Renal: Tubular & Interstitial Diseases, Cancer Flashcards Preview

.Path Slides Exam 3 > Renal: Tubular & Interstitial Diseases, Cancer > Flashcards

Flashcards in Renal: Tubular & Interstitial Diseases, Cancer Deck (105):
1

list lab findings in acute tubular necrosis (ATN)

  • acute decline in GFR
  • serum BUN & creatinine increased
  • metabolic acidosis (low HCO3)
  • hyperkalemia
  • hyperphosphatemia
  • anemia (decreased EPO)

2

describe urinary findings in ATN

  • muddy brown granular casts
  • epithelial cells casts
  • free epithelial cells
  • proteinuria (mild)
  • microscopic hematuria (mild)
  • no pyuria

3

list physical findings in ATN

  • hypotension
  • low urine output (oliguria/anuria)
  • uremic signs (pericardial friction rub; confusion)

4

list ischemic causes of ATN

  • hypotension
  • vasodilatory (septic shock)
  • hemorrhagic shock
  • hypovolemic shock (vomiting, diarrhea)

5

list endogenous causes of nephrotoxicity leading to ATN

hemoglobinuria, myoglobinuria

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6

list exogenous causes of nephrotoxicity leading to ATN

aminoglycosides

contrast media; CT/cardiac cath

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7

list the major causes of acute vs. chronic tubulointerstitial nephritis

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8

the pathogenesis of acute drug-induced interstitial nephritis (AIN) is an ____ reaction manifested by interstitial infiltration of ___, ___ and ____

the pathogenesis of acute drug-induced interstitial nephritis (AIN) is an allergic type reaction manifested by interstitial infiltration of eosinophils, lymphocytes and macrophages

9

the onset of AIN is usually ____ after starting medication which is the first exposure or

____ if second exposure

the onset of AIN is usually 2 weeks after starting medication which is the first exposure or

3-5 days if second exposure

10

describe what is seen in the urine in AIN

  • eosinophils
  • sterile pyuria
  • WBC casts
  • proteinuria (mild)

11

describe what is seen in blood tests in AIN

  • increased BUN & creatinine
  • increased eosinophils count
  • tubular dysfunction: high K, low HCO3

12

____ is when bacteria travel retrograde up the ureters to the kidneys, causing pyelonephritis 

vesicoureteral reflux is when bacteria travel retrograde up the ureters to the kidneys, causing pyelonephritis 

13

the condition seen in the image is most commonly caused by ____

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the condition seen in the image is most commonly caused by E. coli

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14

the condition seen in the image occurs more commonly in which gender? why?

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the condition seen in the image occurs more commonly in females due to  shorter urethra

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15

describe how the condition in the image can come from the bloodstream

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bloodstream: seeding of kidney from sepsis or infective endocarditis

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16

describe the 3 causes of the ascending form of the condition seen in the image

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  • post-renal obstruction: cervical, prostate or bladder cancer, urethral stricture, kidney stones, vesicoureteral reflux (incompetent valves allow retrograde flow of urine) = hydronephrosis
  • neurogenic bladder: autonomic neuropathies, such as diabetes, spinal fractures
  • catheter

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17

describe the presentation of the condition seen in the image

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  • sudden onset of high fever, chills, flank pain, CVA tenderness, dysuria

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18

____ is the most accurate way of diagnosing the condition seen in the image

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urine culture is the most accurate way of diagnosing the condition seen in the image

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19

describe what is seen on urine microscopy of the condition seen in the image

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  • WBCs (neutrophils) & white cell casts

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20

list complications of the condition seen in the image

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pyonephrosis, papillary necrosis & perinephric abscess

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21

list the 2 forms of the condition seen in the image

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  1. chronic obstructive pyelonephritis
    • posterior urethral valves
    • kidney stones
  2. reflux nephropathy (more common):
    • vesicoureteral reflux → preferential scarring & calyceal dilatation at poles

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22

describe gross differences in VUR and obstructive forms of the condition seen in the image

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  • VUR: preferential scarring & calyceal dilatation at poles
    • entire surface of kidney looks abnormal
  • obstructive: diffuse dilatation of calyces & scarring
    • abnormality at upper and lower poles of kidney

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23

chronic pyelonephritis leads to "____" of the kidney

explain

chronic pyelonephritis leads to "thyroidization" of the kidney

atrophic tubules contain eosinophilic proteinaceous material reminiscent of thyroid follicles

24

a complication of the condition seen in the image is that it can progress to ____

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a complication of the condition seen in the image is that it can progress to FSGS

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25

describe the pathogenesis of papillary necrosis caused by chronic analgesic abuse

  • ingestion of large quantities → papillary damage due to direct toxic effect (acetaminophen)
  • ischemic effect of ASA: inhibit PG → abnormal vasoconstriction of intrarenal arteries → chronic tubulointerstitial nephritis 

26

describe what is seen on intravenous pyelogram (IVP) in papillary necrosis

ring defect at the tips of minor calyces

27

in papillary necrosis caused by pyelonephritis, there is interstitial inflammation that compresses ____

in papillary necrosis caused by pyelonephritis, there is interstitial inflammation that compresses medullary vasculature and leads to ischemia and papillary necrosis

28

describe the etiology of the condition seen in the image

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  • BPH
  • cervical, prostate or bladder cancer
  • kidney stones
  • retroperitoneal adenopathy 
  • papillary necrosis → sloughed off papillae
  • strictures
  • horseshoe kidney

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29

the condition in the image occurs when there is continued ____ but unable to excrete due to obstruction, which leads to dilatation of ___ and ____

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the condition in the image occurs when there is continued glomerular filtration but unable to excrete due to obstruction, which leads to dilatation of renal pelvis and calyces

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30

in the condition in the image, high pressure in pelvis is transmitted through ___ Into the ____ causing _____

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in the condition in the image, high pressure in pelvis is transmitted through collecting tubules Into the renal cortex causing renal atrophy

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31

describe the presentation of the condition in the image when it is unilateral vs. bilateral

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  • unilateral = asymptomatic
  • incomplete bilateral = initially polyuria b/c affects ability of tubule to concentrate urine → develop chronic renal failure (waxy casts) and white cell casts → anuria and uremia

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32

list types of renal stones; what is the most common?

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33

describe the pathogenesis of the condition seen in the image

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excessive excretion of minerals in urine

34

the condition in the image becomes symptomatic once it passes into ____

describe symptoms

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the condition in the image becomes symptomatic once it passes into the ureters

  • renal colic: abrupt onset of flank pain radiating to groin
  • superimposed UTI due to urinary stasis 
  • hydronephrosis due to obstruction of ureter

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35

the overall theme of preventing the condition seen in the image is to decrease ____

what are methods to do this?

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the overall theme of preventing the condition seen in the image is to decrease urinary concentration of the causing substance

  • increased fluid intake
  • low sodium diet; decrease urinary Ca2+ excretion
    • Ca2+ reabsorbed in PCT with Na
  • alkalinization of urine 
    • increases solubility of uric acid

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36

the condition in the image occurs due to long-standing ____

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the condition in the image occurs due to long-standing HTN

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37

the condition in the image occurs when ___ leaks into the ____ causing _____

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the condition in the image occurs when plasma proteins leaks into the tunica media causing hyaline arteriosclerosis

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38

in the condition seen in the image, there is ___ and ____thickening

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in the condition seen in the image, there is medial and intimal thickening

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39

the presentation of the condition seen in the image is generally ____ with mild ____

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the presentation of the condition seen in the image is generally asymptomatic with mild proteinuria

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40

a complication of the condition in the image is that it can progress to ____, with prominent risk factors being ___, ___ and ____

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a complication of the condition in the image is that it can progress to chronic renal failure, with prominent risk factors being blacks, high BP and underlying diabetes

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41

diagnosis of the condition seen in the image is by seeing ____ with ___ on urinalysis 

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diagnosis of the condition seen in the image is by seeing bland urine sediment with mild proteinuria on urinalysis 

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42

list extrarenal manifestations of the condition seen in the image

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  • other manifestations:
    • LVH
    • retinopathy
    • stroke

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43

the condition seen in the image mainly affects the ___ arterioles

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the condition seen in the image mainly affects the afferent arterioles

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44

what is the blood pressure seen in the condition in the image?

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>180/120 mmHg, or diastolic >130 mmHg

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45

the condition seen in the image occurs in patients with essential ____ or secondary ____, such as: (2 conditions)

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the condition seen in the image occurs in patients with essential hypertension or secondary hypertension, such as:

pheochromocytoma

primary hyperaldosteronism

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46

on gross appearance of the condition seen in the image, there is a characteristic ____ appearance due to ____ on the cortical surface

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on gross appearance of the condition seen in the image, there is a characteristic flea-bitten appearance due to petechial hemorrhages on the cortical surface

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47

on histology of the condition seen in the image, there is an ____ appearance due to proliferation of _____

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on histology of the condition seen in the image, there is an onion-skin appearance due to proliferation of smooth muscle in the tunica media

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48

a complication of the condition seen in the image is ____

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a complication of the condition seen in the image is  acute renal failure

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49

the presentation of the condition in the image is ____, ____ and ____

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the presentation of the condition in the image is hematuria, oliguria and proteinuria

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50

list the extrarenal manifestations of the condition seen in the image

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51

HUS/TTP are disorders characterized by abnormal _____ leading to thrombosis in arterioles and capillaries throughout the body

HUS/TTP are disorders characterized by abnormal platelet aggregation leading to thrombosis in arterioles and capillaries throughout the body

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52

___ are seen in PB smear in HUS/TTP

schistocytes are seen in PB smear in HUS/TTP

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53

in HUS, there is more severe ____ and less pronounced ____ involvement

in HUS, there is more severe renal failure and less pronounced CNS involvement involvement

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54

HUS is classically seen in children 1 week after episode of ____ caused by _____

HUS is classically seen in children 1 week after episode of bloody diarrhea caused by EHEC (O157:H7)

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55

HUS is associated with infections caused by (other than EHEC).... (3 things)

HUS is associated with infections caused by (other than EHEC)

viral infxns

Shigella

Salmonella

 

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56

HUS can also be drug induced and caused by.... (5 drugs)

HUS can also be drug induced and caused by:

quinine (tonic water)

Gemcitabine

Cyclosporine

Ticlopidine

OCPs

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57

in TTP, there is more ___ involvement and less severe ____ 

in TTP, there is more CNS involvement and less severe renal failure

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58

TTP is associated with... (3 conditions)

TTP is associated with:

SLE

HIV

hematological malignancy

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59

renal artery stenosis is most commonly caused by ____

renal artery stenosis is most commonly caused by occlusion due to atheromatous plaque

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60

the kidney with renal artery stenosis is protected from ____, whereas the contralateral kidney would show _____

the kidney with renal artery stenosis is protected from arteriosclerosis, whereas the contralateral kidney would show hypertensive arteriosclerosis

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61

a physical finding of renal artery stenosis is a ____ heard in the flank or epigastric region

a physical finding of renal artery stenosis is a bruit (d/t turbulent blood flow) heard in the flank or epigastric region

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62

on ultrasound in renal artery stenosis, ____ would be seen

on ultrasound in renal artery stenosis, asymmetrical kidney size (small kidney on side of RA stenosis) would be seen

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63

____ is the gold standard of diagnosing renal artery stenosis 

renal arteriogram is the gold standard of diagnosing renal artery stenosis 

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64

treatment of renal artery stenosis is with ___ and ___

treatment of renal artery stenosis is with angioplasty and stent

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65

list complications of renal artery stenosis

renal failure; hypertensive changes to heart, brain, retina

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66

in renal artery stenosis, the ___ cells can sense hypo-perfusion to the kidney and release ___ leading to hypertension

in renal artery stenosis, the JG cells can sense hypo-perfusion to the kidney and release renin leading to hypertension

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67

the more severe form of the condition seen in the image is caused by a genetic mutation in _____ (aka ___ gene) located on chr. ___

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the more severe form of the condition seen in the image is caused by a genetic mutation in PKD1 (aka polycystin gene) located on chr. 16

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68

the less severe form of the condition seen in the image is caused by a genetic mutation in _____ (aka ___ gene) located on chr. ___

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the less severe form of the condition seen in the image is caused by a genetic mutation in PKD2 (aka polycystin gene) located on chr. 4

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69

describe the presentation of the less severe form of the condition seen in the image (___ gene located on chr. ___)

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PKD2 gene located on chr . 4

  • later onset of cysts
  • fewer and smaller cysts
  • slower progression
  • later age of ESRD

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70

describe the possible mechanism for cyst formation in PKD

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71

how can the condition in the image lead to hypertension?

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  • cysts → compression of renal vessels → renin, aldosterone

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72

how can the condition in the image cause hematuria?

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rupture of cysts in collecting duct

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73

why is there flank pain seen in the condition in the image?

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stretching of renal capsule

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74

list the extrarenal manifestations of the condition seen in the image

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  • hepatic cysts
  • cerebral aneurysms 
  • pancreatic cysts
  • cardiac valve disease (MVP, AR)
  • colonic diverticular disease
  • abdominal wall & inguinal hernia

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75

what is one word that helps describe the extrarenal manifestations of the condition seen in the image?

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CYSTS/weakening of walls

hepatic cysts

cerebral "cysts" = dilatation of vessel walls = aneurysms (Berry)

pancreatic cysts

weakening of chordae tendinae = MVP

weakening of colonic walls = diverticular disease

weakening of abdominal wall = inguinal hernia

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76

describe a genetic test to diagnose the condition associated with the image

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FISH to look for the gene

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77

the most common cause of death in the condition associated with the image is ____

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the most common cause of death in the condition associated with the image is heart failure and MI due to HTN

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78

the condition associated with the image can lead to ____ hemorrhage due to ____

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the condition associated with the image can lead to subarachnoid hemorrhage due to ruptured Berry aneurysm

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79

the condition seen in the image is caused by a mutation in ___ (aka ___ gene) located on chr. ___

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the condition seen in the image is caused by a mutation in PKHD1 (aka fibrocystin gene) located on chr . 6

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80

the cysts in the condition seen in the image originate from ____

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the cysts in the condition seen in the image originate from collecting ducts (homogenous)

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81

the ___ sequence is associated with the condition seen in the image; describe this

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the Potter sequence is associated with the condition seen in the image;

  • oligohydramnios due to renal agenesis
  • breech presentation bc can't flip
  • malpositioning of hands and feet
  • flat face and low set ears
  • pulmonary hypoplasia bc need amniotic fluid to develop

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82

the condition seen in the image is associated with ____ if the patient doesn't die at birth

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the condition seen in the image is associated with hepatic fibrosis/cirrhosis if the patient doesn't die at birth

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83

describe the condition in the image

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medullary (sponge) cystic kidney = benign

84

list the benign renal tumors

  • renal adenoma
  • renal oncocytoma
  • angiomyolipoma

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85

list the malignant renal tumors

  • renal cell carcinoma (90%)
  • urothelial carcinoma
  • children = Wilm's tumor

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86

angiomyolipoma is described as being ____ since it contains muscle, fat, and vessels

angiomyolipoma is described as being triphasic since it contains muscle, fat, and vessels

87

angiomyolipoma is described as being triphasic since it contains ___, ___ and ____

angiomyolipoma is described as being triphasic since it contains muscle, fat and vessels

88

describe the 2 types of angiomyolipomas

  • 50% = tuberous sclerosis (seen in 25 y/o)
    • asymptomatic, small
  • sporadic = 45 y/o
    • flank pain
    • mass
    • hematuria
    • retroperitoneal hemorrhage

89

the condition seen in the image is a malignant tumor of ____ cells

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the condition seen in the image is a malignant tumor of renal tubular epithelial cells

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90

list the genetic mutations in the different types of renal carcinoma

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91

describe the sporadic type of the condition seen in the image; what is it associated with?

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  • sporadic = more common; seen in older pts (60+ yrs)
    • unilateral and unifcoal
    • associated with HTN, obesity, smoking, cadmium batteries, acquired PKD in pts with long-standing dialysis

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92

describe the hereditary type of the condition seen in the image; what 3 conditions are associated with it?

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  • hereditary = younger adults
    • bilateral and multifocal
    • associated w/ pheochromocytoma, cerebellar & retinal hemangioblastomas

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93

the condition in the image is associated with a mutation in ____ which is located on chr. ___

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the condition in the image is associated with a mutation in VHL (tumor suppressor gene) which is located on  chr. 3

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94

list the triad of symptoms of the condition seen in the image; ____ is the most common sign

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triad: painless hematuria, flank pain, flank mass

hematuria is the most common sign

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95

list the paraneoplastic syndromes associated with the condition in the image

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A PEARL

  • A = ACTH → Cushing's
  • P = PTH → hypercalcemia
  • E = EPO → polycythemia
  • A = AA amyloidosis
  • R = renin → HTN
  • L = leukomoid reaction → left shift with bandemia 

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96

describe the 3 types of the condition seen in the image

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  • clear cells = most common; has glycogen and lipids
  • papillary has psammoma bodies
  • chromophobe = well-circumscribed and localized

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97

the treatment for the condition seen in the image is a ____

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the condition in the image is associated with a mutation in subtotal nephrectomy

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98

an ___ is contraindicated in the condition seen in the image; why?

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an incisional biopsy is contraindicated in the condition seen in the image

it can cause it to spread (RCC spread hematogenously, NOT via lymph)

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99

describe complications of the main treatment of the condition seen in the image

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treatment = subtotal nephrectomy = loss of renal mass → FSGS can occur

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100

describe how condition seen in the image can lead to a varicocele

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renal vein thrombosis → left testicular vein → varicocele

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101

describe the triad seen in Von Hippel Lindau

  • RCC
  • pheochromocytoma
  • retinal & cerebellar hemangioblastomas

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102

describe the genetic mutation seen in the papillary type of renal cell carcinoma

papillary = mutation in MET which is an oncogene

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103

describe the stages of the condition seen in the image

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  • stage 1 = confined to kidney
  • stage 2 = perirenal fat
  • stage 3 = lymph node and IVC
  • stage 4 = adjacent organs/metastasis

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104

in the condition seen in the image, there is a mutation in ____ genes located on chr. ___

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in the condition seen in the image, there is a mutation in tumor suppressor genes (WT1 and WT2) located on chr . 11

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105

in the condition seen in the image, there is a ___ pattern seen with blastema, stroma and epithelial cells

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in the condition seen in the image, there is a triphasic pattern seen with blastema, stroma and epithelial cells

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