Lesson 10 - Renal Masses

Question 0

Clinical signs of Multicystic Dysplastic Kidney (MCDK)

Answer 0

• Newborns - palpable mass felt by clinician
• Asymptomatic if unilateral, incompatible with life if bilateral
• Male and female equally affected, as well as the side
• Adult pt often presents with HTN

Question 1

Etiology of Multicystic Dysplastic Kidney (MCDK)

Answer 1

• Nonhereditary!!!!
• 90% are associated with some form of urinary obstruction during embryogenesis
• Usually unilateral!!!!!! and involves whole kidney

Question 2

Sonographic appearance of Multicystic Dysplastic Kidney (MCDK)

Answer 2

• Kidney is small, malformed, and composed of multiple cysts with little if any kidney parenchyma
• Multiple, non communicating cysts
• Compensatory hypertrophy
• 30% have a contralateral UPJ obstruction

Question 3

DDx’s of Multicystic Dysplastic Kidneys (MCDK)

Answer 3

• Hydronephosis

- Parapelvic cysts

Question 4

4 types of Autosomal Recessive Polycystic Kidney Disease (ARPKD)

Answer 4

• Perinatal - more severe kidney disease
• Neonatal
• Infantile
• Juvenile - least severe kidney disease
• Bilateral disease!!!!!

Question 5

Clinical signs of Autosomal Recessive Polycystic Kidney Disease (ARPKD)

Answer 5

• Pt. will have palpable kidney
• Younger pt’s have kidney problems, older pt’s have liver problems. Older children present with portal hypertension (juvenile)

Question 6

Labs associated with Autosomal Recessive Polycystic Kidney Disease (ARPKD)

Answer 6

• Asymptomatic
• HTN
• Renal insufficiency
• Increased BUN/CR

Question 7

Sonographic appearance of autosomal recessive polycystic kidney disease (ARPKD)

Answer 7

• Bilaterally enlarged, echogenic kidneys

- Loss of normal corticomedullary junction

Question 8

Etiology of Autosomal Dominant Polycystic Kidney Disease (ADPKD)

Answer 8

• 1/2 of offspring will have ADPKD!!!!
• Most common hereditary kidney disease!!!!!
• Bilateral disease!!!!!
• 50% will have no family history

Question 9

Clinical signs of autosomal dominant polycystic kidney disease (ADPKD)

Answer 9

• Signs and symptoms usually don’t develop until the 4-5th decade of life (30s and 40s)
• HTN, palpable mass, pain, hematuria
• Renal failure occurs in 50% of pt’s by 60yo

Question 10

Complications of Autosomal Dominant Polycystic Kidney Disease (ADPKD)

Answer 10

• Infection
• Hemorrhage
• Stone formation
• Urinary obstruction

Question 11

Associated anomalies of autosomal dominant polycystic kidney disease

Answer 11

• Circle of Willis aneurysms
• Liver cysts (30-60%), pancreatic cysts (10%), splenic cysts (5-10%)
• Pt’s with ADPKD on dialysis are at increased risk for renal cell CA
• Increased incidence of renal calculi

Question 12

Etiology of Benign Infected Cyst

Answer 12

• Blood born bacteria that settles into the cyst

- Communication from the collecting system to the cyst and the cyst becomes infected

Question 13

Clinical signs of Benign Infected Cyst

Answer 13

• Fever
• Flank pain
• Hematuria (microscopic)

Question 14

Labs associated with Benign Infected Cysts

Answer 14

• Increased WBC

- Hematuria

Question 15

Sonographic appearance of Benign Infected Cyst

Answer 15

-Complex looking cyst, septations, and irregular borders

Question 16

Etiology of Benign Hemorrhagic Cyst

Answer 16

-Trauma to the flank area in a pt with a simple cyst

Question 17

Clinical sign of Hemorrhagic Cyst

Answer 17

• Flank pain
• Hematuria
• Pt’s with polycystic kidney dz or multicystic kidney dz are particularly at risk

Question 18

Sonographic appearance of hemorrhagic cyst

Answer 18

• Internal echoes may have fluid
• Thru transmission
• Hard to differentiate from a neoplasm