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SG F2 E5 > Kidney Cysts- MJ > Flashcards

Kidney Cysts- MJ Flashcards

1
Q

T/F: you can get renal cyst development in the following ways:

  • Genetic and non-genetic processes (autosomal dominant PKD)
  • Variety of childhood and adult diseases (Acquired renal cysts 2° to chronic renal failure)
A

True

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2
Q

What are the 5 ways renal cysts are categorized?

A
  • Size
  • Location
  • Spetations
  • Calcifications
  • Contents
  • Enhancement
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3
Q

65-70% of renal masses are what?

A

simple renal cyst

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4
Q

Simple renal cysts are frequently observed in normal kidneys. What age group is it least common to see these in and what group is it most common?

A
  • Least common: 15 to 29 years – 0% males & 0% females
  • Most common: >70 years – 32% males & 15% females
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5
Q

T/F: Simple renal cysts are the most common incidental finding

A

True

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6
Q

T/F: a patient that is found to have a simple renal cyst has a much higher risk of HTN, CA, CKD or ESRD

A

FALSE

Simple renal cysts have little clinical significance

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7
Q

Where do simple renal cysts develop?

Are they usually solitary or multiple?

Unilateral or bilateral?

A
  • Develop In the cortex of the medulla
  • Can be solitary or multiple, unilateral or bilateral- varies greatly in size and shape
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8
Q
  • Is obstruction, rupture, infection (renal abscess) and HTN caused by a simple renal cyst common or rare?
  • What would be the sxs of rupture of infection?
A

Rare

  • Sxs:
    • Rupture= flank pain, hematuria
    • Infection= fever, vague lumbo-abdominal pain, +/- hematuria/pyuria
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9
Q

What is the main goal for evaluating someone with a simple renal cyst? What is the first line diagnostic study for this?

A
  • Goal is to distinguish simple cysts from complex cysts
  • U/S is first line
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10
Q
A
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11
Q

What are the 3 ultrasound criteria for simple cysts?

A
  • Sharply demarcated w/ smooth thin walls
  • No echoes (anechoic) within the mass
  • Enhanced back wall indicating good transmission through the cyst
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12
Q

What are the 5 ultrasound characteristics of complex cysts?

A
  • Thick walls and/or septations
  • Calcifications
  • Solid components
  • Mixed echogenicity
  • Vascularity
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13
Q

Evaluation of Simple Renal Cyst:

If US is equivical or is consistent w/ complex cyst, what diagnostic study should be ordered next?

A

CT w/ and w/o contrast

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14
Q

Bosniak Classification of Renal Cysts: Which category?

  • CT features:
    • sharply demarcated w/ smooth thin wall
    • homogenous fluid
    • no contrast enhancement
  • Significance:
    • Simple cyst
    • benign
    • image in 6-12 mo
A

Category I

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15
Q

Bosniak Classification of Renal Cysts: Which category?

  • CT features:
    • Closely resemble simple cysts
    • Few thin septa
    • +/- few calcifications
    • < 3cm
    • well marginated
    • No enhancement
  • Significance:
    • Complex cyst
    • benign
    • image in 6-12mo
A

Category II

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16
Q

Bosniak Classification of Renal Cysts: Which category?

  • CT features:
    • Multiple thin septa
    • Walls may be thickened and may contain calcifications
    • > 3cm
  • Significance
    • Complex cyst
    • likely benign (5% malignant)
    • repeat imaging in 3-6mo
A

Category IIF

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17
Q

Bosniak Classification of Renal Cysts: Which category?

  • CT Features:
    • Indeterminate cystic masses
    • Thickened irregular walls or septa
    • measurable enhancement
  • Significance
    • complex cyst
    • 40-60% are malignant
    • monitor or excise
A

Category III

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18
Q

Bosniak Classification of Renal Cysts: Which category? What is the significance of this type of cyst?

  • CT features:
    • Indeterminate cystic masses
    • thickened irregular walls or septa
    • measurable enhancement
    • Soft-tissue enhancing
    • complonents adjacent to cyst wall
A

Category IV

significance: Complex cyst, 85-100% are malignant

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19
Q

What are the two major causes of acquired renal cysts? Which one is most common?

A
  1. Chronic Renal Failure (MC)
  2. Dialysis (incidence increases w/ duration)
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20
Q

What is the diagnostic criteria for acquired renal cysts? (3)

A
  1. Bilateral involvement
  2. > 4 cysts
  3. Diameter rangin from <0.5cm up to 2-3cm
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21
Q

In patients with acquired renal cysts, what size are the kidneys typically?

A

small to normal in size

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22
Q

Acquired Renal Cysts:

Are patients usually symptomatic or asymptomatic?

What is the clinical significance of these cysts?

A
  • Rarely symptomatic
  • Clinical significance= may increase RCC risk
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23
Q

When should you consider screening patients for acquired renal cysts? What should you screen with?

A
  • Yearly screening after being on dialysis for 3-5 years
  • US vs CT w/ and w/o contrast (depending on what initial study shows)
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24
Q

What is the treatment for simple/complex renal cysts?

A
  • Excision based on Bosniak Classification (usually not excised b/c benign)
  • Acetaminophen or NSAID (if nml kidney funct) if having acute/intermittent pain
25
Q

Simple/complex renal cysts:

How do you treat a patient with persistent pain and cysts > 5 cm?

A
  • Percutaneous aspiration w/ injection of sclerosing agent
  • Laparoscopic unroofing
26
Q

T/F: Autosomal Dominant Polycystic Kidney Disease (ADPKD) is often clinically silent

27
Q

What are the two genetic mutations that can cause ADPKD? Which one is more common and more aggressive?

A

PKD1 mutation- MC, more aggressive form

PKD2 mutation- Slow growth

29
Q

Is PKD inherited? If so, is it autosomal dominant or recessive?

A
  • FHx present in 75% of cases (5% due to spontaneous mutation)
  • Autosomal Dominant
30
Q

What does ADPKD cause?

A

Irreversible decline in renal function which begins in 4th decade

31
Q

ADPKD:

  • 50% of patients will have ESRD by age ____
  • Accounts for 10% of ______ patients in US
A
  • 50% of patients will have ESRD by age 60
  • Accounts for 10% of Dialysis patients in US
32
Q

What is the etiology of ADPKD?

A

PKD1/2 gene mutation → obstructed tubules → cyst formation (multiple w/ bilateral involvement) → fluid accumulation → significant kidney enlargement → separate from nephron → compress neighboring renal parenchyma → progressive compromise renal function (GFR)

33
Q

What is the initial presentation of ADPKD and at what age?

A
  • Age: 30s-40s
  • Presentation: abdominal/flank/back/chest pain
  • 50% will also have HTN
34
Q

What will be found on physical exam of a person with ADPKD?

A
  • 50% have HTN
  • Large palpable kidneys
35
Q

If you have a patient who comes in with a combination of HTN and abdominal mass, what is this indicative of?

36
Q

What 2 recurrent sxs can be an early indicator of ADPKD but is often overlooked?

A

Frequent UTIs

Recurrent nephrolithiasis

37
Q

What abx should a pt w/ ADPKD be receiving if they have a UTI?

A

quinolones

38
Q

_____% of patients with ADPKD have HTN by time of ESRD?

39
Q

What is the clinical presentation of ADPKD? (4)

A
  • HTN
  • Pain (vague w/ dull ache or localized w/ sharp pain)
  • Hematuria (usually microscopic, gross suggestshemorrhage)
  • Proteinuria (initially mild)
40
Q

What are the 5 diagnostic studies of ADPKD?

A
  1. US for screening and monitoring
  2. CBC
  3. CMP
  4. UA
  5. Genetic Screening
41
Q

What are 5 associated manifestations of ADPKD?

A

•Hepatic cysts 40 – 50% (estrogen sensitive)

  • Pancreatic/splenic cysts
  • Cerebral aneurysms 10 – 15%

•Mitral valve prolapse – up to 25%

•Colonic diverticula are more common

42
Q

How do you treat ADPKD?

A
  • No tx to halt disease progression or induce regression
  • HTN–> ACE/ARB, low Na diet/limit caffeine
  • Pain management
  • Avoid potentially nephrotoxic agents
  • Avoid contact sports
  • Manage complications (Infection, cyst hemorrhage, kidney stones)
43
Q

How do you tx ESRD caused by ADPKD?

A

Dialysis or kidney transplant

44
Q

Which disorder?

  • Congenital disorder- most sporadic w/o FHx but there is a rare autosomal dominant form
  • Asymptomatic​
  • Found incidentally
A

Medullary Sponge Kidney

45
Q

What 2 things is Medullary Sponge Kidney characterized by?

A
  1. Dilation of collecting tubules
    • 1 or more renal papillae
    • 1 or both kidneys
  2. Medullary cysts of variable size
46
Q

What are the 5 complications of Medullary Sponge Kidney?

A

•Nephrolithiasis

•UTI

•Hematuria

•Decreased urinary concentrating ability

•Renal insufficiency is rare

“DR. HUN”

47
Q

When is Medullary Sponge Kidney often diagnosed? How is it diagnosed?

A
  • 4th or 5th decade
  • Diagnosis
    • Intravenous pyelography (IVP)
    • Multidetector-row CT
48
Q

What do you see on Intravenous pyelography (IVP) in a patient with Medullary Sponge Kidney?

A

•“Brush” or linear striations, radiating outward from calyces

49
Q

How do you treat Medullary Sponge Kidney?

A
  • No known tx
  • Good hydration
  • Thiazide diuretic if hypercalciuria present
  • Abx for UTI
50
Q

What is the prognosis of Medullary Sponge Kidney? Is renal function typically maintained or not?

A
  • Excellent long-term prognosis
  • Renal function is typically well maintained (recurrent UTI/nephrolithiasis can lead to decline)
51
Q

How is Medullary Cystic Disease (Nephronophthisis) inherited?

A

Autosomal recessive

52
Q

In Medullary Cystic Disease (Nephronophthisis), progression usually occurs before what age?

53
Q

T/F: there is an infantile, juvenile and adolescent form of Medullary Cystic Disease (Nephronophthisis)?

54
Q

In Medullary Cystic Disease (Nephronophthisis), what appears after 9 years of age

A

chronic tubulointerstitial nephritis w/ renal cysts

55
Q

What are the characteristic findings of Medullary Cystic Disease (Nephronophthisis)? (3)

A
  • Reduced urinary concentrating ability
    • Bland urinary sediment
    • polyuria
    • polydipsia
56
Q

The following is used to diagnose what disease?

  • Suggested by clinical characteristics
  • Extrarenal manifestations
    • Retinitis pigmentosa
  • Confirmed by genetic testing
  • Ultrasound
    • Normal or slight decrease in kidney size for age
    • Increased echogenicity w/ loss of corticomedullary differentiation
A

Medullary Cystic Disease (Nephronophthisis

57
Q

What is an extrarenal manifestation of Medullary Cystic Disease (Nephronophthisis?

A

Retinitis pigmentosa

58
Q

What is seen on US in Medullary Cystic Disease (Nephronophthisis?

A

•Normal or slight decrease in kidney size for age

•Increased echogenicity w/ loss of corticomedullary differentiation

59
Q

What is the tx for Medullary Cystic Disease (Nephronophthisis)?

A
  • No specific treatment
  • Supportive care

SG F2 E5 (13 decks)

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