Urinary Tract Disorders Flashcards
(184 cards)
1
Q
What level of hematuria warrants investigation?
A
Any level should be inspected to see where it came from.
2
Q
What will make a urinalysis positive for blood (hematuria)?
A
A reagent strip that says there is blood or more than 4 RBC/hpf.
3
Q
Hematuria may be the only and first sign of what?
A
Early urinary tract pathology.
4
Q
What are the 2 categories of hematuria?
A
Without casts or without proteinuria, with casts and proteinuria.
5
Q
What are the types of hematuria without casts or proteinuria? (6)
A
Normal physiology, trauma (to urinary tract), lower urinary tract infections (usually very symptomatic), hypertension, bleeding disorders, kidney pathology (stones, tumors).
6
Q
What constitutes normal physiology that can cause hematuria without casts or proteinuria? (2)
A
Menstrual contamination or following vigorous exercise
7
Q
What are the types of hematuria with casts and proteinuria? (3)
A
acute glomerulonephritis, chronic glomerulonephritis, rheumatoid disease.
8
Q
What would be done for patients with unexplained asymptomatic hematuria? (3)
A
1) Referral to urologist 2) Intravenous urogram (IVP) 3) Cystography
9
Q
What may be the first and only sign of early urinary tract pathology?
A
Proteinuria
10
Q
Name 4 reasons for developing proteinuria?
A
- Functional proteinuria (minimal amounts). 2. Overload proteinuria (pre-renal). 3. Glomerular proteinuria. 4. Tubular proteinuria.
11
Q
What are some causes of functional proteinuria? (5)
A
1) Fever 2) exposure to extremes of heat or cold 3) Excessive exercise 4) emotional stress 5) Orthostatic proteinuria
12
Q
What is an example of overload proteinuria (pre-renal)?
A
Bence-Jones proteinuria
13
Q
What are some causes of glomerular proteinuria? (2)
A
1) Damage to glomerular basement membrane 2) Mild to moderate amounts of protein lost; usually albumin
14
Q
What can cause tubular proteinuria?
A
Failure of tubular reabsorption of proteins that normally filter into the nephron
15
Q
What would be done for patients with unexplained asymptomatic proteinuria? (2)
A
1) 24 hour quantification 2) referral for a urologic evaluation
16
Q
Name 4 tests used to evaluate kidney function?
A
- Clearance test. 2. Creatinine clearance. 3. Serum blood urea nutrogen. 4. Serum creatinine.
17
Q
What will the clearance test screen for?
A
Mild to moderate diffuse glomerular damage.
18
Q
What is creatinine?
A
The end product of skeletal muscle metabolism.
19
Q
What will levels of creatinine in serum represent?
A
skeletal muscle mass not activity.
20
Q
When will levels of creatinine be increased and decreased?
A
Increased- renal disease and increased muscle mass. Reduced- females and children and people with decreased muscle mass.
21
Q
The serum creatinine levels have the same significance as what?
A
Renal azotemia.
22
Q
What is BUN?
A
Blood urea nitrogen that is a non-protein nitrogenous waste from protein metabolism that liberates AA and the AA go to the liver and become urea which goes to the kidneys and is placed in urine.
23
Q
Increased BUN equals what?
A
Azotemia.
24
Q
What level of kidney function is needed for the exrection of BUN and creatinine?
A
only 50%.
25
What are the 7 key elements that would lead one to think of kidney problems?
1. Urine volume changes. 2. Abnoramlities of urine sediment. 3. Abnormal excretion of urine proteins. 4. Reduction in GFR (azotemia). 5. Hypertension and or edema. 6. Electrolyte abnormalites. 7. fever and or pain (flank or suprapubic).
26
What is acute renal failure or acute kidney injury?
sudden loss of renal function due to extreme medicla etiologies. Leading to a decreased renal perfusion or obstruction of outflow from kidneys.
27
What can cause acute renal failure or acute kidney injury? (3)
1) Acute decrease of renal perfusion (artery issue) 2) Acute obstruction of outflow from kidneys 3) Acute tubular necrosis
28
What are some causes of acute tubular necrosis? (2)
1) Exogenous nephrotoxins (drugs) 2) Endogenous nephrotoxins (heme-containing products)
29
What is acute nephritis ?
an acute inflammatory process initiated by immune complexes (antibodies) that deposit onto or in the glomeruli, renal vasculature, interstitium and tubular epithelium and causes inflammatory changes.
30
What is acute nephritis also known as?
Nephritic syndrome or acute glomerulonephritis
31
What happens with damaged glomerular walls with acute nephritis?
They allow the escape of RBC's and proteins into glomerular filtrate which results in cast formation
32
What happens to urine output levels with acute nephritis?
There will be an acute reduction in glomerular filtration rate (GFR) and this results in oligouria.
33
What is oligouria?
<500 ml of urine produced
34
Oligouria can result in what?
Salt and water retention which can lead to hypertension, edema, headache, blurred vision.
35
What are the essentials of diagnosis for acute nephritis? (3)
1) Edema 2) Hypertension 3) Hematuria (with or w/o dysmorphic red cells, red blood cell casts)
36
What type of infections can lead to acute nephritis aka glomerulonephritis?
Lancefield group A beta-hemolytic streptococcus (GABHS) (Strep throat).
37
What happens after someone gets strep throat?
There can be a latent period of 6-10 days between infection and nephritis.
38
How can a postinfectious or poststreptococcal glomerulonephritis be diagnosed?
Clinical history with signs and symptoms Plus a test= antistreptolysin O which is a test identifying the antibody to streptococcal exonenzymes.
39
What are some general lab findings seen with an acute nephritis? (4)
Hematuria, RBC casts, proteinuria, azotemia.
40
What are the essentials of diagnosis for Postinfectious glomerulonephritis? (3)
1) proteinuria 2) Glomerular hematuria 3) Symptoms 1-3 weeks after infection
41
What is Chronic renal failure (CRF)?
Progressive and irreversible destruction of nephrons regardless of the cause.
42
What is required for a CRF diagnosis?
3-6 months of documented redution in GFR, Anemia, Hypocalcemia (hyperphosphatemia), urinary protein and broad casts.
43
Why will CRF patients be anemic?
Kidney cant make enough EPO.
44
Why will CRF patients have hypocalcemia and hyperphosphatemia?
With kidney damage there is less vitamin D3 turned into its active form and there will be less calcium when there is less calcium there will be more phosphate.
45
What are the 3 stages of CRF?
1. Diminished renal reserve- measurable loss of renal function. 2. renal insufficiency- azotemia. 3. Uremia.
46
What is uremia?
Fluid or electrolyte balance disturbances, increasing azotemia, systemic manifetation from toxic effects of protein metabolites.
47
What are the toxic effects seen from protein metabolites?(6)
1) Endocrine-metabolic, 2)neuromuscluar, 3) cardiovascular and pulmonary, 4) dermatologic, 5) GI, 6) hematologic and immunologic.
48
Broad casts are usually only seen with what condition?
Chronic kidney failure.
49
What are the essentials of diagnosis for chronic kidney disease glomerulonephritis? (5)
1) Progressive azotemia over months to years 2) Symptoms and signs of uremia when nearing end-stage disease 3) Hypertension in the majority 4) Isosthenuria and broad casts in urinary sediment are common 5) Bilateral small kidneys on ultrasound are diagnostic
50
What does isosthenuria mean?
Increased specific gravity which means a loss of the concentrating ability of the kidney.
51
What should you think of when you hear nephrotic syndrome?***
Proteinuria.
52
What is nephrotic syndrome?
This occurs as a consequence of a disease which causes specific types of damage to the glomerular structures.
53
Name some diseases that cause damage to the glomerular structures? (4)
DM, Systemic diseases like lupus, nephrotoxic medications, toxemia of pregnancy.
54
Nephrotic syndrome is aka?
secondary nephrotic syndrome since it is caused by systemic diseases.
55
What type of things are seen with nephrotic syndrome? (5)
Massive proteinuria, generalized emdema, hypoalbuminemia, hyperlipidemia, hyperlipiduria.
56
What are the essentials of diagnosis for nephrotic syndrome? (3)
1) Urine protein excretion > 3.5g/1.73 m^2 per 24 hours 2) Hypoalbuminemia (albumin <3 g/dL) 3) peripheral edema
57
What is idiopathic nephrotic syndrome?
A type of nephrotic syndrome with an unknown cause.
58
When will an idiopathic nephrotic syndrome be diagnosed?
At childhood, rarely in adulthood
59
How is an idiopathic nephrotic syndrome diagnosed?
via exclusion of secondary causes and most often requires a renal biopsy.
60
What would renal function tests be like fro idiopathic nephrotic syndromes?
Normal.
61
What is the prognosis for idiopathic nephrotic syndrome?
most types are managed just fine with prednisone and rarely will they progress to end stage renal failure.
62
Name the different types of urinary tract infections? (5)
1. Sterile pyuria. 2. pyelonephritis. (acute pyelonphritis and Chronic low-grade pyelonephritis) 3. urinary bladder infections. 4. prostatitis. 5. urethritis.
63
What is sterile pyuria?
WBC in urine with negative bacteriologic evaluation.
64
What can cause strile pyuria? (5)
1) recent UTI with antibiotic treatment, 2) glucocoticoids, 3) acute febrile episodes, 4) pregnancy 5) normal postmenopausal female
65
What is pyelonephritis?
Kidney infection caused by hematogenous spread or retrograde (ascending) spread of pathogenic microorganism.
66
What are the 2 types of pyelonephritis?
Acute and chronic.
67
What is the clinical symptoms for clinical diagnosis of acute pyleonephritis like? (6)
1) fever, 2) flank pain, 3) nausea/vomiting, 4) costovertebral angle tenderness, 5) cystitis symptoms, 6) sepsis/shock.
68
What will the onset of acute pyleonephritis be like?
Acute onset.
69
What are some characteristics of acute pyelonephritis? (5)
1) spiking fever 2) acute onset 3) back pain 4) positive murphy's punch 5) urine reveals pyuria, WBC clumps and casts and proteinuria
70
Where are urinary casts made?***
Only the kidney
71
What is seen in urine with acute pyelonephritis?
Marked pyuria, WBC clumps, WBC casts and proteinuria.
72
What should you think of when you have WBC clumps and WBC casts?
Clumps- bladder infections. Casts- kidney infections.
73
What is a chronic pyelonephritis like?
Fewer findings that acute and not grossly pyuric and may have some clumps and casts.
74
What is cystitis?
An inflammed bladder usually caused by an infected bladder.
75
Who will be more likely to get a bladder infection?
Women.
76
What are the presentations of cystitis?(7)
1) Dysuria, 2) frequency, 3) urgency, 4) suprapubic pain, 5) fever, 6) nausea, 7) PAINFUL GROSS HEMATURIA.
77
What are the routine findings on urinalysis for a cystitis? (7)
1) hematuria, 2) pyuria, 3) nitrite, 4) alkaline pH, 5) bacteriuria 6) transitional epithelial cells 7) proteinuria.
78
What tests on a urinalysis will show up with bacteriuria?
Leukocyte esterase and nitrite.
79
What is a normal history of a women with cystitis and/or acute urinary tract infection? (3)
1) recent sex, 2) used spermicide, 3) previous history of UTI
80
What are the signs and symptoms of an acute UTI? (5)
1) Dysuria, 2) frequency, 3) urgency, 4) hematuria 5) absense of vaginal irritation and/or discharge
81
What will decrease the likelihood of an acute urinary tract infection for females?
vaginal irritation and or discharge.
82
What are the essentials of diagnosis for cystitis and UTI?
1) irritative voiding symptoms 2) patient usually febrile 3) Positive urine culture; blood cultures may also be positive
83
What are the 3 types of prostatitis?
1. Acute bacterial prostatitis. 2. chronic bacterial prostatitis. 3. Nonbacterial prostatitis.
84
What causes acute bacterial prostatitis? (3)
1) gram negative coliform bacteria that ascends from urethra, refluxes into prostate from infected urine 2) could spread via lymph from rectum 3) hematolgenously from another infection.
85
What are the clinical symptoms of acute bacterial prostatitis? (8)
1) fever, 2) chills, 3) low back and perineal pain, 4) urinary urgency and frequency, 5) nocturnal frequency, 6) dysuria, 7) bladder outlet obstruction, 8) myalgias and arthralgias
86
How will acute bacterial prostatitis be diagnosed?
1. Prostate palpation (swollen, tender and warm). 2. lab- leukocytosis shift to the left, pyuria with mild hematuria, cloudy malodorous urine with gross hematuria. 3. prostatic expressate is purulent and can be cultured.
87
What color is prostatic expressate usually like?
Clear
88
What are the essentials of diagnosis of acute bacterial prostatitis? (4)
1) Fever 2) irritative voiding symptoms 3) Perineal or suprapubic pain; exquisite tenderness common on rectal exam 4) positive urine culture
89
What is more common acute or chronic bacterial prostatitis?
Chronic.
90
What causes chronic bacterial prostatitis?
Etiology is similar to acute and may be due to gram positive bacteria.
91
What is the history like for chronic bacterial prostatitis?
Usually no history of previous acute bacterial prostatitis.
92
What are the clinical symptoms of chronic bacterial prostatitis? (2)
1) range from asymptomatic to irritative voiding dysfunction (nocturia, dysuria, urgency, frequency), 2) back or perinal pain.
93
What will prostate palpation and lab findings be like for chronic bacterial prostatitis?
palpation ranges from normal to slightly boggy to focal indurations, lab- hazy prostatic expressate due to WBC's, positive culture
94
What are the essentials of diagnosis of chronic bacterial prostatitis? (3)
1) Irritative voiding symptoms 2) Perineal or suprapubic discomfort, often dull and poorly localized 3) Positive expressed prostatic secretions and culture
95
What are some possible causes of nonbaceterial prostatitis?
Etiology is unkonwn but could be from caffine, alcohol, and spicy foods.
96
What is more common chronic bacterial or nonbacterial prostatitis?
Nonbacterial prostatitis.
97
What are the findings with nonbacterial prostatitis?
Similar to chronic bacterial prostatitis with negative WBC cultures of prostate expressate.
98
What is urethritis and what are the 2 types?
Inflammation of the urethra. Gonococcal and nongonococcal.
99
Gonococcal urethritis commonly affects males or females?
Males.
100
What are the clinical signs and symptoms of gonococcal urethritis? (3)
1) penial discharge, 2) dysuria, 3) urethral itching.
101
What labs should be done with gonococcal urethritis?
Not urinalysis since it should be done CCMS. The penile discharge should be collected 1-4 hours after voiding and be cultured.
102
What is the difference between gonococcal and nongonococcal urethritis?
Nongonococcal has same signs and symptoms but is often caused by chlamydia.
103
What is another name for hypertension that damages the kidneys?
nephrosclerosis.
104
What type of damage is done to the kidneys with hypertension?
serious and irreversible renal damage due to persistent hypertension
105
What is the age of onset for nephrosclerosis to take place?
30-60 years with a history of hypertension for 2-6 years.
106
Hypertension can cause a type of what?
chronic renal failure.
107
What are the laboratory evidence of renal damage from hypertension? (4)
1) Anemia, 2) mild proteinuria and hematuria (in early stages). 3) Marked proteinuria, hematuria, urinary casts (hyaline, epithelial, granular, fatty, waxy, broad)(very late stages). 4) Azotemia (usually indicates chronic kidney disease)
108
With nephrosclerosis (kidney damage due to hypertension) what would indicate chronic renal failure is taking place?
Azotemia.
109
What is nephrolithiasis?
Urinary stone disease or kidney stones.
110
Nephrolithiasis is the ____ most common urinary tract problem.
Third.
111
What is the first and second most common type of urinary tract problems?
1. infections. 2. prostatic disorders.
112
What are the main type of kidney stones?
Those made of calcium salts.
113
How much more common are kidney stones in male than females?
4:1 in 20's and 30's in 50-60's 1:1.
114
What increases the incidence of nephrolithiasis increased?
Sedentary lifestyle, summer months and humidity.
115
What factors promote stone formation?
Certain Diets and Dehydration, stress, chronic infections.
116
What diets promote stone formation?
Diets excess sodium, excess protein, high calcium, high oxalate and purines.
117
What factors will inhibit stone formation?
citrate, pyrophosphates, magnesium diets and increased water intake.
118
What is the most common symptoms with nephrolithiasis?
Pain.
119
What is the pain like for kidney stones?
one of the most intense pains suffered by humans, but may be dull and persistant. May refer to testis or labium as stone moves through ureter with possible radiation to the abdomen
120
What will the patients response to the pain be?
they tend to move about due to pain but cant get relief.
121
What are some other symptoms of nephrolithiasis besides pain? (3)
1) nausea and vomiting 2) urinary frequency/urgency (if stone lodged at ureterovesical junction) 3) Fever (esecially if accompanied by persistent urinary tract infections)
122
What are the laboratory findings for nephrolithiasis?
Urinalysis: micro or gross hematuria, crystals may indicate type of stone. CBC: Possible increase in WBC if infection if present.
123
Besides a urinalysis and CBC what other blood tests would be used for first time stone formers?
24 hour urine assays for calcium, uric acid, oxalates and citrates performed on first time stone formers
124
Besides a urinalysis and CBC what other blood tests would be used for recurrent stone formers?
24 hour urine collection with and without dietary restrictions and loading with certain biochemicals to analyze volume, pH, calcium, uric acid, oxalate, phosphate and citrate. PTH assays often needed d/t common calcium involvement
125
Can imaging be used to find nephrolithiasis?
Plain film abdominal and renal ltrasound examinations are capable of seeing 85% because calcium salts
126
What are the essentials of diagnosis for nephrolithiasis? (3)
1) Flank pain 2) Nausea and vomitting 3) ID on noncontrast images
127
What are the 2 types of urinary tract obstructions?
congenital and aquired.
128
What are the 3 areas of urinary tract obstructions?
1. Ureter. 2. bladder outlet. 3. urethra.
129
What is a congenital cause of bladder outlet obstruction?
Narrowed neck of the bladder
130
What are the acquired causes of bladder outlet obstructions?
bladder cancer, benign prostatic hyperplasia, prostate cancer.
131
What are some congenital causes of urethral obstruction?
1) Incompetent urethral valves 2) Meatus stenosis
132
What is an acquired cause of urethral obstruction?
Trauma
133
What is the second most common urologic cancer and how does it rank for all cancers?
Bladder Cancer and it ranksas the 6th most common cancer
134
What is the mean age of a diagnosed bladder cancer?
65 years.
135
What is the male:female ratio for bladder cancer?
3:1 male-to-female.
136
What are the known risk factors for bladder cancer?**
Smoking (60% of new cases), industrial dyes and solvent exposure (15% of new cases).
137
What are the clinical findings of bladder cancer?
ranges from none (most common) to irritative voiding (frequency and/or urgency)
138
What are the lab findings seen with bladder cancer? (3)
1) chronic hematuria gross or micro 2) pyuria, azotemia, anemia 3) increased normal and abnormal urothelium observed in microscoic examination of urine sediment.
139
What type of imaging should be done for bladder cancer? (4)
1) intravenous urography, 2) ultrasound, 3) CT or MRI, 4) cystourethroscopy.
140
What are the essentials of diagnosis for bladder cancer? (4)
1) Irritative voiding symptoms 2) Gross or microscopic 3) Positive urinary cytology in most patients 4) Filling defect within bladder noted on imaging
141
Who is most likely to get benign prostatic hyperplasia?
50% of men by the 6th decade (50-60) of life.
142
What causes benign prostatic hyperplasia?
Not totally understood. Has association with endocrinologic (dihydrotestosterone- associated with hair loss).
143
What are the 2 types of complaints seen with benign prostatic hyperplasia?
Obstructive and irritative.
144
What things are seen with obstructive complaints (benign prostatic hyperplasia)? (6)
1) hesitancy, 2) decreased force and caliber, 3) sensation of incomplete bladder emptying, 4) double voiding (twice within 2 hours), 5) straining 6) postvoid dribbling.
145
What things are seen with irritative complaints (benign prostatic hyperplasia)?
Urgency, frequency, nocturia.
146
What lab tests can be done for Benign prostatic hyperplasia?
some to rule out DDx like; 1) Urinalysis to rule out infection, 2) serum creatinine to assess renal function, 3) serum PSA to help rule out prostate cancer.
147
What are the essential of diagnosis for benign prostatic hyperplasia? (3)
1) Obstructive or irritative coiding symptoms 2) May have enlarged prostate on rectal exam 3) Absence of urinary tract infection, neurologic disorder, stricture disease, prostatic or bladder malignancy
148
What type of cancer is the most common cancer detected in American men?
Prosate cancer (not benign prostatic hyperplasia).
149
How common is prostate cancer?
40% of those over 50. 70% of those 80-89.
150
Where is prostate cancer most common at?
North America and Europe. Lowest is in Far East.
151
What are the risk factors for prostate cancer?
Family history, blacks, fatty diets.
152
How are prostatic cancers detected currently?
Digital rectal examinations (DRE) and serum PSA
153
What are the findings seen with DRE for prostatic cancer?
Focal nodules, areas of indurations.
154
Are signs of urinary retention and obstrutive voiding common for prostate cancer?
No, urinary retention and obstructive voiding are rare and most often due to benign prostatic hyperplasia
155
Besides DRE what are other ways to detect prostatic cancer? (4)
1) prostate specific antigen test. 2) Transrectal ultrasound (TRUS). 3) Biopsy. 4) History- signs of urinary retention and obstructive voiding symptoms are rare and most often due to benign prostatic cancer.
156
How often does digital rectal exam detect prostate cancer?
1.5-7% of cancers stage T3 or greater
157
What is the most accurate way to detect prostatic cancer?
Biopsy.
158
How accurate is TRUS?
lacks specificity and leads to too many biopsies. Detection rate is not much better than a combination of digital rectal exam and PSA
159
What is PSA?
a glycoprotein produced in the cytoplasm of prostate cells.
160
Why would PSA serum levels be helpful in detecting prostate cancer?
They will correlate in volume in serum for benign and malignant prostatic tissues and will be helpful in detecting, treating, staging the disease and detecting recurrence
161
What is the goal of PSA testing?
Enhanced sensitivity (increase cancer detection) and enhanced specificity (eliminate costly and invasive prostate biopsies that show normal results)
162
What is a good number for normal PSA levels?
Depends on age but less than 2 is good usually (but could still have cancer).
163
What is a PSA density?
A ratio of Serum PSA concentration and prostate volume as determined by TRUS.
164
What is a better way to monitor serum PSA besides PSA density?
PSA velocity- see how much PSA levels increase over a period of time.
165
What is a good and a bad PSA velocity?
greater than 0.75 increases the likelihood of cancer. Those with 0.35 or less have a 92% prostate-cancer-survival rate.
166
What is a glisan score used for?***
It is used to check the progression of prostate cancer and used for treatment of prostate cancer.
167
What are the different types of PSA?
2 types; 1. Complexed form (complexed with different proteins). 2. Free PSA.
168
What will the levels of the different types of serum PSA be like with prostatic cancer?
Cancer cells produce less free PSA by % even though the total volume of PSA levels increase. >25% free PSA unlikely to have cancer. <10%= 50% chance of cancer.
169
Total PSA levels below what will have a low risk of prostatic cancer?
below 2-2.5.
170
Total PSA levels above what will have a high risk of prostatic cancer?
Above 10.
171
What should be done when the lab total PSA levels show somewhere between 2.5-10?
See if the % of free PSA is within normal limits (below 10%).
172
What should be done if DRE and PSA levels indicate prostatic cancer?
Biopsy if life expectancy is greater than 10-15 years since prostatic cancer has about 10-15 survival rate.
173
What should you think of when you hear painless gross hematuria?
Kidney tumor until proven otherwise.
174
How common is renal cell carcinoma? When is the peak incidence?
3% of all reported cancers. Peak incidency in 6th (50-60) decade of life.
175
Who is more likely to get renal cell carcinoma Male or females?
males 2x as common as females.
176
What is a risk factor for renal cell carcinoma?
Cigarette smoking.
177
What are the clinical findings seen with renal cell carcinoma?
ranging from none to flank pain, abdominal mass, and symptoms of metatstaic diseases like cough or bone pain.
178
What parts of the body are most common for experiencing metastatic cancer?
Lungs and Bone pain
179
What are some common signs and symptoms seen with renal cell carcinoma?
Hematuria (60%), abdominal pain, palpable mass in the flank or abdomen.
180
What are some non-specific symtoms and signs of renal cell carcinoma?
fever, night sweats, weight loss, malaise.
181
When will most renal cell carcinomas be detected?
As incidental detection due to increased use of CT and US for diverse reasons.
182
What are the lab findings seen with renal cell carcinoma? (5)
Hematuria (gross or microscopic, 60%), anemia (due to loss of EPO), erythrocytosis (due to increased kidney cells that make EPO, 5%), hypercalcemia (10%, humoral hypercalcemia of malignancy), elevated alkaline phosphatae (with bony metastasis).
183
What are some advanced imaging that can be done for renal cell carcinoma?
Intravenous urography, ultrasound, CT, chest radiographs and bone scans
184
What are the essentials of diagnosis for renal cell carcinoma? (4)
1) Gross or microscopic hematuria 2) Flank pain or mass in some patients 3) systemic symptoms such as fever, weght loss may be prominent 4) solid renal mass on imaging
