Kidney Cysts- MJ Flashcards
(59 cards)
1
Q
T/F: you can get renal cyst development in the following ways:
- Genetic and non-genetic processes (autosomal dominant PKD)
- Variety of childhood and adult diseases (Acquired renal cysts 2° to chronic renal failure)
A
True
2
Q
What are the 5 ways renal cysts are categorized?
A
- Size
- Location
- Spetations
- Calcifications
- Contents
- Enhancement
3
Q
65-70% of renal masses are what?
A
simple renal cyst
4
Q
Simple renal cysts are frequently observed in normal kidneys. What age group is it least common to see these in and what group is it most common?
A
- Least common: 15 to 29 years – 0% males & 0% females
- Most common: >70 years – 32% males & 15% females
5
Q
T/F: Simple renal cysts are the most common incidental finding
A
True
6
Q
T/F: a patient that is found to have a simple renal cyst has a much higher risk of HTN, CA, CKD or ESRD
A
FALSE
Simple renal cysts have little clinical significance
7
Q
Where do simple renal cysts develop?
Are they usually solitary or multiple?
Unilateral or bilateral?
A
- Develop In the cortex of the medulla
- Can be solitary or multiple, unilateral or bilateral- varies greatly in size and shape
8
Q
- Is obstruction, rupture, infection (renal abscess) and HTN caused by a simple renal cyst common or rare?
- What would be the sxs of rupture of infection?
A
Rare
- Sxs:
- Rupture= flank pain, hematuria
- Infection= fever, vague lumbo-abdominal pain, +/- hematuria/pyuria
9
Q
What is the main goal for evaluating someone with a simple renal cyst? What is the first line diagnostic study for this?
A
- Goal is to distinguish simple cysts from complex cysts
- U/S is first line
10
Q
A
11
Q
What are the 3 ultrasound criteria for simple cysts?
A
- Sharply demarcated w/ smooth thin walls
- No echoes (anechoic) within the mass
- Enhanced back wall indicating good transmission through the cyst
12
Q
What are the 5 ultrasound characteristics of complex cysts?
A
- Thick walls and/or septations
- Calcifications
- Solid components
- Mixed echogenicity
- Vascularity
13
Q
Evaluation of Simple Renal Cyst:
If US is equivical or is consistent w/ complex cyst, what diagnostic study should be ordered next?
A
CT w/ and w/o contrast
14
Q
Bosniak Classification of Renal Cysts: Which category?
- CT features:
- sharply demarcated w/ smooth thin wall
- homogenous fluid
- no contrast enhancement
- Significance:
- Simple cyst
- benign
- image in 6-12 mo
A
Category I
15
Q
Bosniak Classification of Renal Cysts: Which category?
- CT features:
- Closely resemble simple cysts
- Few thin septa
- +/- few calcifications
- < 3cm
- well marginated
- No enhancement
- Significance:
- Complex cyst
- benign
- image in 6-12mo
A
Category II
16
Q
Bosniak Classification of Renal Cysts: Which category?
- CT features:
- Multiple thin septa
- Walls may be thickened and may contain calcifications
- > 3cm
- Significance
- Complex cyst
- likely benign (5% malignant)
- repeat imaging in 3-6mo
A
Category IIF
17
Q
Bosniak Classification of Renal Cysts: Which category?
- CT Features:
- Indeterminate cystic masses
- Thickened irregular walls or septa
- measurable enhancement
- Significance
- complex cyst
- 40-60% are malignant
- monitor or excise
A
Category III
18
Q
Bosniak Classification of Renal Cysts: Which category? What is the significance of this type of cyst?
- CT features:
- Indeterminate cystic masses
- thickened irregular walls or septa
- measurable enhancement
- Soft-tissue enhancing
- complonents adjacent to cyst wall
A
Category IV
significance: Complex cyst, 85-100% are malignant
19
Q
What are the two major causes of acquired renal cysts? Which one is most common?
A
- Chronic Renal Failure (MC)
- Dialysis (incidence increases w/ duration)
20
Q
What is the diagnostic criteria for acquired renal cysts? (3)
A
- Bilateral involvement
- > 4 cysts
- Diameter rangin from <0.5cm up to 2-3cm
21
Q
In patients with acquired renal cysts, what size are the kidneys typically?
A
small to normal in size
22
Q
Acquired Renal Cysts:
Are patients usually symptomatic or asymptomatic?
What is the clinical significance of these cysts?
A
- Rarely symptomatic
- Clinical significance= may increase RCC risk
23
Q
When should you consider screening patients for acquired renal cysts? What should you screen with?
A
- Yearly screening after being on dialysis for 3-5 years
- US vs CT w/ and w/o contrast (depending on what initial study shows)
24
Q
What is the treatment for simple/complex renal cysts?
A
- Excision based on Bosniak Classification (usually not excised b/c benign)
- Acetaminophen or NSAID (if nml kidney funct) if having acute/intermittent pain
25
Simple/complex renal cysts:
How do you treat a patient with **persistent pain and cysts \> 5 cm**?
* Percutaneous aspiration w/ injection of sclerosing agent
* Laparoscopic unroofing
26
T/F: Autosomal Dominant Polycystic Kidney Disease (ADPKD) is often clinically silent
True
27
What are the two genetic mutations that can cause ADPKD? Which one is more common and more aggressive?
**PKD1** mutation- MC, more aggressive form
**PKD2** mutation- Slow growth
28
29
Is PKD inherited? If so, is it autosomal dominant or recessive?
* FHx present in 75% of cases (5% due to spontaneous mutation)
* **Autosomal Dominant**
30
What does ADPKD cause?
**Irreversible decline in renal function** which begins in 4th decade
31
ADPKD:
* 50% of patients will have ESRD by age \_\_\_\_
* Accounts for 10% of ______ patients in US
* 50% of patients will have ESRD by age **_60_**
* Accounts for 10% of **_Dialysis_** patients in US
32
What is the etiology of ADPKD?
PKD1/2 gene **mutation** → obstructed tubules → **cyst formation** (multiple w/ bilateral involvement) → fluid accumulation → significant kidney **enlargement** → separate from nephron → compress neighboring renal parenchyma → **progressive compromise renal function (GFR)**
33
What is the **initial presentation** of ADPKD and at what age?
* Age: **30s-40s**
* Presentation: **abdominal/flank/back**/chest **pain**
* 50% will also have **HTN**
34
What will be found on physical exam of a person with ADPKD?
* 50% have **HTN**
* **Large palpable kidneys**
35
If you have a patient who comes in with a combination of HTN and abdominal mass, what is this indicative of?
ADPKD
36
What 2 recurrent sxs can be an early indicator of ADPKD but is often overlooked?
Frequent UTIs
Recurrent nephrolithiasis
37
What abx should a pt w/ ADPKD be receiving if they have a UTI?
quinolones
38
\_\_\_\_\_% of patients with ADPKD have HTN by time of ESRD?
100%
39
What is the clinical presentation of ADPKD? (4)
* **HTN**
* **Pain** (vague w/ dull ache or localized w/ sharp pain)
* **Hematuria** (usually microscopic, gross suggestshemorrhage)
* **Proteinuria** (initially mild)
40
What are the 5 diagnostic studies of ADPKD?
1. **US** for screening and monitoring
2. CBC
3. CMP
4. UA
5. Genetic Screening
41
What are 5 associated manifestations of ADPKD?
**•Hepatic cysts** 40 – 50% (estrogen sensitive)
* **Pancreatic/splenic** cysts
* **Cerebral aneurysms** 10 – 15%
**•Mitral valve prolapse** – up to 25%
•Colonic diverticula are more common
42
How do you treat ADPKD?
* No tx to halt disease progression or induce regression
* HTN--\> **ACE/ARB**, low Na diet/limit caffeine
* Pain management
* Avoid potentially nephrotoxic agents
* **Avoid contact sports**
* Manage complications (Infection, cyst hemorrhage, kidney stones)
43
How do you tx ESRD caused by ADPKD?
Dialysis or kidney transplant
44
Which disorder?
* **Congenital disorde**r- most sporadic w/o FHx but there is a rare autosomal dominant form
* **Asymptomatic**
* Found **incidentally**
**Medullary Sponge Kidney**
45
What 2 things is Medullary Sponge Kidney characterized by?
1. **Dilation of collecting tubules**
* 1 or more renal papillae
* 1 or both kidneys
2. **Medullary cyst**s of variable size
46
What are the 5 complications of Medullary Sponge Kidney?
**•Nephrolithiasis**
**•UTI**
**•Hematuria**
**•Decreased urinary concentrating ability**
•Renal insufficiency is rare
"DR. HUN"
47
When is Medullary Sponge Kidney often diagnosed? How is it diagnosed?
* **4th or 5th decade**
* Diagnosis
* **Intravenous pyelograph**y (IVP)
* **Multidetector-row CT**
48
What do you see on Intravenous pyelography (IVP) in a patient with Medullary Sponge Kidney?
•**“Brush” or linear striations**, radiating outward from calyces
49
How do you treat Medullary Sponge Kidney?
* **No known tx**
* Good hydration
* Thiazide diuretic if hypercalciuria present
* Abx for UTI
50
What is the prognosis of Medullary Sponge Kidney? Is renal function typically maintained or not?
* **Excellent long-term** **prognosis**
* **Renal function** is typically **well maintained (**recurrent UTI/nephrolithiasis can lead to decline)
51
How is Medullary Cystic Disease (Nephronophthisis) inherited?
Autosomal recessive
52
In Medullary Cystic Disease (Nephronophthisis), progression usually occurs before what age?
20 y/o
53
T/F: there is an infantile, juvenile and adolescent form of Medullary Cystic Disease (Nephronophthisis)?
True
54
In Medullary Cystic Disease (Nephronophthisis), what appears after 9 years of age
**chronic tubulointerstitial nephritis w/ renal cysts**
55
What are the characteristic findings of Medullary Cystic Disease (Nephronophthisis)? (3)
* Reduced urinary concentrating ability
* **Bland urinary sediment**
* **polyuria**
* **polydipsia**
56
**The following is used to diagnose what disease?**
* Suggested by clinical characteristics
* Extrarenal manifestations
* **Retinitis pigmentosa**
* Confirmed by genetic testing
* Ultrasound
* Normal or **slight decrease in kidney size** for age
* **Increased echogenicity w/ loss of corticomedullary differentiation**
Medullary Cystic Disease (Nephronophthisis
57
What is an extrarenal manifestation of Medullary Cystic Disease (Nephronophthisis?
**_Retinitis pigmentosa_**
58
What is seen on US in Medullary Cystic Disease (Nephronophthisis?
•Normal or **slight decrease in kidney size for age**
## Footnote
**•Increased echogenicity w/ loss of corticomedullary differentiation**
59
What is the tx for Medullary Cystic Disease (Nephronophthisis)?
* No specific treatment
* Supportive care
