Renal Cysts Flashcards

1
Q

What are age related reasons for developing renal cysts

A

Adults: genetic (PKD) or non-genetic

Kids and adults: chronic renal failure leading to acquired renal cysts

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2
Q

What are simple renal cysts

A

round/oval cysts w/ ONE epithelial layer lining, filled with clear or straw colored fluid
in cortex or medulla

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3
Q

Are simple renal cysts dangerous

A

Not really, no risk for HTN, cancer, CKD, or ESRD

Incidental findings

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4
Q

Simple renal cysts rarely (but still might) cause

A

Obstruction of calyxes or renal pelvis
Rupture (Sx: flank pain, hemturia)
Infection (Sx: fever, lumbar/abd pain, hematuria, pyuria)
HTN (d/t compression of a&v in renal parenchyma)

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5
Q

How do you treat hypertension caused by simple renal cysts

A

ACE/ARB

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6
Q

On US, what do Simple renal cysts look like compared to complex renal cysts

A

Simple: sharply demarcated, smooth thin walls, no echoes/debris, enhanced back wall (good transmission)
Complex: thick walls, septations, calcifications, solid parts, mixed echogenicity, vascularity

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7
Q

What if you get an US and it is shady?

A

Get a CT with and without to further eval the cyst

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8
Q

What do we need to know about Bosniak categories

A

IIF: >3cm, thick walls, calcifications— likely benign, repeat imaging in 3-6 mo
III: masses, enhancement— high change malignancy, monitor or excise
IV: masses and soft tissue enhancement next to cyst wall– very high malignancy

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9
Q

Describe acquired renal cysts

A

Bilateral, 4+ cysts, due to chronic renal failure
kidneys are small-normal size
rarely symptomatic

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10
Q

When should you screen for acquired renal cysts

A

yearly after being on dialysis 3-5 yrs.

Use US vs CT with and without

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11
Q

Acquired renal cysts have a small chance of

A

increase in Renal cell carcinoma risk

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12
Q

How do you treat a simple/complex renal cyst

A

based on Bosniak!
Pain? APAP (or NSAID if they have normal renal fxn)
Persistent pain/ cyst >5cm? percutaneous aspiration w/ injection of sclerosing agent (tetracycline)// OR laparoscopic unroofing

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13
Q

What is Autosomal Dominant PKD

A

hereditary PKD due to PKD1/2 mutation, often clinically silent

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14
Q

How are PKD 1/2 different

A

PKD1: aggressive form
PKD2 slow growth
(most are due to family history, only 5% spontaneous)

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15
Q

ADPKD leads to

A

irreversible decrease in renal function (in 40’s)
-GFR decreases 4.4-5.9 every year
1/2 pts have ESRD by 60 y/o

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16
Q

What is the pathology of ADPKD

A

gene mutation= obstructed tubules= cysts= parenchyma compression= decrease in renal function

17
Q

What is the etiology of ADPKD

A

Bilateral cysts that cause gradual loss of renal parenchyma, significant renal enlargement (up to 4000g), and a decrease in GFR

18
Q

When does ADPKD present and how (Sx)

A

30-40 y/o
abd pain, flank pain, back pain, chest pain
frequent UTI’s
+/- hematuria, pyuria

19
Q

What is your RED FLAG symptom of ADPKD

A

Hypertension and palpable kidneys!!!

20
Q

How do you treat the recurrent UTI’s associated with ADPKD

A

Quinolones (Ciprofloxacin)

21
Q

What does ADPKD screening include

A

US (CT/MRI only if US is inconclusive)

CBC, CMP, UA, genetic screen for diagnosis

22
Q

What manifestations are associated with ADPKD

A
Hepatic cysts (estrogen sensitive) 
Pancreatic/splenic cysts 
aneurysm 
MVP
colonic diverticuli
23
Q

How do you treat ADPKD

A

Nothing definitive, only symptomatic Tx
HTN: ACE/ARB, decrease Na and caffeine
Pain manage, avoid nephrotoxic agents, avoid contact sports
ESRD: dialysis or transplant

24
Q

What is Medullary Sponge kidney

A

usually a sporadic congenital disorder (rarely FHx) that is asymptomatic
Leads to collecting tubule dilation and medullary cysts

25
What are complications of medullary sponge kidney
Nephrolithiasis UTI Hematuria Decreased urine concentration
26
How do you diagnose medullary sponge kidney
CT (shows cystic dilation of distal collecting tubule) | usually in 40-50 y/o
27
How do you treat medullary sponge kidney
good hydration If hypercalcemic, thiazide diuretic *Renal function is usually maintained
28
What is medullary cystic disease
Autosomal Recessive disease due to multiple gene mutations causes ESRD before 20 y/o varies based on age of onset (infantile, juvenile, or adolescent)
29
What are findings consistent with medullary cystic disease
Decreased urine concentrating ability (bland urine, polyuria, polydipsia) tubulointerstitial nephritis with cysts developing after 9 years old
30
How do you diagnose medullary cystic disease
Clinical characteristics (polyuria/dipsia) retinitis pigmentosa (blindness) *confirm with genetic testing* US shows mild decrease in kidney size, increased echogenicity, and no corticomedullary differentiation
31
How do you treat medullary cystic disease
Supportive care :(