UA - hematuria - proteinuria (mild) - pyruia - bacteriuria - loss of concentrating ability GFR drops as progresses

10 - Renal Cysts Flashcards by michael english

Types of renal cyst?

Simple cyst
Acquired cyst
ADPKD
Medullary sponge kidney

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What are renal cysts?

Epithelium-;lined cavities filled w fluid or semisolid material

Develop from renal tubular elements

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Renal cyst common?

One or more simple cysts are found in 50% of ppl >50yo

- rarely symptomatic

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60-70% of all renal masses are?

Simple renal cysts

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Where are simple renal cysts?

Usually at outer cotex

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Describe simple renal cyst?

Thin-walled w clear amber fluid

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Symptoms of simple renal cysts?

Typically asymptomatic but:

large cysts - flank pain
infected - flank pain, malaise, fever
rupture - flank pain , bleeding

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PE for simple renal cyst?

Usually normal

poss mass (large)
CVA tenderness (infection/trauma)

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Main concern w simple renal cysts?

Differentiation form

malignancy
abscess
PKD

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Dx of simple renal cyst?

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US criteria for benign renal cyst?

Echo free (anechoic)
Sharply demarcated mass w smooth walls
Enhanced back wall (good transmission through cyst)

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CT criteria for benign cyst?

Smooth thin wall that is sharply demarcated

- No enhancement w contrast media

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If lesion is inconsistent w simple renal cyst?

Surgical exploration (urology referral)

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MC inherited kidney disease?

Autosomal dominant PKD?

1/800

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50% Autosomal dominant PKD pts will have?

ESRD by age 60

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Genetic mutations for autosomal PKD?

ADPKD1 - 85-90%
ADPKD2 - 10-15%
-

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Which ADPKD has a longer life expectancy?

PKD2 - slower progression

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Pt presentation for ADPKD?

Age 20-40
ABD mass
HTN
H/o
- UTI
- nephrolitiasis
Abdominal flank pain
Painless hematuria
Large kidneys on exam (size of a football, no shit slide 14)

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ADPKD labs?

hematuria
proteinuria (mild)
pyruia
bacteriuria
loss of concentrating ability

GFR drops as progresses

ADPKD diagnosis confirmation?

CT if US is unclear

Associated w ADPKD?

Hepatic cysts
pancreatic cysts
splenic cyst
cerebral aneurysms
clonic diverticula
cardiac valvular/vasculitis
risk for ectopic pregnancy

Cardiac abnormalities w ADPKD?

Valvular or vascular

mitral valve prolapse
aortic valve abnormalities
aortic aneurysms

Complications and their treatments for ADPKD?

Pain

causes infection, bleeding into cysts, and nephrolithiasis
tx: bed rest, anylgesics, cyst decompression

Hematuria
Causes: cyst rupture (MC), stones, UTI
Tx: bed rest, hydration

Persisten hematuria w ADPKD?

Consider renal cell carcinoma

- esp men >50

Never give ___ to ADPKD

NSAIDS

Renal infarction with ADPKD?

Common Flank pain, feer, leukocytosis H wall thickness (CT) Tx: abx (2 weeks of IV)

Nephrolithiasis tx (ADPKD)

Hydration and pain control

HTN tx w ADPKD?

Aggressive HTN control | - leads to slowed rise in volume but does nothing for the decrease in GFR

ADPKD can be linked with cerebral aneurysms but screening is not recommended unless?

- Pos FHx of aneurysm - Undergoing elective surgery w risk of perioperative HTN - high risk profession (pilot etc)

ADPKD maintenance?

Avoid caffeine (prevent cysts) HTN tx and low protein diet Avoid contact sports Avoids NSAIDS Monitor BP and renal function Annual renal US

Genetic likelihood of ADPKD?

75% pos FMx Autosomal dominant inheritant - dad only gets 1/2 the kids - mom gets all of them

Maj cause of mortality with ADPKD?

Progressive renal dysfunciton - grossly enlarged kidneys - kidney failure

ADPKD pts need?

50% need renal replacement by age 60

Survival of renal replacement w ADPKD?

5 yr - 88%

What is medullary sponge kidney?

Relatively common Benign disorder, present at birth but not diagnosed till 40-50s Autosomal dominant MCKD1 or MCKD2

Medullary sponge kidney causes?

Irregular enlargement of medullar and interpapillary collecting ducts w diffuse medullary cysts - swill cheese apperance L urinary concentrating ability Nephrocalcinosis Incomplete type I dystal renal tubular acidosis

Medullary sponge kidney presentation

Hematuria Recurrent UTI Nephrolithaisis

UA for medullary sponge kidney?

L urinary concentrating ability (tubular damage)

Radiology for medullary sponge kidney?

Plain film - small round calculi in pyramidal regions - just beyond calyces CT - cystic dilation of DCT - striated appearance - calcifications in renal collecting system

Tx for medullary sponge kidney

No known theapy Tx directed toward complications - pyelonephritis/UTI - renal calculi - fluids - hypercalciuria - thiazide diuretics to lower calcium excretion - renal tubular acidosis -alkali therapy

With medullary sponge kidney if renal function is good?

Renal function is well maintained unless complications - i.e.. UTI, nephrolithiasis Leads to good prognosis

Acquired renal cystic disease is?

Seen in pts w dialysis or long standing renal failure - bilateral

Acquired renal cystic disease progresses to?

Malignancy ESRD - loss of nephron mass - fibrosis

Presentation of acquired renal cystic disease?

Back pain or hematuria

Diagnosis of acquired renal cystic disease?

US | CT scan

Tx for acquired renal cystic disease?

Renal transplant | Nephrectomy

Lets say the kidney fell on the floor

Does the 5 second rule apply?