I n t e r n a L medicine questions Bank

Renal cell cancer

Overview

• 
  also known as: hypernephroma
  
• 
  accounts for 85% of primary renal neoplasms
  
• 
  arises from proximal renal tubular epithelium
  

Associations

• 
  more common in middle-aged men
  
• 
  smoking
  
• 
  von Hippel-Lindau syndrome
  
• 
  autosomal dominant polycystic kidney disease
  
• 
  tuberose sclerosis
  

Features

• 
  classical triad: haematuria, loin pain, abdominal mass
  
• 
  pyrexia of unknown origin
  
• 
  left varicocele (due to occlusion of left testicular vein)
  
• 
  endocrine effects: may secrete EPO (polycythaemia), PTH (hypercalcaemia), renin, ACTH
  

Management

• 
  radical nephrectomy for confined disease
  
• 
  in disseminated disease, recent studies have shown a survival advantage for nephrectomy prior to interferon-alpha
  

4 2-A 6-year-old boy presents is diagnosed as having nephrotic syndrome. A presumptive diagnosis of minimal change glomerulonephritis is made. What is the most appropriate treatment?

	A.		Cyclophosphamide
		B.	Supportive treatment as an inpatient
		C.	Plasma exchange
		D.	Renal biopsy followed by prednisolone
		E.	Prednisolone

A renal biopsy is only indicated if response to steroids is poor