A 59-year-old man is admitted to the hospital with complaints of weight loss, flank pain, hypertension, supraclavicular lymphadenopathy, and malaise. He had been reasonably healthy all of his life and had never been hospitalized before. A full work-up was done, including blood work, abdominal X-ray, and CT.
Vital signs are as follows: BP 155/100 mm of Hg, P 88 beats/min, RR 16 per min, T 98.9 degrees Fahrenheit.
Lab tests revealed a CBC within normal limits and hypercalcemia. Urinalysis was normal except for trace hematuria. The abdominal CT showed a 1cm solid mass in the left kidney.
Which of the following concerning renal cell carcinoma is true?
Women are affected more than men
The classic triad of flank pain, hematuria, and flank mass is most commonly seen and indicates advanced disease
Approximately 30% of patients present with metastatic disease
The most common presentation is hypertension
The disease is more common in those of Asian and African descent
A 56-year-old man presents to the hospital with complaints of hematuria, dull, constant abdominal pain, fatigue, and loss of appetite. His medical history is significant for heavy alcohol and smoking over the past 20 years. He also has a history of excessive NSAID usage due to osteoarthritis. His symptoms began about 2 weeks ago and have been progressively worsening.
Vital signs are as follows: blood pressure 144/90 mm Hg, pulse 80/min, respiratory rate 15 per minute, and temp 98.2 Fahrenheit.
Physical exam reveals a slightly anxious, well-developed man with tenderness in the right lower quadrant and a palpable mass located in the pelvis. The rest of the exam is within normal limits. A radiograph reveals a large, irregular shaped mass in the pelvis. The patient is admitted and a biopsy is performed. The diagnosis of transitional cell carcinoma is made.
Which of the following is true concerning the patient's condition?
An elevated urinary lactate dehydrogenase level is diagnostic
The most common symptom is dull, colicky pain
They are generally highly malignant with a poor prognosis
It is more common than squamous cell carcinoma of the bladder
Environmental factors are not believed to play a large role in development
A 55-year-old African American man with years of poor medical follow-up initiates care at your office. His blood pressure is 160/90 mmHg. He is afebrile and, other than arteriolar retinal narrowing, his exam is normal. He recalls being told he had hypertension years ago, but he never took the prescribed medications. He denies illicit drug use, nephrolithiasis, diabetes, analgesic use, cigarette use, toxic exposures, and a family history of kidney disease.
Serum creatinine 2.8 mg/dL
Urinalysis pH 6, large protein, no casts, 25 dysmorphic red cells, no white cells, no crystals, no nitrate, no leukocyte esterase
Blood hemoglobin 11.5 g/L
Renal ultrasound Patient failed to have this done despite 3 requests
Urine albumin/creatinine ratio 1000 mg/g 24-hour urine albumin 1.1 g/24 hour
What is the most likely cause of his hematuria?
A 35-year-old African American man complains of increasing abdominal girth over the past 6 months, despite diet and exercise. He drinks no alcohol and takes no prescribed or illicit drugs. He has no known medical history and had his last physical 2 years ago. He was adopted and doesn't know his family history. Physical exam shows a blood pressure of 145/85 mm Hg, hepatomegaly, and bilateral renal enlargement. His lung, cardiac, and lower extremity exams are normal. Urinalysis specific gravity 1.020, pH 6, trace protein, no cells or casts Hemoglobin 16 g/dl Serum creatinine 1.5 mg/dl Glomerular filtration rate 68 ml/min/1.73 m2 Renal ultrasound mild renomegaly, 3 fluid-filled right renal cysts, 3 fluid-filled left renal cysts Hepatic ultrasound few hepatic cysts
What is his most likely diagnosis?
Autosomal dominant polycystic kidney disease
Autosomal recessive polycystic kidney disease
Acquired cystic kidney disease