Condition
A 62-year-old man with a history of long-standing type 2 diabetes and hypertension presents for follow-up. He reports increasing fatigue, pruritus, and mild lower extremity swelling. He denies hematuria or recent illness.
On exam, he has bilateral pitting edema and pale conjunctiva.
Laboratory results:
Creatinine: 3.2 mg/dL (baseline 2.8)
eGFR: 25 mL/min/1.73m²
Hemoglobin: 9.6 g/dL (low)
BUN: 55 mg/dL
Potassium: 5.5 mEq/L
Urinalysis: broad waxy casts and proteinuria
Renal ultrasound: bilaterally small, echogenic kidneys
CKD - Stage IV
Abnormal PDK1 and PDK2 genes
Autosomal polycystic kidney disease
MC comorbidity/condition seen in diabetic kidney disease?
diabetic retinopathy
Best initial screening lab for diabetic kidney disease?
urine albumin:Cr
Overall tx for CKD?
Tx for preventing progression of albuminuria?
Overal = control DM and HTN
Preventing progression = ACEI/ARB, SGLT2, GLP1, MRA
A 4-year-old girl is brought to the pediatrician by her parents who noticed a painless abdominal mass while bathing her. She has no fever, dysuria, or recent illness, but has been notably constipated. On exam, the mass is smooth, firm, and does not cross the midline. Mild hypertension is noted (BP 128/78 mmHg).
Laboratory and imaging studies:
CBC: normal
UA: microscopic hematuria
Abdominal ultrasound: solid renal mass
CT abdomen: well-circumscribed renal mass without metastasis
Wilm's tumor
Abdominal/renal bruit
RAS
2 MCC of CKD?
Diabetes, HTN
What can horseshoe kidney be seen on?
US or CT urography
Tx for Wilm's tumor?
total nephrectomy w/ LN sampling and chemo
A 58-year-old man with a history of hypertension presents for follow-up. Despite being on three antihypertensive medications, including an ACE inhibitor, his blood pressure remains uncontrolled at 182/102 mmHg. He also reports new-onset fatigue.
On exam, he has an audible abdominal bruit.
Laboratory results:
Creatinine: 2.1 mg/dL (baseline 1.0 before starting ACE inhibitor)
Potassium: 5.6 mEq/L
UA: normal
Renal ultrasound with Doppler: asymmetry in kidney size, with reduced perfusion to the right kidney
RAS
Kidneys <9cm on US
CKD
MC type of dialysis used in the US?
Hemodialysis
Initial test for Wilm's tumor?
Best test?
Initial = US
Best = CT w contrast or MRI
Tx for RCC?
nephrectomy and immunotherapy
A 35-year-old man presents with flank pain, headaches, and hematuria. He reports that his father required dialysis in his 50s. On exam, his blood pressure is 168/94 mmHg, and both kidneys are palpably enlarged.
Laboratory results:
Creatinine: 1.8 mg/dL (mildly elevated)
UA: microscopic hematuria, mild proteinuria
Imaging:
Renal ultrasound: bilateral enlarged kidneys with multiple cysts
Additional findings:
Brain MRI: berry aneurysm in the circle of Willis
Autosomal polycystic kidney disease
Flank pain, hematuria, painless abdominal/renal mass
RCC
MC form of RAS in elderly? Women <50yo?
Elderly = atherosclerotic ischemic
Women <50 = Fibromuscular dysplasia
Best imaging for RAS?
1. US and doppler
2. MRA and renal angiography
1. elderly
2. women <50yo
1. ACEI/ARB
2. Angioplasty = curative w/ FMD
A 59-year-old woman with long-standing type 2 diabetes and hypertension presents with progressive fatigue, nausea, pruritus, and bilateral leg swelling. She has missed several follow-up appointments.
On exam, she has pallor, periorbital edema, and bilateral pitting edema in the legs. BP is 176/98 mmHg.
Laboratory results:
Creatinine: 8.4 mg/dL
eGFR: 12 mL/min/1.73 m²
BUN: 102 mg/dL
Potassium: 6.1 mEq/L
Bicarbonate: 16 mEq/L
Hemoglobin: 8.5 g/dL
Phosphate: high
Calcium: low
PTH: high
UA: broad waxy casts
Renal ultrasound: bilateral small, echogenic kidneys
Stage V CKD
Palpable abdominal mass + constipation and hematuria
Wilm's tumor
MC type of RCC? MC site of metastasis?
Renal clear cell carcinoma
Lung = MC site of metast
Criteria on US for autosomal polycystic kidney disease in:
1. age 30-59yo
2. age 60+yo
1. 2+ cysts in each kidney
2. 4+ cysts
-
- fluid intake
- FQs if infection (fever, leukocytosis)
- ACEI/ARB for HTN
- Tolvaptan - if high risk of progression