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Foundations II- Nephrology > Renal Cysts > Flashcards

Renal Cysts Flashcards

1
Q

How can cysts develop?

A

genetic and non genetic processes

variety of childhood and adulthood diseases

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2
Q

How are cysts categorized?

A 
Size
Location
Septations
Calcifications
Contents
Enhancement
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3
Q

How common are simple renal cysts?

A

65-70% of all renal masses

freq. seen in normal kidneys

MC incidental findings

M >W

little clinical significance

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4
Q

Is there a risk of HTN with simple renal cysts?

A

rarely but not really

no risk of: CA, CKD, or ESRD

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5
Q

Describe simple renal cysts

A

develop in the cortex and medulla

Solitary or multiple  / unilateral or bilateral
< 1 cm to > 10 cm
Round or oval
Lining is single epithelial layer
Fluid filled
Clear to straw-colored fluid
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6
Q

Clinical manifestations of simple renal cysts?

A

usually NONE

obstruction of calyxes or renal pelvis is rare, rupture is rare, inf. rare, HTN rare

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7
Q

What happens when a simple renal cyst does become infected?

A

presents as renal abscess

  • insidious fever
  • vague lumbo-abd pain
  • +/- hematuria or pyuria
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8
Q

What do simple renal cysts look like on US?

A

Sharply demarcated w/ smooth thin walls

No echoes (anechoic) within the mass

Enhanced back wall indicating good transmission through the cyst

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9
Q

What do complex cysts look like on US?

A

Thick walls and/or septations

Calcifications

Solid components

Mixed echogenicity

Vascularity

~Associated with malignancy!

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10
Q

What should you do if US is concerning or consistent with complex cyst?

A

order CT w/ and w/out contrast

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11
Q

FU for simple cyst?

A

repeat imagining in 6-12 months

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12
Q

FU for complex renal cysts?

A

follow up more closely, repeat imaging

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13
Q

What is the MC reason for acquired renal cysts?

A

chronic renal failure

-dialysis pts

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14
Q

Dx criteria for acquired renal cysts?

A

Bilateral involvement

> 4 cysts

Diameter range <0.5 cm up to 2 – 3 cm

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15
Q

Describe acquired renal cysts?

A

can be simple or complex

kidneys are small/norm size

rarely sxs

clinical sig: may increase risk of RCC

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16
Q

When should you screen for acquired renal cysts?

A

yearly screening after being on dialysis for 3-5 yrs

US > CT w and w/out contrast

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17
Q

Tx for renal cysts?

A

excision based on Bosniak classification

Acute/intermittent pain > Acetaminophen or NSAIDS if normal kidney func.

Persistent pain, usually with large cyst: percutaneous aspiration w/ injection of sclerosing agent or laparoscopic unroofing

18
Q

Epidemiology of Autosomal Dominant Polycystic kidney Disease (ADPKD)

A

Autosomal Dominant

but variable penetrance > disease is often clinical silent

19
Q

ADPKD results in a…

A

irreversible decline in renal func.

usually starts in 4th decade of life

50% will have ESRD by 60

20
Q

Etiology of ADPKD?

A

PKD1/2 gene mutation → obstructed tubules →
cyst formation →
fluid accumulation → enlargement →
separate from nephron → compress neighboring renal parenchyma →
progressive compromise renal function

21
Q

Describe ADPKD

A

multiple cysts with bi involvement

gradual cyst growth

gradual loss of renal parenchyma

sig. kidney enlargement > progressive decline in renal func.

22
Q

In ADPKD GFR will be maintained until around age? Why is this?

A

30 y/o

hyperfiltration

23
Q

What are some sxs associated with ADPKD

A

urinary concentrating defects

HTN

dull pain and discomfort

proteinuria

24
Q

clinical presentation of ADPKD?

A

30-40s

pain: abd, flank, back, chest

50% w/ HTN (100% by ESRD)

large palpable kidneys on PE

freq. UTIS or recurrent nephrolithiasis can be early indicator

hematuria-typically microscopic

proteinuria initially mild

25
Q

What are the abx of choice for UTI in pts with ADPKD?

A

quinolones

26
Q

Dx studies for ADPKD?

A

US for screening and monitoring

CBC, CMP, UA, genetic screening

27
Q

What are some associated manifestations in pts with ADPKD?

A

hepatic cysts (Estrogen sensitive)

Pancreatic and/or splenic cysts

cerebral aneurysm

MVP

colonic diverticula are more common

~All assoc. with gene mutation

28
Q

Tx for ADPKD?

A

No definitive tx

Manage HTN: ACE or ARB, low salt diet, limit caffeine

Pain management

Avoid nephrotoxic agents i.e. IV contrast

Manage comps

ESRD- dialysis of kidney transplant

29
Q

What is medullary sponge kidney ?

A

congenital disorder

most sporadic

usually asxs

often found incidentally

30
Q

Path of medullary sponge kidney?

A

Dilation of collecting tubules:

  • 1 or more renal papillae
  • 1 or both kidneys

Medullary cysts of variable size

31
Q

Comps of medullary sponge kidney?

A

Nephrolithiasis

UTI

Hematuria

Decreased urinary concentrating ability but renal insufficiency is rare

32
Q

When is medullary sponge kidney usually dx? How?

A

usually not until 4th or 5th decade

CT >Cystic dilated of the distal collecting tubules

33
Q

Tx for medullary sponge kidney?

A

No known therapy

Good hydration

Thiazide diuretic if hypercalciuria is present

Renal function is typically well maintained

34
Q

What can cause decline in renal func in pt with medullary sponge kidney?

A

recurrent UTIs or nephrolithiasis

35
Q

Transmission of medullary cystic disease?

A

Autosomal recessive- mutations in a number of genes

36
Q

What are the clinical variants of medullary cystic disease?

A

infantile, juvenile and adolescent forms

progression to ESRD usually by 20 y/o

37
Q

Characterisitics findings of medullary cystic disease?

A

Reduced urinary concentrating ability
-Bland urinary sediment, polyuria, polydipsia

Chronic tubulointerstitial nephritis w/ renal cysts appearing after 9 years of age

38
Q

Dx of medullary cystic disease?

A

suggested by clinical characteristics

Confirmed by genetic testing

Ultrasound: Normal or slightly decrease in kidney size for age, increased echogenicity w/ loss of corticomedullary differentiation

39
Q

What are some extrarenal manifestations of medullary cystic disease?

A

Retinitis pigmentosa

40
Q

Tx for medullary cystic disease?

A

supportive care

no specific tx

Foundations II- Nephrology (7 decks)

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