- Stage I, II and III
Surgery is curative
Advanced RCC (stage IV) treatment
3. Systemic therapy
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
Why would we order a CMP and CBC in the evaluation of RCC?
Check for paraneoplastic syndrome
If the tumor is <3 cm, what treatment option can we consider?
If the tumor is <2 cm, what treatment option can we consider?
-Imaging q 3-6 months x2 yrs
-Then q 6-12 months
If the tumor is <1 cm, what treatment option can we consider?
If the tumor is <4 cm, what treatment option can we consider?
Surgery: Partial Nephrectomy
What makes up 95% of primary renal malignancies in children <15 y.o.?
What is the MC clinical presentation in Wilms Tumor
What is the definitive dx for Wilms tumor?
-Surgical excision or biopsy
What is the INITIAL STUDY for evaluation of a Wilms Tumor
Why would we order coags in Wilms Tumor?
look for bleeding disorder that is commonly seen in this cancer=Von Willebrand dz
What is the 5-year survival for Wilms?
Wilms Tummor treatment
Chemotherapy and surgical excision
What makes up the majority of secondary hypertension causes?
Atherosclerotic Renal Artery Stenosis= 80-90%
What is the other cause of secondary hypertension ?
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
What is your best INITIAL test in renovascular dz?
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
What population does fibromusclar dysplasia MCly occur in?
Women <50 y.o.
What is the clinical presentation of fibromusclar dysplasia?
2. Pulsatile tinnitus
3. Neck pain
4. Flank or abdominal pain
7. Cervical/abdominal bruit
fibromusclar dysplasia medical management
ACE-1 or ARB
fibromusclar dysplasia surgical intervention?
What is the MC clinical presentation of Simple renal cyst?
MC incidental findings
U/S criteria for simple cyst
1. Sharply demarcated with smooth thin walls
2. No echoes (anechoic) w/in the mass
U/S characteristics of complex cyst
1. Thick walls and/or septations
3. Solid components
4. Mixed echogenicity
What is the MC reason for acquired renal cysts?
Chronic renal failure
acquired renal cysts dx criteria
1. Bilateral involvement
2. > 4 cysts
3. Diameter range <0.5 cm up to 2 – 3 cm
Treatment for acquired renal cyst if persistent pain and cyst >5 cm
1. Percutaneous aspiration
2. Laparoscopic unroofing
What mutation is the most aggressive form of Autosomal Dominant Polycystic Kidney Disease (ADPKD)?
What is the slow growing ADPKD?
What would you expect to see in 75% of cases of ADPKD?
Peak age of ADPKD?
Clinical presentation in ADPKD
1. PAIN: Abdominal, flank or back pain
2. HTN= 50% of patients
3. Abdominal mass
What is an early indicator of ADPKD that is often overlooked?
1. Frequent UTI's
2. Recurrent nephrolithiasis
What is the best initial diagnostic test for ADPKD?
1. Manage HTN: ACE-1 or ARB, low sodium
2. Pain management
3. Avoid nephrotoxic agents
4. Avoid contact sports
Medullary Sponge kidney etiology
1. Most sporadic w/ no family hx
2. Familial autosomal dominant= RARE
Medullary Sponge kidney etiology presentation
What would you expect to see on a CT in Medullary Sponge kidney
Cystic dilated of the distal collecting tubules
If hypercalciruria is present in Medullary Sponge kidney, how can we treat this?
Complication of Thiazide diuretic
Recurrent UTI’s or nephrolithiasis can lead to decline
Medullary Cystic Disease (Nephronophthisis) etiology
Autosomal recessive inheritance
What is the major complication of Medullary Cystic Disease (Nephronophthisis)?
Progression to ESRD before age 20
Clinical presentation of Medullary Cystic Disease (Nephronophthisis)
3. Bland urinary sediment
What is associated with Medullary Cystic Disease (Nephronophthisis)?