Kidneys: Part 3 (paulson) Flashcards
Cystic Kidney Disease=
Renal cysts made of epithelial cells from renal tubules and collecting ducts
Cystic Kidney Disease:
-list the 2 types of cysts
- Simple Cysts (most renal masses)
- Complex Cysts
Cystic Kidney Disease:
-MUST differentiate ______
Malignancy, Abscess, PKD, Benign
Describe simple cysts
Simple Cysts=Thin wall
WITHOUT septa, NO calcifications, & NO solid components
Cystic kidney disease: simple cysts
- demographic?
- Symptoms?
- Men > women
- Patients >50 more common
- Can see 1 cyst or multiple & bilateral
- Asymptomatic
Cystic kidney disease: simple cysts
-may be associated with ____
HTN
Cystic kidney disease: simple cysts
-If ruptures: _____ (which Sx occur?)
Hematuria, flank pain
Cystic kidney disease: simple cysts
-If they get infected:
Can form renal abscess
Cystic kidney disease: simple cysts
-diagnostic imaging?
Diagnosis: Ultrasound or CT
Cystic kidney disease: simple cysts
-diagnostic imaging?
Diagnosis: Ultrasound or CT
Cystic kidney disease: Complex cysts
-describe the components
May have septa, calcifications, or solid components
Cystic kidney disease: Complex cysts
-associated with increased risk of _________
malignancy
Cystic kidney disease: Complex cysts
-which classification system is used?
Bosniak Classification System used
the higher the #, the more concerning
Cystic kidney disease: Complex cysts
-diagnostic imaging?
Needs further imaging (CT with contrast)
Polycystic Kidney Disease (PKD)= inherited diseases that cause _____
renal cyst development and progressive renal failure from continued enlargement of cysts
Polycystic Kidney Disease (PKD):
-List the 2 known genetic mutations that cause autosomal dominant PKD
PKD1 & PKD2
Polycystic Kidney Disease (PKD):
___% get ESRD by age 60
50%
Polycystic Kidney Disease (PKD):
-what decade does renal function start to decline?
4th decade of life (in their 30s)**
-**Then declines 4-6 ml/min/year
PKD:
-List possible clinical presentation/Renal Manifestations
- Hypertension
- Hematuria
- Proteinuria
- Renal insufficiency found on labs
- Flank pain
- Nephrolithiasis–> Most uric acid stones, the rest calcium oxalate
- Renal Cell Carcinoma
PKD:
-what is the MC symptom reported by Pts? what is the cause?
**Flank pain= MC symptom reported by Pts–> From renal hemorrhage, calculi, or UTI
PKD: Extrarenal Manifestations
- Cerebral aneurysms
- Hepatic cysts
- Pancreatic cysts
- Cardiac valve disease
- Colonic diverticula
- Abdominal wall and inguinal hernia
PKD:
Describe the MC complications of Cerebral Aneurysms
- SAH or ICH most serious complication
- 5% (younger)-20% (>60 years) of patients
PKD: diagnosis
-imaging study MC used? and findings?
- 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
PKD:
-which diagnostic test is preferred in younger Pts (since US is less reliable in this age group)
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
