Nephro - Cysts and cancer - Online MedEd Flashcards
Cysts can be divided into
Simple and complex
Simples cysts in kidney - what do they mean?
Meaningless Asymptomatic Usually find due to incidental -Small, no loculations, no septations -Just a balloon filled with fluid -Do nothing -Treat none of these -Incidence increases with age
Complex cysts in kidney - what do they mean?
Larger, will have loculations and septations, not homogeneous, multiple pockets
- Decide - is this likely to be cancer
- Often come up as flank mass on test, usually found incidental
Complex cyst can present as..
Pain
Pyelo
Rupture and bleed - hematuria
Mass
Diagnostic workup of complex cyst
U/A
CT scan
US for pregnant
Make dx: do Bx
Treatment of complex cyst
Resection usually
If abscess, drain
Malignancy, resect, radiation
Renal cell carcinoma - presents like complex cyst… except
Classic triad of RCC: flank pain, flank mass, hematuria
What to do for RCC?
CT or US
Do not Bx if think RCC
Instead do a resection (partial/radical nephrectomy)
-Bx - will have risk of hematoma and seeding of cancer! So the nephrectomy acts as Bx
-So need to do CT to determine likelihood of cancer
Cancer might have __ Hgb
Low Hgb because cancer steals the Hgb
EPO producing tumour might result in what Hgb
High Hgb - polycythemia
RCC spreads by what route
Hematogenous
Might find a piece in renal vein or IVC
Autosomal dominant polycystic kidney disease - presentation
Adults
Patient present asymptomatic who gets HTN and ESRD
Possible that cysts are palpable (flank mass)
Cysts can get infected and pyelo, hematuria
-Born with normal kidneys; get more cysts with age (cysts replace kidney parenchyma), worsening Cr
Autosomal recessive polycystic kidney disease - who does this occur?
Newborns
Autosomal recessive polycystic kidney disease - presentation
In babies - anuric, oligo (not producing urine so little amniotic fluid), might see hydro no US in prenatal
Palpable flank masses bilateral
Autosomal recessive polycystic kidney disease - what to do?
US
Bx - radially oriented cysts
Supportive treatment and transplant! Might not be large enough to accept kidney
Diagnosis of autosomal dominant polycystic kidney disease
CT scan/US
Biopsy
Treatment of autosomal dominant polycystic kidney disease
Treatment - supportive, prevent renal disease (keep BP low)
ACEi/ARBs for proteinuria
Eventually go on dialysis
Can be transplanted
In adults with autosomal dominant PKD… where else can they get cysts?
Liver (hepatitis) and pancreas (pancreatitis)
What is an important risk factor of autosomal dominant PKD?
Risk of subarachnoid aneurysms (berry aneurysms) - need MRA/CTA/need to be clipped and coiled!!!
-Need to check for this!
