Nephro - Cysts and cancer - Online MedEd Flashcards Preview

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Flashcards in Nephro - Cysts and cancer - Online MedEd Deck (19):
1

Cysts can be divided into

Simple and complex

2

Simples cysts in kidney - what do they mean?

Meaningless
Asymptomatic
Usually find due to incidental
-Small, no loculations, no septations
-Just a balloon filled with fluid
-Do nothing
-Treat none of these
-Incidence increases with age

3

Complex cysts in kidney - what do they mean?

Larger, will have loculations and septations, not homogeneous, multiple pockets
-Decide - is this likely to be cancer
-Often come up as flank mass on test, usually found incidental

4

Complex cyst can present as..

Pain
Pyelo
Rupture and bleed - hematuria
Mass

5

Diagnostic workup of complex cyst

U/A
CT scan
US for pregnant
Make dx: do Bx

6

Treatment of complex cyst

Resection usually
If abscess, drain
Malignancy, resect, radiation

7

Renal cell carcinoma - presents like complex cyst... except

Classic triad of RCC: flank pain, flank mass, hematuria

8

What to do for RCC?

CT or US
Do not Bx if think RCC
Instead do a resection (partial/radical nephrectomy)
-Bx - will have risk of hematoma and seeding of cancer! So the nephrectomy acts as Bx
-So need to do CT to determine likelihood of cancer

9

Cancer might have __ Hgb

Low Hgb because cancer steals the Hgb

10

EPO producing tumour might result in what Hgb

High Hgb - polycythemia

11

RCC spreads by what route

Hematogenous
Might find a piece in renal vein or IVC

12

Autosomal dominant polycystic kidney disease - presentation

Adults
Patient present asymptomatic who gets HTN and ESRD
Possible that cysts are palpable (flank mass)
Cysts can get infected and pyelo, hematuria
-Born with normal kidneys; get more cysts with age (cysts replace kidney parenchyma), worsening Cr

13

Autosomal recessive polycystic kidney disease - who does this occur?

Newborns

14

Autosomal recessive polycystic kidney disease - presentation

In babies - anuric, oligo (not producing urine so little amniotic fluid), might see hydro no US in prenatal
Palpable flank masses bilateral

15

Autosomal recessive polycystic kidney disease - what to do?

US
Bx - radially oriented cysts
Supportive treatment and transplant! Might not be large enough to accept kidney

16

Diagnosis of autosomal dominant polycystic kidney disease

CT scan/US
Biopsy

17

Treatment of autosomal dominant polycystic kidney disease

Treatment - supportive, prevent renal disease (keep BP low)
ACEi/ARBs for proteinuria
Eventually go on dialysis
Can be transplanted

18

In adults with autosomal dominant PKD... where else can they get cysts?

Liver (hepatitis) and pancreas (pancreatitis)

19

What is an important risk factor of autosomal dominant PKD?

Risk of subarachnoid aneurysms (berry aneurysms) - need MRA/CTA/need to be clipped and coiled!!!
-Need to check for this!