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Foundations of Clinical Practice II > Renal Cysts > Flashcards

Renal Cysts Flashcards

1
Q

Simple Renal Cysts

A
  • More common the older you get
  • Little clinical significance
  • clear to straw-colored fluid inside
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2
Q

Where do simple renal cysts develop?

A
  • cortex

- medulla

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3
Q

Ultrasound characteristics of simple cysts

A
  1. Sharply demarcated with smooth thin walls
  2. No echoes (no debris inside cyst)
  3. Enhanced back wall (good transmission through the cyst)
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4
Q

Ultrasound characteristics of complex cysts

A
  1. Thick walls +/- septations
  2. Calcifications
  3. Solid components
  4. Mixed echogenicity
  5. Vascularity (indicating malignancy)
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5
Q

What is the second test you would perform after an ultrasound

A

CT with and without contrast

do this if US is equivocal or consistent with a complex cyst

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6
Q

On the Bosniak Classification of Renal Cysts of I-IV, which are complex cysts?

A

II, IIF, III and IV are complex

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7
Q

On the Bosniak Classification of Renal Cysts of I-IV, which are simple cysts?

A

Category I

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8
Q

Which categories of the Bosniak Classification of Renal Cysts are associated with malignancy?

A

IIF, III, IV

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9
Q

Most common reason for acquired renal cysts

A

chronic renal failure (dialysis increases risk)

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10
Q

Acquired renal cysts: diagnostic criteria

A
  1. Bilateral
  2. > 4 cysts
  3. Diameter <0.5 - 3cm
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11
Q

How often does someone need to be screen for acquired renal cysts?

A

Yearly, if dialysis for 3-5 years

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12
Q

How do you screen for acquired renal cysts in dialysis patients?

A

Ultrasound**

or

CT w and without contrast

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13
Q

What is the treatment for acute pain in renal cysts?

A

acetaminophen** or NSAID (if normal kidney function)

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14
Q

What is the treatment for persistent pain or cysts >5cm?

A
  1. Percutaneous aspiration with injection of sclerosing agent (ex. Tetracycline)
  2. Laparoscopic unroofing
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15
Q

Pattern of heredity for adult polycystic kidney disease

A

Autosomal dominant

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16
Q

Which form of polycystic kidney disease is aggressive and more common?

A

PKD1

17
Q

Which form of polycystic kidney disease is the slow growth form and less common?

A

PKD2

18
Q

What percent of patients with polycystic kidney disease will have ESRD by age 60

A

50%

19
Q

Is polycystic kidney disease unilateral or bilateral?

A

bilateral

20
Q

Polycystic kidney disease etiology

A
  • Multiple cysts
  • Gradual cyst growth
  • Gradual loss of renal parenchyma
  • Significant kidney enlargement
  • Progressive decline in GFR
21
Q

Describe the pattern of kidney function/dysfunction in ADPKD

A

normal, hyperfiltration, impairment, failure

22
Q

ADPKD clinical presentation

A
  1. dull, achy pain (sharp with cyst rupture)
  2. HTN
  3. Large palpable kidneys
  4. Frequent UTIs or recurrent nephrolithiasis
  5. Hematuria (typically microscopic)
  6. Proteinuria (mild but progressive as disease worsens)
23
Q

What is the proper treatment for a patient with ADPKD presenting with UTI?

A

fluroquinolone

24
Q

What is the diagnostic study of choice for ADPKD?

A

US for screening and monitoring

CBC - anemia
CMP - GFR, cr, and BUN
UA - RBCs and protein
Genetic screening

25
Q

ADPKD associated manifestations? (5)

A
  1. Hepatic cysts (estrogen sensitive)
  2. Pancreatic or splenic cysts
  3. Mitral valve prolapse
  4. Colonic diverticula
  5. Cerebral aneurysms
26
Q

What is the treatment for ADPKD?

A
  • HTN (ACE or ARB)
  • Pain management
  • Avoid nephrotoxic agents
  • Avoid contact sports
  • Manage complications (ex. infection, cysts, kidney stones)
27
Q

Symptoms of Medullary Sponge kidney

A

asymptomatic

28
Q

When is medullary sponge kidney usually diagnosed?

A

congenital disorder, often found incidentally in the 40s or 50s

29
Q

What are the 2 characteristic findings in medullary sponge kidney?

A
  1. Dilation of the collecting tubules

2. Medullary cysts of variable size

30
Q

What is the most common complication of Medullary sponge kidney?

A

Decreased ability to concentrate urine (dilute urine!)

31
Q

What is the best way to diagnose medullary sponge kidney

A

CT (showing cystic dilated distal collecting tubules)

32
Q

Medullary Sponge Kidney: Tx

A
  • Stay hydrated

- Thiazide diuretic (ex. HCTZ) if hypercalciuria to help keep calcium in the body

33
Q

Medullary Cystic Disease: inheritance

A

Autosomal recessive

34
Q

Medullary Cystic Disease: Characteristic findings

A
  1. Reduced urinary concentrating ability
    - Bland urinary sediment
    * *, polyuria, polydipsia
  2. Chronic tubulointerstitial nephritis with renal cysts appearing after 9 years of age
35
Q

Medullary Cystic Disease: extrarenal manifestation

A

-Retinitis pigmentosa (can lead to blindness)**

36
Q

Medullary Cystic Disease: ultrasound (3)

A
  • Normal or slightly decreased kidney size
  • Increased echogenicity
  • loss of corticomedullary differentiation**

Foundations of Clinical Practice II (25 decks)

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