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Senior - GU Test 1 > 10 - Renal Cysts > Flashcards

10 - Renal Cysts Flashcards

1
Q

Types of renal cyst?

A

Simple cyst
Acquired cyst
ADPKD
Medullary sponge kidney

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2
Q

What are renal cysts?

A

Epithelium-;lined cavities filled w fluid or semisolid material

Develop from renal tubular elements

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3
Q

Renal cyst common?

A

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

- rarely symptomatic

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4
Q

60-70% of all renal masses are?

A

Simple renal cysts

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5
Q

Where are simple renal cysts?

A

Usually at outer cotex

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6
Q

Describe simple renal cyst?

A

Thin-walled w clear amber fluid

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7
Q

Symptoms of simple renal cysts?

A

Typically asymptomatic but:

  • large cysts - flank pain
  • infected - flank pain, malaise, fever
  • rupture - flank pain , bleeding
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8
Q

PE for simple renal cyst?

A

Usually normal

  • poss mass (large)
  • CVA tenderness (infection/trauma)
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9
Q

Main concern w simple renal cysts?

A

Differentiation form

  • malignancy
  • abscess
  • PKD
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10
Q

Dx of simple renal cyst?

A

US

CT

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11
Q

US criteria for benign renal cyst?

A
  1. Echo free (anechoic)
  2. Sharply demarcated mass w smooth walls
  3. Enhanced back wall (good transmission through cyst)
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12
Q

CT criteria for benign cyst?

A
  • Smooth thin wall that is sharply demarcated

- No enhancement w contrast media

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13
Q

If lesion is inconsistent w simple renal cyst?

A

Surgical exploration (urology referral)

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14
Q

MC inherited kidney disease?

A

Autosomal dominant PKD?

1/800

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15
Q

50% Autosomal dominant PKD pts will have?

A

ESRD by age 60

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16
Q

Genetic mutations for autosomal PKD?

A

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

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17
Q

Which ADPKD has a longer life expectancy?

A

PKD2 - slower progression

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18
Q

Pt presentation for ADPKD?

A 
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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19
Q

ADPKD labs?

A

UA

  • hematuria
  • proteinuria (mild)
  • pyruia
  • bacteriuria
  • loss of concentrating ability

GFR drops as progresses

20
Q

ADPKD diagnosis confirmation?

A

US

CT if US is unclear

21
Q

Associated w ADPKD?

A
  • Hepatic cysts
  • pancreatic cysts
  • splenic cyst
  • cerebral aneurysms
  • clonic diverticula
  • cardiac valvular/vasculitis
  • risk for ectopic pregnancy
22
Q

Cardiac abnormalities w ADPKD?

A

Valvular or vascular

  • mitral valve prolapse
  • aortic valve abnormalities
  • aortic aneurysms
23
Q

Complications and their treatments for ADPKD?

A

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

24
Q

Persisten hematuria w ADPKD?

A

Consider renal cell carcinoma

- esp men >50

25
Q

Never give ___ to ADPKD

A

NSAIDS

26
Q

Renal infarction with ADPKD?

A

Common

Flank pain, feer, leukocytosis

H wall thickness (CT)

Tx: abx (2 weeks of IV)

27
Q

Nephrolithiasis tx (ADPKD)

A

Hydration and pain control

28
Q

HTN tx w ADPKD?

A

Aggressive HTN control

- leads to slowed rise in volume but does nothing for the decrease in GFR

29
Q

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

A
  • Pos FHx of aneurysm
  • Undergoing elective surgery w risk of perioperative HTN
  • high risk profession (pilot etc)
30
Q

ADPKD maintenance?

A

Avoid caffeine (prevent cysts)

HTN tx and low protein diet

Avoid contact sports

Avoids NSAIDS

Monitor BP and renal function

Annual renal US

31
Q

Genetic likelihood of ADPKD?

A

75% pos FMx

Autosomal dominant inheritant

  • dad only gets 1/2 the kids
  • mom gets all of them
32
Q

Maj cause of mortality with ADPKD?

A

Progressive renal dysfunciton

  • grossly enlarged kidneys
  • kidney failure
33
Q

ADPKD pts need?

A

50% need renal replacement by age 60

34
Q

Survival of renal replacement w ADPKD?

A

5 yr - 88%

35
Q

What is medullary sponge kidney?

A

Relatively common

Benign disorder, present at birth but not diagnosed till 40-50s

Autosomal dominant MCKD1 or MCKD2

36
Q

Medullary sponge kidney causes?

A

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

37
Q

Medullary sponge kidney presentation

A

Hematuria
Recurrent UTI
Nephrolithaisis

38
Q

UA for medullary sponge kidney?

A

L urinary concentrating ability (tubular damage)

39
Q

Radiology for medullary sponge kidney?

A

Plain film - small round calculi in pyramidal regions - just beyond calyces

CT

  • cystic dilation of DCT
  • striated appearance
  • calcifications in renal collecting system
40
Q

Tx for medullary sponge kidney

A

No known theapy

Tx directed toward complications

  • pyelonephritis/UTI
  • renal calculi - fluids
  • hypercalciuria - thiazide diuretics to lower calcium excretion
  • renal tubular acidosis -alkali therapy
41
Q

With medullary sponge kidney if renal function is good?

A

Renal function is well maintained unless complications
- i.e.. UTI, nephrolithiasis

Leads to good prognosis

42
Q

Acquired renal cystic disease is?

A

Seen in pts w dialysis or long standing renal failure

  • bilateral
43
Q

Acquired renal cystic disease progresses to?

A

Malignancy

ESRD

  • loss of nephron mass
  • fibrosis
44
Q

Presentation of acquired renal cystic disease?

A

Back pain or hematuria

45
Q

Diagnosis of acquired renal cystic disease?

A

US

CT scan

46
Q

Tx for acquired renal cystic disease?

A

Renal transplant

Nephrectomy

47
Q

Lets say the kidney fell on the floor

A

Does the 5 second rule apply?

Senior - GU Test 1 (13 decks)

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