Nephrology Lecture Notes

Overview

• Instructor: Medicosa
• Topic: Renal Cell Carcinoma (RCC)
• Related Topics Covered in Previous Videos:
  • Nephritic Syndrome
  • Nephrotic Syndrome
  • Acute & Chronic Kidney Failure
  • Kidney Infections (e.g. Pyelonephritis)
  • Cystic Kidney Diseases
  • Angiomyolipoma

Kidney Tumors

• Types of Urological Tumors:
  • Kidney, ureter, and bladder cancers
• Hematuria:
  • Any adult with hematuria (except post-trauma) is presumed to have cancer until proven otherwise.

Workup for Kidney Cancer

• Initial Steps:
  1. Physical exam
  2. Imaging (Ultrasound, CT scan, MRI)
• Most Accurate Test: Biopsy
  • Approaches:
    • Percutaneous (needle through the skin)
    • Open surgery
    • Cystoscopy for bladder cancer
• Types of Kidney Cancer:
  • Primary: Starts in the kidney (e.g. RCC)
  • Secondary: Metastasis from other organs (e.g. adrenal gland, liver, colon)

Renal Cell Carcinoma (RCC)

• Origin: Proximal renal tubular cells
• Common Subtype: Clear cell adenocarcinoma
  • Characteristic appearance: Clear cells under microscope
• Pathological Features:
  • Can secrete erythropoietin, causing inappropriate polycythemia

Risk Factors for RCC

• Age (usually older individuals)
• Gender (twice as likely in males)
• Lifestyle factors:
  • Smoking
  • Obesity
  • Long-term dialysis
• Environmental exposure:
  • Lead, asbestos, petroleum products
• Genetic syndromes:
  • Von Hippel-Lindau disease (chromosome 3 translocation)

Clinical Presentation

• Classic Triad:
  • Flank pain
  • Costovertebral angle pain
  • Hematuria
• Other Symptoms:
  • Possible varicocele (if metastasizes to left renal vein)
  • Paraneoplastic syndromes (hypercalcemia, polycythemia)
  • Cachexia, weight loss, liver dysfunction (Stauffer's syndrome)

Diagnosis & Prognosis

• Diagnostic Approach:
  • History, physical exam, imaging, biopsy
• Prognosis:
  • Depends on metastasis; 5-year survival rate drops to 45% with metastasis
  • Poor prognosis if extends to renal vein or capsule
• Lab Findings:
  • Elevated ESR (non-specific)
  • Anemia (normalcytic in most cases)

Management

• Surgical Options:
  • Total nephrectomy (removal of entire kidney)
  • Approaches: open surgery, laparoscopic, robotic
• Other Therapies:
  • Immunotherapy, targeted therapy (e.g. tyrosine kinase inhibitors)

Comparison with Bladder Cancer

• Most Common Bladder Cancer: Transitional cell carcinoma
• Risk Factors:
  • Similar to RCC, including smoking and exposure to chemicals
• Diagnosis:
  • Similar to RCC; history, imaging, physical exam

Conclusion

• Resources:
  • Courses available on Medicosa's website for further study on cancer and kidney pathology.

Note: This summary encapsulates key points from the lecture, providing a structured overview of renal cell carcinoma and related nephrological topics.