Paulson - Kidneys 103 Flashcards
renal cysts made of epithelial cells from renal tubules and collecting ducts
cystic kidney dz
2 types of cystic kidney dz
simple cysts
complex cysts
mc type of cystic kidney dz
simple cysts
w. cystic kidney dz, you must differentiate btw (4)
malignancy
abscess
pkd
benign
characteristics of simple cysts
think wall without septa, calcifications, or solid components
simple cysts are mc in __
and pt’s older than __,
and are usually
men
50 yo
asymptomatic
comorbidity possibly associated w. simple cysts
htn
sx of ruptured simple cyst (2)
hematuria
flank pain
complication of infected simple cyst
renal abscess
diagnostic test for simple cyst (2)
US
CT
characteristics of complex cysts
+/- septa, calcifications, or solid components
complex cysts are associated w. increased risk for
malignancy
what classification system is used for complex cysts
bosniak
imaging for complex cysts
CT w. contrast
inherited dz’s that cause renal cyst development and progressive renal faiure from continued enlargement of cysts
polycystic kidney dz (pkd)
2 genetic mutations associated w. pkd
pkd 1
pkd 2
50% of pkd pt’s get __ by age 60
esrd
when does renal fxn begin to decline
4th decade of life → continues to decline 4-6 ml/min/year
major sx of pkd
htn
other possible sx of pkd (6)
hematuria
proteinuria
renal insufficiency on labs
flank pain
nephrolithiasis
renal cell carcinoma
mc sx of pkd reported by pt’s
flank pain
what causes flank pain in pkd (3)
renal hemorrhage
calculi
UTI
2 mc types of renal stones associated w. pkd
uric acid
calcium oxalate
extrarenal sx of pkd
cerebral aneurysms
hepatic cysts
pancreatic cysts
cardiac valve dz
colonic diverticula
abd wall and inguinal hernia
most serious complication of pkd
SAH or ICH
mc dx imaging for pkd
US
most sensitive imaging for pkd (2)
CT
MRI
US findings of pkd
large kidneys
extensive bilateral cysts
indication for screening for pkd
positive fh
screening for pkd recommended for younger pt’s
genetic testing
genetic type of pkd
autosomal dominant polycystic kidney dz (adpkd)
tx for adpkd (3)
rigorous control of bp
dietary Na restriction
statin
which tx for adpkd prevents progression of renal dz and decreases risk of CV mortality
rigorous control of bp
initial bp control med for adpkd
ACEI
t/f: adpkd is considered coronary heart dz risk equivalent in terms of statin recs
T!
what class of drug is tolvapatan (samsca)
vasopressor
indications for tolvapatan (samsca) in pkd
18-55 yo
GFR >25
high risk for progression to esrd
how are tolvapatan indications established (2)
total kidney volume (tkv)
CT or MRI
what drug is dz modifying for pkd and slows progression
tolvapatan (samsca)
pt ed for tolvapatan (samsca)
adequate PO water intake
contraindications for tolvapatan (samsca) (3)
liver failure
hypovolemia
hypernatremia
s.e of tolvapatan (samsca) (5)
liver toxicity → increasted LFTs
polyuria
polydipsia
cp
ha
non pharm tx for pkd
increased fluid intake → 3L/day
dialysis
kidney transplant
pain mangament → surgical aspiration
how does increased fluid intake inhibit cyst growth
suppresses ADH levels
mc cause of death in pkd pt’s
cardiac
other: neurologic from ruptured intracranial aneurysm/hemorrhage
