Kidneys: Part 3 (paulson) Flashcards by Sammy B

Q

Cystic Kidney Disease=

A

Renal cysts made of epithelial cells from renal tubules and collecting ducts

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Q

Cystic Kidney Disease:

-list the 2 types of cysts

A

Simple Cysts (most renal masses)

- Complex Cysts

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Q

Cystic Kidney Disease:

-MUST differentiate ______

A

Malignancy, Abscess, PKD, Benign

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Q

Describe simple cysts

A

Simple Cysts=Thin wall

WITHOUT septa, NO calcifications, & NO solid components

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Q

Cystic kidney disease: simple cysts

demographic?
Symptoms?

A

Men > women
Patients >50 more common
Can see 1 cyst or multiple & bilateral
Asymptomatic

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Q

Cystic kidney disease: simple cysts

-may be associated with ____

A

HTN

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Q

Cystic kidney disease: simple cysts

-If ruptures: _____ (which Sx occur?)

A

Hematuria, flank pain

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Q

Cystic kidney disease: simple cysts

-If they get infected:

A

Can form renal abscess

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Q

Cystic kidney disease: simple cysts

-diagnostic imaging?

A

Diagnosis: Ultrasound or CT

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Q

Cystic kidney disease: simple cysts

-diagnostic imaging?

A

Diagnosis: Ultrasound or CT

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Q

Cystic kidney disease: Complex cysts

-describe the components

A

May have septa, calcifications, or solid components

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Q

Cystic kidney disease: Complex cysts

-associated with increased risk of _________

A

malignancy

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Q

Cystic kidney disease: Complex cysts

-which classification system is used?

A

Bosniak Classification System used

the higher the #, the more concerning

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Q

Cystic kidney disease: Complex cysts

-diagnostic imaging?

A

Needs further imaging (CT with contrast)

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Q

Polycystic Kidney Disease (PKD)= inherited diseases that cause _____

A

renal cyst development and progressive renal failure from continued enlargement of cysts

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Q

Polycystic Kidney Disease (PKD):

-List the 2 known genetic mutations that cause autosomal dominant PKD

A

PKD1 & PKD2

Q

Polycystic Kidney Disease (PKD):

___% get ESRD by age 60

A

50%

Q

Polycystic Kidney Disease (PKD):

-what decade does renal function start to decline?

A

4th decade of life (in their 30s)**

-**Then declines 4-6 ml/min/year

Q

PKD:

-List possible clinical presentation/Renal Manifestations

A

Hypertension
Hematuria
Proteinuria
Renal insufficiency found on labs
Flank pain
Nephrolithiasis–> Most uric acid stones, the rest calcium oxalate
Renal Cell Carcinoma

Q

PKD:

-what is the MC symptom reported by Pts? what is the cause?

A

**Flank pain= MC symptom reported by Pts–> From renal hemorrhage, calculi, or UTI

Q

PKD: Extrarenal Manifestations

A

Cerebral aneurysms
Hepatic cysts
Pancreatic cysts
Cardiac valve disease
Colonic diverticula
Abdominal wall and inguinal hernia

Q

PKD:

Describe the MC complications of Cerebral Aneurysms

A

SAH or ICH most serious complication

- 5% (younger)-20% (>60 years) of patients

Q

PKD: diagnosis

-imaging study MC used? and findings?

A

Ultrasound MC used
-Large kidneys and extensive bilateral cysts
-Recommended for screening of those with positive FH
-Less reliable in younger patients

-**CT & MRI more sensitive

Q

PKD:

-which diagnostic test is preferred in younger Pts (since US is less reliable in this age group)

A

genetic testing

Autosomal Dominant Polycystic Kidney Disease (ADPKD): tx?

- HTN: Rigorous control of BP - Dietary Sodium Restriction (<2 grams per day) - Statin therapy - +/- Tolvaptan (Samsca)

ADPKD: tx - why is rigorous control of BP (HTN) so important? - initial agent should be ____

- **Prevents progression of renal disease and ↓risk of CV mortality - **ACEI should be initial agent

PKD: tx | -describe statin therapy

- Treat HLD aggressively with statins - Considered a coronary heart disease risk equivalent - Statins may (?) help to preserve renal function

PKD: tx - When should Tolvaptan (Samsca) be initiated? - Medication fx?

- **For those 18-55 with a GFR >25 at high risk for progression to ESRD--> Selection of patients by TKV (total kidney volume), CT, or MRI - Slows progression of PKD--> Disease-modifying - Need to ensure adequate PO water intake (notes: Pts with high risk for progressing to ESRD (end stage renal disease) will get this Medication--> Tolvaptan (Samsca)-– this is a very specialized medication)

Tolvaptan (Samsca): | -contraindicated in which Pt population?

-Contraindicated in: liver failure, hypovolemia, hypernatremia

Tolvaptan (Samsca): | -S/E?

↑ LFTs/liver toxicity, polyuria, polydipsia, chest pain, headache

PKD: | -other forms of treatment?

- Increased fluid intake - -Suppresses ADH levels--> inhibits cyst growth - -3 liters/day - Dialysis - Kidney transplant - Pain management--> Surgical aspiration or sclerosis of cysts

PKD: prognosis | -most Pts die from _____

- Most patients die from cardiac causes | - Neurologic deaths from ruptured intracranial aneurysm & hypertensive intracerebral hemorrhage