Flashcards in Nephro - Cysts and cancer - Online MedEd Deck (19):
Cysts can be divided into
Simple and complex
Simples cysts in kidney - what do they mean?
Usually find due to incidental
-Small, no loculations, no septations
-Just a balloon filled with fluid
-Treat none of these
-Incidence increases with age
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
Complex cyst can present as..
Rupture and bleed - hematuria
Diagnostic workup of complex cyst
US for pregnant
Make dx: do Bx
Treatment of complex cyst
If abscess, drain
Malignancy, resect, radiation
Renal cell carcinoma - presents like complex cyst... except
Classic triad of RCC: flank pain, flank mass, hematuria
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
Cancer might have __ Hgb
Low Hgb because cancer steals the Hgb
EPO producing tumour might result in what Hgb
High Hgb - polycythemia
RCC spreads by what route
Might find a piece in renal vein or IVC
Autosomal dominant polycystic kidney disease - presentation
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
Autosomal recessive polycystic kidney disease - who does this occur?
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
Autosomal recessive polycystic kidney disease - what to do?
Bx - radially oriented cysts
Supportive treatment and transplant! Might not be large enough to accept kidney
Diagnosis of autosomal dominant polycystic kidney disease
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
In adults with autosomal dominant PKD... where else can they get cysts?
Liver (hepatitis) and pancreas (pancreatitis)