10 - Renal Cysts Flashcards
Types of renal cyst?
Simple cyst
Acquired cyst
ADPKD
Medullary sponge kidney
What are renal cysts?
Epithelium-;lined cavities filled w fluid or semisolid material
Develop from renal tubular elements
Renal cyst common?
One or more simple cysts are found in 50% of ppl >50yo
- rarely symptomatic
60-70% of all renal masses are?
Simple renal cysts
Where are simple renal cysts?
Usually at outer cotex
Describe simple renal cyst?
Thin-walled w clear amber fluid
Symptoms of simple renal cysts?
Typically asymptomatic but:
- large cysts - flank pain
- infected - flank pain, malaise, fever
- rupture - flank pain , bleeding
PE for simple renal cyst?
Usually normal
- poss mass (large)
- CVA tenderness (infection/trauma)
Main concern w simple renal cysts?
Differentiation form
- malignancy
- abscess
- PKD
Dx of simple renal cyst?
US
CT
US criteria for benign renal cyst?
- Echo free (anechoic)
- Sharply demarcated mass w smooth walls
- Enhanced back wall (good transmission through cyst)
CT criteria for benign cyst?
- Smooth thin wall that is sharply demarcated
- No enhancement w contrast media
If lesion is inconsistent w simple renal cyst?
Surgical exploration (urology referral)
MC inherited kidney disease?
Autosomal dominant PKD?
1/800
50% Autosomal dominant PKD pts will have?
ESRD by age 60
Genetic mutations for autosomal PKD?
ADPKD1 - 85-90%
ADPKD2 - 10-15%
-
Which ADPKD has a longer life expectancy?
PKD2 - slower progression
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)
ADPKD labs?
UA
- hematuria
- proteinuria (mild)
- pyruia
- bacteriuria
- loss of concentrating ability
GFR drops as progresses
ADPKD diagnosis confirmation?
US
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?
