Nephro: Vasc, Cysts, Neoplasms, Infections

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96 Terms

1
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primary HTN

mcc of HTN

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secondary HTN

causes include: apnea, bruits, bad kidneys, catecholamines, drugs, diet, endocrine

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renal artery stenosis (RAS)

signs: patient has a primary disease +/- azotemia

bruit is heard over the renal arteries

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atherosclerotic

m/c RAS, > 45 y/o

diffuse > focal

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fibromuscular

RAS m/c in females < 50 y/o; abnormal development of fibrous collagen and smooth muscle

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AKI with ACEi/ARB

what is something common in the medical history of a patient with RAS?

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fibromuscular dysplasia

looks like a string of beads on film

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arteriography

gold standard for diagnosing RAS

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ACE/ARB +/- diuretic

medical treatment for all patients with RAS

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closely monitored

in patients with B/L RAS taking ACEi/ARB for treatment must be...

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angio +/- stent, bypass

surgical treatment for RAS

only if med tx has failed, patient has recurrent CHF, etc

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resection of the pressor kidney

treatment of last resort for RAS

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renal vasculitis

Inflammation of blood vessels in kidneys- leads to stenosis

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polycystic kidney disease (PCKD/PKD)

mutation (PKD1/2); buildup of abnormal substances in kidneys/other tissues driving abnormal cell growth, cyst formation & expansion, progressive loss of nephrons

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autosomal dominant

m/c form of PCKD, may not be clinically evident until 30s/40s

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autosomal recessive

infantile onset of PCKD

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s/s of PCKD, don't need them all!!

flank pain, ballotable mass, HTN, hematuria

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liver

m/c extra renal manifestation of cysts in PCKD occurs in what organ?

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CKD, UTIs, kidney stones

renal manifestations of PCKD

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mitral valve prolapse

cardiac manifestation of PCKD

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cerebral berry aneurysms

associated brain anomaly in PCKD, most severe of extrarenal manifestations

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US or CT

what imaging can be used to dx PCKD?

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Tolvaptan

Vasopressin V2-receptor (V2R)

antagonist; can lower cyst burden & preserve kidney function

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serious liver disease

CI to taking Tolvaptan

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renal cysts

rare, usu asymptomatic , incidence and size increase with age

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simple renal cyst

benign, round, well defined, thin walled, fluid filled renal cyst

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complex renal cyst

Inc P (cancer), irregular shape, thicker wall, inc density/solid, septations

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Pheochromocytoma

a benign tumor of the adrenal medulla that causes the gland to produce excess catecholamines; HTN & hyperadrenergic spells

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palpitations, perspiration, pain in the head

triad of symptoms from a pheo

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metanephrines and catecholamines

step 1 of diagnosing a pheo involves biochemical screening (urine or blood) looking for....

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CT/MRI of abdomen/pelvis

if biochemical screening is (+), step 2 of diagnosing a pheo is ....

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PET scan

if pheo tumor is large & there is a concern for mets, do a ....

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surgery

optimal treatment of a pheo

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alpha blockers (phenoxybenzamine)

med that is always given FIRST in patients with a pheo

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beta blocker

after adequate alpha blockade in pt with pheo, add a...

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CCB

can be given as a solo drug tx option for a pheo

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metyrosine

direct catecholamine blocker sometimes used in patients with a pheo

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renal infarct

under-reported 2/2 similarity to other conditions- abd/flank pain, hematuria

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cardioembolic thrombi, post AAA repair

causes of renal infarct

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angiography

gold standard for dx renal infarct

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wedge-shaped perfusion defect

what can be seen in patients with a renal infarct on a CT with contrast?

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anticoagulation

main treatment for renal infarct

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renal papillary necrosis (RPN)

ischemia of renal pyramids/collection ducts; always 2/2 to something else

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sickle cell, obstruction, diabetes, analgesics

name some causes of RPN

hint: SODA acronym

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necrotic tissue in urine

how is RPN diagnosed?

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ring shadow

an IVP will show a ______ in patients with RPN

47
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renal cell carcinoma (RCC)

m/c cancer of the kidney, usu in proximal tubule & usu sporadic

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smoking

major risk factor for RCC

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hematuria, flank pain, mass

triad of renal cell carcinoma (RCC)

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paraneoplastic syndrome of RCC

erythrocytosis, HTN, hypercalcemia

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US, CT, MRI

dx of RCC

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nephrectomy, +/- chemo, immunotherapy, radiation

tx of RCC

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bladder cancer

painless hematuria (>3 rbcs), voiding, mass, systemic symptoms if very advanced

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transitional/urothelial

mc form of bladder cancer

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smoking, male

risk factors for bladder cancer

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cytoscopy with biopsy

dx of bladder cancer

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superficial/non-muscle invasive bladder cancer tx

bladder resection (TURBT), chemo (cisplatin), immunotherapy (BCG)

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high rate of recurrence

a cytoscopy f/u is needed in after superficial bladder cancer is treated. Why?

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deep/muscle invasive bladder cancer treatment

radical cystectomy with urinary diversion (urostomy, indiana pouch, orthotopic neobladder)

60
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renal pelvis/ureteral tumors

rare, commonly associated w bladder cancer;

risk factors include smokers, exposure to Thorotrast

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transitional cell

mc histology of renal pelvis/ureteral tumors

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biopsy, CT urography or IVU/P

dx of renal pelvis/ureteral tumors

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Nephroblastoma (Wilms tumor)

abn tumor suppressor genes cause primitive (blast) renal cells to develop into cancer; children, <10 y/o, seen with other malformations

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painless, palpable abdominal mass

mc sign of wilms tumor

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US/CT/MRI

dx of wilms tumor

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biopsies - very fragile tumor, could spill cells

what should be avoided in nephroblastomas and why?

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chest

m/c site of metastases (if it occurs) in patients with nephroblastoma

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renal agenesis

absence of one or both kidneys

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unilateral renal agenesis (URA)

prognosis depends on function of formed

kidney, can be clinically silent in early life (other kidney will attempt to compensate which can lead to hyperfiltration & CKD)

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bilateral renal agenesis (BRA)

incompatible with extrauterine life beyond days/weeks; often associated with other developmental abnormalities

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Potter sequence (oligohydramnios)

what is a common cause of renal agenesis?

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congenital hypoplasia

low # of nephrons in miniature, histologically normal kidney, can lead to CKD & failure to thrive

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renal ectopia

kidneys in abn location- low lumbar, iliac, pelvic; most asymptomatic, need to eval the urinary tract

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simple

congenital ectopy -kidney on correct side but abnormal position

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crossed

congenital ectopy -

kidney crosses the midline +/- fusion to other kidney

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horseshoe kidney

kidneys fused across midline, typically @ inferior poles; pelvis & ureters are separate

77
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duplex ureters/collecting system

two separate ureters with two separate

insertions or fuse before inserting into

bladder (Y) shaped

no intervention required if asymptomatic

w/out complications

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nephroptosis

floating kidney

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vesicoureteral reflux (VUR)

abnormal flow of urine from the bladder back into the ureters

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medullary sponge kidney (MSK)

rare congenital dilation/cysts of the terminal tubule /collecting ducts

swiss cheese appearance

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recurrent stones, UTIs

is MSK shows symptoms, what are they?

patient might not show any symptoms

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interstitial cystitis (IC)

chronic inflammation of submucosa & muscularis layer of bladder; sharp pain improved with bladder emptying

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cytoscopy

how is IC diagnosed?

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diffusely reddened surface epithelium, Hunner's ulcer

cytoscopy of interstitial cystitis will often show...

85
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amytriptyline

considered first line medicinal tx of IC; antidepressant with pain control

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cystitis

bladder inflammation, lower tract; m/c cause is fecal contamination (E. coli)

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uncomplicated cystitis

healthy, non preg, adult, woman

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complicated cystitis

comorbidities, pregnant, male, anatomic abnormality, recent instrumentation, hospital acquired, extremes of age

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UA of cystitis

leukocyte esterase, nitrites, cloudy

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abx (bactrim)

primary treatment of cystitis

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Pyridium (phenazopyridine)

analgesic that relieves lower urinary tract mucosal pain, burning, urgency & frequency; only use for 2 days, may turn urine orange

92
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pregnant, pre op urologic surgery, recent renal transplant

when does asymptomatic bacteriuria need to be treated?

93
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pyelonephritis

upper tract, ascending, kidney infection; UTI with fever, chills, CVAT

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leukocytosis

CBC of pyelonephritis will show...

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WBC casts

UA of pyelonephritis will show...

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Fluoroquinolones (cipro/levo)

treatment of pyelonephritis if discharged