Mock 3 RCC
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Stem
Young patient with a background of hyperthyroidism, has now developed secondary renal failure. He also has renal stones. Blood results available.How is hyperparathyroidism caused in renal failure?
Abnormalities in renal tubular absorption of phosphate → hyperphosphatemia
Decrease production of 1,25-dihydroxy vitamin D → hypocalcaemia
Hyperphosphatemia and hypocalcaemia → ↑ PTH → secondary hyperparathyroidismWhat is lining epithelium of urinary tract?
Stratified transitional epithelium.
What are the types of stones?
Calcium stones (oxalate and phosphate)
Struvite stones
Uric acid stones
Cystine stonesWhat are the genitourinary complications of stones?
Obstruction
Infection (e.g. pyelonephritis)
Renal cell carcinoma
Fistula
Deterioration of renal functions.
RuptureWhat are the different modalities for management of renal stones?
According to its size and location in the urinary tract (see NICE guidelines – NG118)
Stone < 5mmWatchful waiting, analgesia, alpha blockers
Stone < 10 mm Offer SWL
Consider URS:
• if there are contraindications for SWL or
• if a previous course of SWL has failed or
• because of anatomical reasons, SWL is not indicated
Consider PCNL if SWL and URS have failed to treat the current stone
Stone 10-20 mm Consider URS or SWL.
Offer PCNL if URS or SWL has failed
Stone > 20mm, including staghorn stones Offer PCNL
Stone any size + obstructionUrgent decompression (ureteroscopy, nephrostomy)What are the risk factors for RCC?
Smoking
Hypertension
Obesity
Stones
Industrial dyes exposure
Chronic kidney diseaseHow can stones cause cancer?
Stones → chronic infections and inflammation → metaplasia → dysplasia and DNA damage → cancer
What is the most common renal cell carcinoma?
Clear cell carcinoma
What is the second most common renal cell carcinoma?
Papillary cell carcinoma.
What is the most common renal cell carcinoma in patients with acquired cystic kidney disease, renal failure, and dialysis?
Papillary cell carcinoma.
What are macroscopic findings in renal carcinoma (in reference to the pathology report)?
-Clear cell carcinoma
Arises from proximal convoluted tubules
Unilateral and Solitary
Bright yellow-grey-white masses spherical masses
Margins are sharply defined and confined within the renal capsule
Prominent areas of cystic softening or of haemorrhage
-Papillary carcinoma
Arises from distal convoluted tubules
Bilateral and multiple
Less vibrantly orange yellow because of their lower lipid content
Papilla formation with fibrovascular cores
Necrosis, haemorrhage and cystic degenerationWhat are the microscopic findings in renal carcinoma (in reference to the pathology report)?
-Clear cell carcinoma
Rounded or polygonal shape and abundant clear or granular cytoplasm, which contains glycogen and lipid
-Papillary carcinoma
Cuboidal or low columnar cells arranged in papillary formations
Interstitial foam cells
Psammoma bodies may be present
Stroma is usually emptyWhat is R1?
Microscopic residual tumour
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