Nephro - Cysts and cancer - Online MedEd

Question 1

Cysts can be divided into

Answer 1

Simple and complex

Question 2

Simples cysts in kidney - what do they mean?

Answer 2

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

Question 3

Complex cysts in kidney - what do they mean?

Answer 3

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

Question 4

Complex cyst can present as..

Answer 4

Pain
Pyelo
Rupture and bleed - hematuria
Mass

Question 5

Diagnostic workup of complex cyst

Answer 5

U/A
CT scan
US for pregnant
Make dx: do Bx

Question 6

Treatment of complex cyst

Answer 6

Resection usually
If abscess, drain
Malignancy, resect, radiation

Question 7

Renal cell carcinoma - presents like complex cyst… except

Answer 7

Classic triad of RCC: flank pain, flank mass, hematuria

Question 8

What to do for RCC?

Answer 8

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

Question 9

Cancer might have __ Hgb

Answer 9

Low Hgb because cancer steals the Hgb

Question 10

EPO producing tumour might result in what Hgb

Answer 10

High Hgb - polycythemia

Question 11

RCC spreads by what route

Answer 11

Hematogenous

Might find a piece in renal vein or IVC

Question 12

Autosomal dominant polycystic kidney disease - presentation

Answer 12

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

Question 13

Autosomal recessive polycystic kidney disease - who does this occur?

Answer 13

Newborns

Question 14

Autosomal recessive polycystic kidney disease - presentation

Answer 14

In babies - anuric, oligo (not producing urine so little amniotic fluid), might see hydro no US in prenatal
Palpable flank masses bilateral

Question 15

Autosomal recessive polycystic kidney disease - what to do?

Answer 15

US
Bx - radially oriented cysts
Supportive treatment and transplant! Might not be large enough to accept kidney

Question 16

Diagnosis of autosomal dominant polycystic kidney disease

Answer 16

CT scan/US

Biopsy

Question 17

Treatment of autosomal dominant polycystic kidney disease

Answer 17

Treatment - supportive, prevent renal disease (keep BP low)
ACEi/ARBs for proteinuria
Eventually go on dialysis
Can be transplanted

Question 18

In adults with autosomal dominant PKD… where else can they get cysts?

Answer 18

Liver (hepatitis) and pancreas (pancreatitis)

Question 19

What is an important risk factor of autosomal dominant PKD?

Answer 19

Risk of subarachnoid aneurysms (berry aneurysms) - need MRA/CTA/need to be clipped and coiled!!!
-Need to check for this!