Kidneys Pt 3

Question 1

What is Cystic Kidney disease? What must you differentitate?

Answer 1

Renal cysts made of epithelial cells from renal tubules

Two types - simple cysts (most renal masses) or complex cysts

Must differentitate from malignancy, abscess, PKD, Benign

Question 2

What are simple cysts? How do you diagnose them?

Answer 2

These are thin walled without septa, calcifications, or solid components)

Diagnosis: Ultrasound or CT

Question 3

What symptoms do people have from simple cysts?

Answer 3

Asymptomatic, but can be associated with HTN

If ruptures: Hematuria, flank pain is common

If infected - Can form renal abscess

Question 4

Simple cysts are more common in?

Answer 4

Men>women

Patients >50 more common

Question 5

What are complex cysts? How do you diagnose them?

Answer 5

These are cysts that may have septa, calcifications, or solid components

Needs further imaging - CT with contrast

Question 6

Complex cysts are associated with? What classification system is used?

Answer 6

Associated with increased risk of malignancy,

Bosniak classification system is used.

Question 7

What is polycystic kidney disease? (PKD) What causes it?

Answer 7

Inherited diseases that cause renal cyst development and progrssive renal failure from continued enlargement of cysts.

Inherited genes - 2 genetic mutations cause autosomal dominant PKD: PKD1 & PKD2

Question 8

People with PKD see renal function starting to decline by? By age 60 what do 50% of people have?

Answer 8

Renal function starts to decline in the 4th decade of life - 30s

Then declines 4-6 ml/min/year

By age 60 50% get ESRD

Question 9

What are possible clinical presentations/renal manifestations of PKD?

Answer 9

Hypertension - Majority have htn on presentation

Hematuria
Proteinuria

Renal insufficiency found on labs

Flank pain most common symptom reported by patients - renal hemorrhage, calculi, or UTI

Nephrolithiaiss - most uric acid stones, rest calcium oxalate

Renal cell carcinoma

Question 10

What are extrarenal manifestations of PKD?

Answer 10

Cerebral aneuryssms - SAH or ICH most serious complication, 5% (younger) - 20% (>60 years) of patients

Hepatic cysts

Pancreatic cysts

Cardiac valve disease

colonic diverticula

abdominal wall and inguinal hernia

Question 11

How do you diagnose PKD? Most commonly used? Most sensitive?

Answer 11

Ultrasound most commonly used

Large kidneys and extensive bilaterial cysts,

Recommended to screen for those with positive FH - genetic screening more reliable than ultrasound in younger patients.

CT & MRI most sensitive

Question 12

What do you use to treat HTN in PKD?

Answer 12

• HTN: rigorous control of BP -
  
  • Prevents progression of renal disease and decreases CV risk mortality
  • ACEi should be initial agent
• Dietary sodium restriction - <2grams per day
• Statin
  
  • Treat HLD aggressively with statins
  • Considereded a coronary heart disease risk equivalent
  • May help preserve renal fxn?

Question 13

What is a disease modifiying drug that is used for those 18-55 with a GFR >25 at high risk for progression to ESRD?

Answer 13

Tolvaptan (samsca)

Selection of patients by total kidney volume, CT, or MRI

Question 14

When taking Tolvaptan (Samsca) what do you need to ensure? What is it contraindicated in?

Answer 14

Need to ensure adequate PO water intake

Contraindicated in: liver failure, hypovolemia, hypernatremia

S/e: Increase LFTs/liver toxicitiy, polyuria, polydipsia, chest pain, headache

Question 15

How much fluid intake should be given to patietnts with PKD?

Answer 15

3 liters/day

Suppresses ADH levels –> inhibits cyst growth

Question 16

What is endstage treatment for CKD?

Answer 16

Dialysis, kidney transplant, pain management (surgical aspiration or sclerosis of cysts)

Question 17

Prognosis of PKD?

Answer 17

Most patients die from cardiac causes

Neurologic deaths from ruptured intracranial aneurysm and hypertensive intracerebral hemorrhage.