Renal 2

Front 1

Pediatric renal neoplasms

Back 1

Wilms tumor (nephroblastoma) and Mesoblastic nephroma

Front 2

Adult benign renal neoplasms

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Papillary adenoma, oncocytoma, angiomyolipoma

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Adult malignant renal neoplasms

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Renal cell carcinoma and urothelial carcinoma

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Malignant pediatric tumor of the kidneys comprised of embryonal nephrogenic elements

Back 4

Wilms tumor

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Wilms tumor is a triphasic neoplasms: what are the 3 possible tissue constituents?

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Blastema, Epithelium, Stroma

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Wilms tumor 4 Rules of 5

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5% childhood cancers, 5% bilateral, 5% multicentric, 5% anaplastic (worse prognosis)

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Organomegaly, hemihypertrophy; WT2 gene mutation; 5% develop Wilms tumor

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Beckwith-Wiedeman syndrome

Front 8

Wilms-aniridia-genital anomaly-retardation; WT1 gene mutation; 33% develop Wilms tumor

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WAGR syndrome

Front 9

Glomerulonephritis, male pseudohermaphroditism; WT1 gene mutation; 90% develop Wilms tumor

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Denys-Drash syndrome

Front 10

Loss of or mutation in tumor suppressor genes on chromosome 11 (WT1 and WT2 genes)

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Wilms Tumor

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Most common renal tumor of infancy; composed fo spindled cells with varying resemblance to immature tissues from mesoderm

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Mesoblastic Nephroma

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Papillary renal tumor <0.5 cm

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Renal papillary adenoma

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Papillary renal tumor >0.5 cm

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Papillary renal cell carcinoma

Front 14

Most common renal tubular epithelial neoplasm

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Renal papillary adenoma

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Central Stellate Scar

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Oncocytoma

Front 16

Multiple angiomyolipomas suggests

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Tuberous sclerosis

Front 17

Most common malignant renal neoplasm in adults

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Renal cell carcinoma

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Transitional cell carcinoma (TCC) involving the collecting system (calyces and pelvis)

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Urothelial carcinoma

Front 19

Classic triad of Renal Cell Carcinoma

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Flank pain, palpable mass, and hematuria

Front 20

Most common neoplastic recipient of a metastasis from another malignant neoplasm

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Renal cell carcinoma

Front 21

Mutation of VHL gene in >90% of cases

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Clear Cell Renal Cell Carcinoma

Front 22

Second most common type of RCC - rarely a germline mutation in c-met; more often multiple than any other type of RCC

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Papillary Renal Cell Carcinoma

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Fibrovascular cores contain numerous "foam cells"

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Characteristic of Papillary RCC

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Worse prognosis of typical RCC subtypes

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Collecting Duct Carcinoma

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Very rare, very aggressive; all have been African-American or Mediterranean; associated with sickle cell trait or disease

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Renal Medullary Carcinoma

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Urolithiasis

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Formation of urinary stones

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4 main types of Urolithiasis

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Calcium, Struvite, Uric acid, Cystine

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"Triple stones": magnesium ammonium phosphate

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Struvite

Front 29

Struvite stones indicative of

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Bacterial infections (Proteus); large stones (staghorn calculi)

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Muscularis mucosa

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Incomplete slips of smooth muscle

Front 31

Muscularis propria

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Detrusor muscle- thick bundles of smooth muscle

Front 32

Exposes bladder muscosa to external environment; anterior bladder wall and abdominal wall are absent

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Exstrophy

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Out-pouchings of visceral organ consisting of all layers of the wall of the organ

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True Diverticula

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Vestigial remnant of the connection of the bladder apex to the allantois

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Urachus

Front 35

Michaelis-Gutmann bodies within lysosomes of macrophages

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Malacoplakia

Front 36

Not all of this kind of urothelial carcinoma are invasive

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Papillary Urothelial Carcinoma

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Invasive, by definition, is this kind of urothelial carcinoma

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Flat - associated with urothelial carcinoma in situ

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Ta

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noninvasive, papillary

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Tis

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Carcinoma in situ (noninvasive, flat)

Front 40

T1

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Lamina propria invasion

Front 41

T2

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Muscularis propria invasion

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T3a

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Microscopic extra-vesicle invasion

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T3b

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Grossly apparent extra-vesicle invasion

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T4

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Invades adjacent structures

Front 45

Most common in countries where urinary schistosomiasis is endemic

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Squamous cell carcinoma

Front 46

Normal PCO2; Normal HCO3-

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PCO2= 40; HCO3-= 24

Front 47

For each Gram drop in serum albumin, the anion gap decreases by a factor of

Back 47

Around 2.5

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Urine Anion Gap =

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Na + K - Cl

Front 49

Normal Urinary Anion Gap =

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-10 - 10

Front 50

An increase in ammonium excretion is synonymous with an increase in excretion of this

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Chloride

Front 51

As chloride excretion increases, the urinary anion gap becomes more

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Negative (Na + K - Cl)

Front 52

If there is a loss of bicarb from the kidneys; what happens to ammonium and the urinary anion gap

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Ammonium excretion is decreased and the urinary gap becomes more positive

Front 53

An osmolar gap over 20 indicates

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The presence of other osmolarly active substances in the blood

Front 54

Normal Flora of urinary tract in women

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Lactobacillus, Coag negative staph, streptococcus, mycoplasma (low numbers), enteric gram-negatives (low numbers)

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Normal Flora of urinary tract in Men

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Coag negative staph, streptococcus, mycoplasma

Front 56

Most causative bacteria in community aquired UTI

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Escherichia coli

Front 57

Biochemical characteristics of E. coli

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Indole positive, Voges-Proskauer negative, Lysine decarboxylase positive, Lactose fermentation positive

Front 58

Glomerular Filtration Rate

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Normal=180 L/day; Volume/time

Front 59

Filtration Fraction

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GFR/RPF - is greater at low plasma flow than at high flow

Front 60

Does vasoconstrict, but normally RBF and GFR remain constant

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ADH (AVP)

Front 61

Afferent dilation, thus causes increases in both GFR and RBF; also inhibits the secretion of renin

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ANP

Front 62

Generally protective against excessive vasoconstriction like you might see with lots of SNS and ANG II

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Prostaglandins

Front 63

Na < 135 mmole/L

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hyponatremia

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Na > 144 mmole/L

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Hypernatremia

Front 65

Reflects the concentration of all solutes

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Osmolality

Front 66

Reflects the concentration of solutes that will cause a water shift

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Tonicity

Front 67

Most abundant cation in the body

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Potassium

Front 68

Most of the body's potassium is __ with a concentration of around 150 mEq/L

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Intracellular

Front 69

Extracellular potassium is around

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3.5 - 5 mEq/L

Front 70

Intracellular transport of potassium is mediated by

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Insulin and Beta-2 adrenergic stimulation

Front 71

U WAVE

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Hypokalemia EKG change

Front 72

Intermittent episodes of muscle weakness associated with transient acute shifts of K+ into cells

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Hypokalemic periodic paralysis

Front 73

Autosomal dominant hypertension, impressive cardiovascular sequalae and in many cases hypokalemia

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Liddle Syndrome

Front 74

Treat Liddle Syndrome with

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Triamterene combined with dietary salt restriction (normalizes BP and corrects hypokalemia)

Front 75

Defect, usually diagnosed in childhood, of impaired NaCl reabsorption in the loop of Henle (similar to loop diuretics)

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Bartter's Syndrome

Front 76

Autosomal recessive, usually diagnosed later in life; findings mimic a thiazide diuretic; don't have high urine Ca but do have low serum magnesium levels

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Gitelman's syndrome

Front 77

4 ways for Normotensive Renal Potassium Wasting

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Bartter syndrome, Gitelman syndrome, diuretic use, Distal RTA

Front 78

Maximum IV Potassium Replacement

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20 mEq/hr under constant cardiac monitoring

Front 79

EKG manifestations of hyperkalemia

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Peaked T waves, Prolonged QT intervals, Widened QRS complex, disappearance of P wave, Sine wave

Front 80

Short stature, stiff spine, and deformities of hands and feet; suppressed renin activity

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Gordon syondrome

Front 81

Treatment for Gordon syndrome

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Responds well to thiazide diuretics

Front 82

3 steps to treat Hyperkalemia

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Stabilize the myocardial membrane, Drive extracellular potassium into the cells, Removal of Potassium from the body

Front 83

Two things to give to help stabilize the myocardial membrane in hyperkalemia

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Calcium gluconate and calcium chloride

Front 84

2 things to drive extracellular potassium intracellularly

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Beta-2 agonists and Insulin

Front 85

Give this if hyperkalemia is secondary to ongoing severe metabolic acidosis

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Sodium Bicarbonate

Front 86

Exchanges sodium for potassium and binds it in the gut, primarily the large intestine, decreasing total body potassium

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Sodium Polystyrene Sulfonate

Front 87

What controls total body water

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ADH (Vasopressin) and Thirst center

Front 88

What controls Na in the body

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Aldosterone

Front 89

Where is the thirst center located

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In the hypothalamus

Front 90

Calculated Sosm

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2 x (Plasma Na) + (BUN)/2.8 + (Glucose)/18

Front 91

Clinical manifestations of hyponatremia are largely related to complications of

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Cerebral edema

Front 92

Symptoms of acute hyponatremia

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Nausea, vomiting, lethargy, confusion, seizures, coma

Front 93

Pt hyperglycemic: Corrected Na =

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1.6[(Pt glucose - 100)/100] + Pt. Na

Front 94

Sodium Replacement Calculation

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(.6 x ideal wt kg)(desired Na - pt Na)

Front 95

In Hypervolemic Hyponatremia, is the problem increased or decreased effective circulating volume

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Decreased

Front 96

Treatment for Hypervolemic hyponatremia

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Fluid restriction, Na restriction, loop diuretics

Front 97

Euvolemic hyponatremia: Uosm < 100

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Primary polydipsia, beer potomania, tea and toast diet

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Euvolemic hyponatremia: Uosm > 100

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SIADH, hypothyroidism, glucocorticoid deficiency

Front 99

Caused by HPV; presents with papillary lesions on the glans of shaft of the penis

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Condylomata Acuminata

Front 100

Inflammation of prepuce associated with the inability to retract the prepuce over the glands penis

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Phimosis

Front 101

Angulation of the penis during erection

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Peyronie's disease

Front 102

Cause of Syphylitic hard chancre

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Treponema pallidum

Front 103

Cause of chancroid (soft chancre)

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Haemophilus ducreyi

Front 104

2 things that can cause Urethritis

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Gonococcal or Nongonococcal

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Nongonococcal urethritis caused by:

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Chlamydia trachomatis (most common), Ureaplasma urealyticum, Trichomonas vaginalis

Front 106

Most common site in women for a urethral meatal stenosis

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Bulbous urethra

Front 107

Most common cause in men for a urethral meatal stenosis

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Posterior Urethral Valve

Front 108

With bloody urine with dysuria think

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Hemorrhagic cystitis

Front 109

Kind of cancer to associate with Schistosomiasis hematobium

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Squamous cell carcinoma

Front 110

Elevate the scrotum and the pain goes away

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Prehn's Sign

Front 111

Most common type of Testicular tumor

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Seminoma

Front 112

Cobra head configuration on an IVU

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Ureterocele

Front 113

Weigert-Meyer law

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The portion of the ureter that comes from the inferior collecting system will have the superior orifice (and vice versa)

Front 114

Most common tumor in the kidney

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Renal (clear) cell carcinoma

Front 115

Priaprism

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Maintained erection for over 4 hours which is often painful

Front 116

Treat over active bladder syndrome with

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Anticholinergics

Front 117

Stage 1 CKD

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GFR > or = 90

Front 118

Stage 2 CKD

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GFR 60-89

Front 119

Stage 3 CKD

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GFR 30-59

Front 120

Stage 4 CKD

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GFR 15-29

Front 121

Stage 5 CKD

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GFR < 15 (or dialysis)

Front 122

Treatments to slow progression of CKD

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Strict glycemic control, ACE-I/ARBs, Strict BP control (perhaps dietary proteins restricted)

Front 123

Cockcroft-Gault

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[(140-age)x wt. kg]/Pcr x 72

Front 124

Provides a more accurate estimate of GFR than other equations

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MDRD equation

Front 125

Serum Cr levels of 1.5 mg/dL have been considered

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Indicative of Chronic Kidney Disease

Front 126

Fraction of calcium that is hormonally regulated - is biologically active

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Ionized Calcium