Renal cysts Flashcards
What are renal cysts?
Fluid filled sacs found in the kidney - are either simple or complex
Describe a simple renal cyst + its pathophysiology
Well-defined outline + homogeneous features
Thought to develop from renal tubule in repose to previous ischaemia
Describe a complex renal cyst + its pathophysiology
More complicated structure - thick walls, septations, calcifications on imaging
These have a risk of malignancy
What are some risk factors for renal cysts?
Increasing age Smoking Hypertension Male Genetic conditions - e.g. polycystic kidney disease
What is polycystic kidney disease?
Most commonly an autosomal dominant inherited condition - mutations in PKD1 or PKD2 cause multiple renal cysts to form.
What features other than renal cysts are often found in people with polycystic kidney disease?
Berry aneurysms - leading to subarachnoid haemorrhage
Mitral valve disease
Liver cysts
End stage renal disease
Diverticulosis
Pregnancy complications - e.g. preeclampsia
How does polycystic kidney disease present?
Often asymptomatic at younger ages. Flank pain Haematuria Hypertension Flank mass / feeling of fullness in the abdomen Kidney failure UTIs Kidney stones
How does someone with renal cysts present?
Normally found incidentally and are asymptomatic.
If symptomatic
- flank pain - if ruptured or infected
- haematuria
What is the main differential for a renal cyst?
Malignancy - renal cell carcinoma
How are renal cysts investigated?
CT or MRI imaging with IV contrast
Ultrasound is the imaging that often first picks up the presence of the cysts but will require the above after this.
Bloods - FBCs , U+ Es –> eGFR
How are renal cysts managed?
Asymptomatic simple - don’t normally require treatment
Symptomatic simple
- analgesia
- needle aspiration
Complex (depends on their complexity / staging)
- surveillance
- surgical intervention - consideration for nephrectomy
What are some complications of renal cysts?
Infection
Haemorrhage
Rupture
Complex cysts - risk of malignancy
What is the Bosniak scoring system used fir?
Classifying complexity of renal cysts + their associates risk of malignancy
