Renal cysts Flashcards
1
Q
What are renal cysts?
A
Fluid filled sacs within the kidney
Can be simple or complex
2
Q
Simple cysts
A
- Well defined outline
- Homogenous features
- Very common in older patients
- Develop from renal tubule epithelium in response to previous ischaemia - but still not fully understood
3
Q
Complex cysts
A
- Complex structure - thick walls, septations, calcifications, heterogenous enhancement
- Classified using Bosniak classifcation
- All complex cysts have risk of malignancy - increases with increasing complexity
4
Q
RF for renal cysts
A
- Increasing age
- Smoking
- Hypertension
- Male
- Genetic - PCKD, tuberous sclerosis, Von Hippel-Lindau
5
Q
Mutation for PCKD
A
- Autosomal dominant
- Mutations in PKD1 or PKD2 = multiple renal cysts
6
Q
What is PCKD associated with?
A
- Berry aneurysms - leading to SAH
- Mitral valve disease - prolapse
- Liver cysts
- Eventually develop ESRF and need dialysis or transplant
7
Q
What is autosomal recessive PCKD?
A
Rarer condition
Inherited
Diagnosed in utero
60% neonates not survive first month of life
8
Q
Symptoms of renal cysts
A
- Found incidentally on imaging usually - asymptomatic OR
- Flank pain - if ruptures or becomes infected
- Haematuria
9
Q
Signs of renal cysts - exam
A
- Uncontrolled HTN
- Flank mass
10
Q
Imaging for renal cysts
A
- CT or MRI with pre and post IV contrast scans
- Bosniak scoring can then be used
- USS - will require CT or MRI
11
Q
Bedside and bloods for ?renal cysts
A
- U&E - ensure no impact on renal function
- Monitor these regularly if genetic risk for cyst formation
12
Q
CT vs MRI for renal cysts
A
- MRI more sensitive and specific for Bosniak IIF-IV
- Should also be initial choice in young or patients where exposure to radiation is concern
13
Q
Bosniak scoring and f/u
A
- Scored I-IV
- I is simple cyst, all others are complex
- I and II have no f/u
- IIF has CT scan at 3,6 and 12 months
- III has surviellance or surgery
- IV has surgery
14
Q
Management renal cysts
A
- Asymptomatic - usually no f/u or treatment
- Symptomatic simple - analgesia, needle aspiration or cyst deroofing if impacting patient
- Complex - managed depending on Bosniak stage so surveillance or surgery inc nephrectomy
15
Q
What is cyst deroofing?
A
- Laparascopically
- Aspirate cyst and excise part of wall to discourage cyst recurrence
