Renal Cystic Diseases and Neoplasia (Lecture 20a)

What is multicystic dysplastic kidney (MCDK)? What is CP? What are the SF? What is the d/d?

- Congenital unilateral developmental abnormality where renal cortex is replaced by cysts (NO functional tissue left)

- CP: abdominal mass in newborn, asymptomatic (other kidney is functioning)

SF for in utero or children:

- multiple cysts

- absence of normal kidney (parenchyma and renal sinus)

SF for adult:

- hypoplastic kidney (shrinks)

- extensive calcification

- Compensatory hypertrophy in contralateral kidney

- d/d: hydronephrosis (hydro = cystic area connect, MCDK = cysts separated)

What is multilocular cystic nephroma (MLCN)? What is the pt population and CP? What are the SF? What are the d/d?

- Benign cystic neoplasm w/ multiseptated and thick fibrous capsule

CP:

- Children: m/c males less than 4 yr old, painless abdo mass

- Adult: m/c females 40-60, asymptomatic, abdo pain, hematuria, UTI

SF:

- Multiple anechoic spaces separated by hyperechoic septa

- Small locules (echogenic masses)

- D/D: RCC, complex cysts

What is acquired cystic kidney disease (ACKD)? What is there an increased risk of with this condition? What is the CP? What are the SF? What is the D/D?

- Renal cyst formation in pts w/ renal failure on dialysis (m/c hemodialysis)

- Inc duration of dialysis = Inc size and # of cysts

- Inc risk of RCC

- CP: asymptomatic, dialysis pt

- SF: small echogenic kidneys w/ multiple small cysts, free fluid from peritoneal dialysis

- D/D: ADPKD (genetic condition), medullary cystic disease

What is hypernephroma? What is the m/c cause? What are the 3 risk factors? How does it spread? What is the pt population and CP? What are the SF? Name 2 D/D. What are the treatments?

Another name for RCC

- M/c adult renal primary tumours

- Cause: sporadic**/hereditary

- Risk factors: von-hippel lindau, tuberous sclerosis, dialysis (ACKD)

- Spread: hematologically venously***, direct spread from retroperitoneum, lymphadenopathy, systemic

CP:

- Older males

- Mostly asymptomatic

- Classic triad: gross hematuria, flank pain, palpable mass

- Other s/s: fever, weight loss, hypertension

SF:

- Inc vasc

- Solid: variable echo

- Cystic: multi/unilocular, necrotic, arising from simple cyst

- D/D: complex cyst, multilocular cystic nephroma, oncocytoma, AML

- Treatments: RF ablation, cryoblation, partial/radical nephrectomy (I or II Robson staging), palliative (III or IV)

What is TCC? What is its alternate name? How does it spread? What is pt population and CP? What are the SF? What are the treatments?

- Malignant tumour of transitional epithelium lining of renal pelvis, ureter, and bladder (bladder is m/c site of origin)

- Alternate name: urothelial carcinoma

- Direct spread through collecting system

- Pt population: older males, heavy smokers, vesicoureteric reflux, carcinogen exposure, analgesic abuse

- CP: gross hematuria, flank pain, urinary frequency, dysuria

- SF: hypoechoic mass in collecting system, papillary (w/ stalk), possible dystrophic calcifications

- D/D: papillary necrosis, blood clot, fungus balls

- Treatments: depending on staging - radical nephroureterectomy, chemo, rad therapy, palliative care