Nephrology Exam||Newest Exam With Over
350 Most Examinable Questions And Well
Verified Correct answers
What are the top 5 functions of the kidneys?
-remove waste
-control BP by secreting renin which initiates RAAS
-stimulates RBC production by secretion of EPO
-maintains bone health by secreting calcitriol --> reducing Ca2+ loss
-controls pH
What make up about 90% of all renal cancers?
renal cell carcinoma (parenchyma)- includes adenocarcinomas
What are the types of renal cancers?
-renal cell carcinoma (includes adenocarcinoma)
-transitional cell carcinoma - renal pelvis
-wilms' tumor (kids)
-renal sarcoma- originated from vasculature or connective tissue of
kidney
What is the etiology behind RCC?
- 6th decade of life
-cigarette smoking
-physical inactivity, obesity, HTN, acquired cystic kidney disease
associated with dialysis, ADPKD
-effects Proximal tubule cells
Which renal cancer is associated with paraneoplastic syndrome?
renal cell carcinoma
-Paraneoplastic syndrome is symptoms due to remote effects of cancer
,Describe the presentation of a patient with renal cell carcinoma.
-gross or microscopic hematuria
-flank pain or mass
-fever, weight loss
-solid mass on imaging
-night sweats, malaise
-*erythrocytosis but anemia is more common*
-hypercalcemia
-stauffer syndrome - hepatic dysfunction in absence of liver metastasis
(elevated LFT)
-scrotal varicoceles
What is the best initial test for renal cell carcinoma?
-US: inexpensive, no radiation and high sensitivity
-then do CT or MRI
-then biopsy or nephrectomy
-bone scan if metastasis is suspected
What is the treatment for renal cell carcinoma?
-surgery is gold standard - partial or radical
-curative in stages 1-3
-resistant to chemo or radiation
Describe renal cell carcinoma staging.
I: confined to renal capsule and <7cm
II: confined to renal capsule and >7cm
III: through renal capsule but not through fascia; renal vein, IVC, or
regional nodal involvement
IV: through fascia or with distant metastasis
What is the prognosis of RCC?
-after part/radical nephrectomy
-T1-T2 have 5 year survival of 90-100%
-T3 or T4 5 year survival of 50-60%
-node + stage III or IV 5 year survival is 0-15%
What is Wilms' tumor?
-nephroblastoma
,-MC renal malignancy in children
-Dx before 10yo
-African Americans are more at risk
Describe the presentation of a patient with Wilms' tumor?
-Painless palpable abdominal mass rarely cross midline
-abdominal pain
-hematuria
-HTN
-careful to not rupture the tumor during PE.
-may have subcapsular hemorrhage (fever, rapid abd enlargement,
anemia, HTN)
Which patients should be screened for Wilms' tumor?
-Beckwith-Wiedmann syndrome every 3 months until age 7
-WAGR syndrome every 3 months until age 5
Describe the workup in a patient with a Wilms' tumor?
-US then CT or MRI
-evaluate for lung metastasis
-SCr, CMP, UA, maybe coagulation studies if indicated
-Diagnosis is based on imaging--> surgery
Describe the staging of a Wilms' tumor.
I: limited to kidney and completely excised w/o rupture or biopsy- renal
capsule intact
II: tumor extends through renal capsule but all is removed- vessels
outside kidney contain tumor - OR "local spillage on removal"
III: residual tumor confined to abd - involvement of abd lymph nodes-
"diffuse" contamination by rupture- microscopic margins positive post
resection
IV: hematogenous metastasis at any site
V: bilateral renal involvement
How are Wilms' tumors treated?
-surgical excision
-chemotherapy with low risk tumors
-radiation for advanced stage and histology
, What is the prognosis of Wilms' tumor?
5 year survival of 90%
follow with CT - pulmonary and abdominal Q3mo/2 years then Q6mo/2
more years
Describe multiple myeloma.
-malignancy of plasma cells
-Light chain immunoglobulins called Bence Jones protein causes renal
toxicity by precipitating in the tubules causing obstruction
-Hypercalcemia
-Tx: correction of hypercalcemia, volume repletion, chemotherapy
What is ADPKD?
Autosomal dominant polycystic kidney disease
-cysts # increase with age (bilateral kidneys)
-MC hereditary disorder in the US
Describe the presentation of ADPKD.
-often have HTN and abdominal mass (palpable kidneys)
-family history
-abdominal/ flank pain
-hematuria
-Hx of UTI/ nephrolithiasis
What genetic mutations were found for ADPKD?
PKD1 and PKD2
-PKD1 has worse prognosis and faster progression of disease
What are diagnostics for a patient with family history of ADPKD? what
about if they didn't know?
-With history: Dx is confirmed with US
-W/o: Dx is confirmed with CT (numerous cysts)
How is ADPKD treated?
treat symptoms
-Abd/ flank pain: cyst decompression/drainage/removal and analgesics
-Hematuria: bed rest, hydration
-renal infection: ABX- Bactrim, chloramphenicol
-nephrolithiasis: hydration
350 Most Examinable Questions And Well
Verified Correct answers
What are the top 5 functions of the kidneys?
-remove waste
-control BP by secreting renin which initiates RAAS
-stimulates RBC production by secretion of EPO
-maintains bone health by secreting calcitriol --> reducing Ca2+ loss
-controls pH
What make up about 90% of all renal cancers?
renal cell carcinoma (parenchyma)- includes adenocarcinomas
What are the types of renal cancers?
-renal cell carcinoma (includes adenocarcinoma)
-transitional cell carcinoma - renal pelvis
-wilms' tumor (kids)
-renal sarcoma- originated from vasculature or connective tissue of
kidney
What is the etiology behind RCC?
- 6th decade of life
-cigarette smoking
-physical inactivity, obesity, HTN, acquired cystic kidney disease
associated with dialysis, ADPKD
-effects Proximal tubule cells
Which renal cancer is associated with paraneoplastic syndrome?
renal cell carcinoma
-Paraneoplastic syndrome is symptoms due to remote effects of cancer
,Describe the presentation of a patient with renal cell carcinoma.
-gross or microscopic hematuria
-flank pain or mass
-fever, weight loss
-solid mass on imaging
-night sweats, malaise
-*erythrocytosis but anemia is more common*
-hypercalcemia
-stauffer syndrome - hepatic dysfunction in absence of liver metastasis
(elevated LFT)
-scrotal varicoceles
What is the best initial test for renal cell carcinoma?
-US: inexpensive, no radiation and high sensitivity
-then do CT or MRI
-then biopsy or nephrectomy
-bone scan if metastasis is suspected
What is the treatment for renal cell carcinoma?
-surgery is gold standard - partial or radical
-curative in stages 1-3
-resistant to chemo or radiation
Describe renal cell carcinoma staging.
I: confined to renal capsule and <7cm
II: confined to renal capsule and >7cm
III: through renal capsule but not through fascia; renal vein, IVC, or
regional nodal involvement
IV: through fascia or with distant metastasis
What is the prognosis of RCC?
-after part/radical nephrectomy
-T1-T2 have 5 year survival of 90-100%
-T3 or T4 5 year survival of 50-60%
-node + stage III or IV 5 year survival is 0-15%
What is Wilms' tumor?
-nephroblastoma
,-MC renal malignancy in children
-Dx before 10yo
-African Americans are more at risk
Describe the presentation of a patient with Wilms' tumor?
-Painless palpable abdominal mass rarely cross midline
-abdominal pain
-hematuria
-HTN
-careful to not rupture the tumor during PE.
-may have subcapsular hemorrhage (fever, rapid abd enlargement,
anemia, HTN)
Which patients should be screened for Wilms' tumor?
-Beckwith-Wiedmann syndrome every 3 months until age 7
-WAGR syndrome every 3 months until age 5
Describe the workup in a patient with a Wilms' tumor?
-US then CT or MRI
-evaluate for lung metastasis
-SCr, CMP, UA, maybe coagulation studies if indicated
-Diagnosis is based on imaging--> surgery
Describe the staging of a Wilms' tumor.
I: limited to kidney and completely excised w/o rupture or biopsy- renal
capsule intact
II: tumor extends through renal capsule but all is removed- vessels
outside kidney contain tumor - OR "local spillage on removal"
III: residual tumor confined to abd - involvement of abd lymph nodes-
"diffuse" contamination by rupture- microscopic margins positive post
resection
IV: hematogenous metastasis at any site
V: bilateral renal involvement
How are Wilms' tumors treated?
-surgical excision
-chemotherapy with low risk tumors
-radiation for advanced stage and histology
, What is the prognosis of Wilms' tumor?
5 year survival of 90%
follow with CT - pulmonary and abdominal Q3mo/2 years then Q6mo/2
more years
Describe multiple myeloma.
-malignancy of plasma cells
-Light chain immunoglobulins called Bence Jones protein causes renal
toxicity by precipitating in the tubules causing obstruction
-Hypercalcemia
-Tx: correction of hypercalcemia, volume repletion, chemotherapy
What is ADPKD?
Autosomal dominant polycystic kidney disease
-cysts # increase with age (bilateral kidneys)
-MC hereditary disorder in the US
Describe the presentation of ADPKD.
-often have HTN and abdominal mass (palpable kidneys)
-family history
-abdominal/ flank pain
-hematuria
-Hx of UTI/ nephrolithiasis
What genetic mutations were found for ADPKD?
PKD1 and PKD2
-PKD1 has worse prognosis and faster progression of disease
What are diagnostics for a patient with family history of ADPKD? what
about if they didn't know?
-With history: Dx is confirmed with US
-W/o: Dx is confirmed with CT (numerous cysts)
How is ADPKD treated?
treat symptoms
-Abd/ flank pain: cyst decompression/drainage/removal and analgesics
-Hematuria: bed rest, hydration
-renal infection: ABX- Bactrim, chloramphenicol
-nephrolithiasis: hydration
