Chapter 14 Renal Pathology power point Flashcards
Angiomylolipoma- (hamartoma)
Cysts
Pathology – Benign
a mass composed of fat, blood vessels and smooth muscle tissue
Highly echogenic , homogenous.
Angiomylolipoma- (hamartoma)
simple,parapelvic,hemorrhagic,multicystic dysplastic,polycystic kidney disease, (autosomal recessive and autosomal dominant)
Cysts
Most common renal mass
Spherical, smooth wall, anechoic, posterior acoustic enhancement
Normally asymptomatic, unless they become large and compress adjacent renal tissue
Clinically insignificant
50% of the population > age 50 have these
Simple renal cyst
cyst projects outward away from the kidney
Exophytic
cyst lies within the renal cortex
Cortical
cyst that originates in the renal parenchyma and protrude into the renal sinus
Parapelvic
cyst that originate in the renal sinus
Peripelvic
A cyst that does not meet the diagnostic criteria of a simple cyst
Septations, internal debris, mural nodules, papillary projections, irregular borders are worrisome for malignancy and will be followed up with other imaging modalities or surgery
Renal cell carcinoma can manifest as a multicystic mass
Complex renal cysts
Autosomal Dominant Polycystic Kidney Disease (ADPKD) also known as Adult Polycystic Disease (APKD)
Normally lies dormant for many years and manifests itself in the third to fourth decade (30-40 years of age)
Patient may also develop multiple cysts of varying sizes in other organs including pancreas, liver and spleen
40% associated with polycystic liver disease
Polycystic kidney disease
Can be asymptomatic until third to fourth decade of life Decreased renal function UTI Renal calculi Flank pain Hematuria Palpable abdominal mass
clinical findings of APKD
Autosomal recessive (ARPKD)- relatively rare genetic disorder divided into four types depending on onset.
- Perinatal-found in-utero, common leading factor for demise. Oligohydramnios and enlarged echogenic kidneys
- Neonatal
- Infantile
- Juvenille
Polycystic kidney disease
Often recognized in the fetus
Confirmed with a postnatal ultrasound
Perinatal death often occurs
Secondary complications of renal failure and hepatic disease often causes early death
Bilateral disease, loss of corticomedullary differentiation
arpkd
Renal failure
Hepatic disease
Clinical findings of ARPKD
a mass composed of fat, blood vessels and smooth muscle tissue
Highly echogenic , homogenous
Usually discovered incidentally
Unilateral
Patients with tuberous sclerosis have a tendancy to develop these, usually bilateral
Not painful unless there is hemorrhage within the mass
Angiomylolipoma- (hamartoma)
Rare, benign
Caused by an accumulation of calcium in the renal parenchyma
Two forms, Medullary and Cortical
Medullary is congenital
Kidneys are small to normal in size with increased echogenicity in the renal pyramids that may shadow
Nephrocalcinosis/Medullary Sponge Kidney
Hypercalcemia
Hyperparathyroidism
Urinary tract infection
History of urinary calculi
Cortical nephrocalcinosis may be caused by
Benign Often found in men in their 60’s Stellate scar may be seen within mass Scar most easily seen on CT scan RCC also has scar Difficult to distinguish from RCC and surgical excision is often done
oncocytoma
renal cell carcinoma/ hypernephroma/adenocarcinoma of the kidney
Malignant renal masses
Smoking Hypertension Obesity Tuberous sclerosis von Hippel-Lindau disease Aquired renal cysts from long term dialysis
Malignant renal masses
Risk Factors
Anorexia Flank pain Gross hematuria Hypertension Palpable mass Weight loss
Malignant renal masses
Clinical Symptoms
Often found in the renal pelvis
May also be found in the ureter and bladder
Can cause obstruction due to location
Transitional cell carcinoma TCC
from the lungs or breast most common
prostate,pancreas and melanoma less frequently
RCC can also metastasize from the contralateral kidney
need to check invasion of tumor into the renal vein and IVC
metastases
