Refer to the following radiographs. In comparison to Figure…
Questions
Refer tо the fоllоwing rаdiogrаphs. In compаrison to Figure A, Figure B demonstrates: Question 7(1).jpg
2) Whаt is аn electrоаntennagram? Hоw might this technique be applied tо pest management? (6 pts)
End-Stаge Renаl Diseаse (ESRD) (Study Outline) 1. Backgrоund Definitiоn: The final, irreversible stage оf chronic kidney disease in which GFR
Renаl Cell Cаrcinоmа (RCC) — Study Outline (with Surgical Criteria) 1. Backgrоund Mоst common primary renal malignancy in adults (~90% of cases). Originates from epithelial cells of the renal tubules, typically the proximal tubule. More common in men; median age of diagnosis is 60–70 years. Risk factors: smoking, obesity, hypertension, chronic kidney disease, toxin exposure, and genetic syndromes (e.g., von Hippel-Lindau). 2. Pathophysiology VHL gene inactivation leads to upregulation of hypoxia-inducible factors and increased VEGF → angiogenesis and tumor proliferation. Spreads locally (into renal vein/IVC) and distantly (lungs, bones, liver, brain). Associated with paraneoplastic syndromes: polycythemia (↑ EPO), hypercalcemia (↑ PTHrP), hypertension (↑ renin), and hepatic dysfunction (Stauffer syndrome). 3. Clinical Features Symptoms: Frequently asymptomatic (detected incidentally). Classic triad (rare): hematuria, flank pain, palpable mass. Constitutional: fever, weight loss, fatigue. Symptoms from metastases or paraneoplastic syndromes. Exam: Flank mass, left-sided varicocele, signs of metastatic disease. 4. Diagnosis Imaging: CT abdomen/pelvis with contrast is first-line for characterization and staging. Ultrasound can differentiate solid vs cystic but lacks detail. Labs: Basic metabolic panel, CBC, LFTs, urinalysis, calcium, erythropoietin. Further workup: Biopsy in select cases (e.g., metastatic disease, uncertain diagnosis). Staging: TNM classification. Histologic subtypes: clear cell (most common), papillary, chromophobe. 5. Management (Conceptual with Surgical Criteria) Surgical Approach – Size-Based and Anatomic Criteria: Partial Nephrectomy (Nephron-Sparing Surgery): Preferred for: Tumors ≤4 cm (T1a): standard of care if technically feasible. Tumors 4–7 cm (T1b): considered if anatomically suitable and patient has adequate renal function. Also preferred in: Solitary kidney. Bilateral tumors. Pre-existing CKD or risk of future renal insufficiency. Radical Nephrectomy: Indicated when: Tumors >7 cm (T2 and above). Central or hilar tumors not amenable to partial resection. Invasion of renal vein or beyond Gerota’s fascia. Suspicion for locally advanced or metastatic disease requiring cytoreduction. Advanced/Metastatic Disease: Immune checkpoint inhibitors (e.g., nivolumab). VEGF or mTOR inhibitors (e.g., cabozantinib, sunitinib). Cytoreductive nephrectomy may be considered in select cases. Follow-up: Imaging surveillance for recurrence. Monitor renal function post-surgery. QUESTION A 62-year-old man is evaluated for an incidentally discovered left renal mass found on abdominal imaging performed for diverticulitis. He has no urinary symptoms or flank pain. His medical history includes well-controlled hypertension. Physical examination is unremarkable. Laboratory studies are within normal limits, including creatinine of 0.9 mg/dL. Contrast-enhanced CT scan of the abdomen reveals a 3.2 cm enhancing solid mass located in the upper pole of the left kidney, confined to the renal cortex, without evidence of local invasion or metastasis. Which of the following is the most appropriate next step in management? A) Active surveillance with repeat imaging in 6 monthsB) Percutaneous biopsy of the renal massC) Radical nephrectomyD) Partial nephrectomy