Simple renal cyst
Introduction
Introduction to simple renal cyst Simple renal cyst (simplerenal cyst) is the most common type of renal cystic disease, the mildest one. It is common in adults over 50 years old and rare in children. It may be acquired, and it may be isolated or multiple. Sexuality, more common in males and left kidneys, often unilateral onset, can also be combined with contralateral renal lesions. basic knowledge The proportion of the disease: the probability of the population is 0.31% Susceptible people: adults who are more than 50 years old Mode of infection: non-infectious Complications: high blood pressure
Cause
Cause of simple renal cyst
(1) Causes of the disease
Can be caused by congenital glomeruli, structural changes in the renal tubules, but also due to acquired damage, infection and so on.
(two) pathogenesis
The pathogenesis of simple renal cysts has not been fully elucidated. Although it is a non-hereditary congenital disease, Schnlzinger (1994) found two families of simple renal cysts, and the gene linkage analysis of them has not been found to be more autosomal dominant. Cystic kidney (ADPKD) is associated with autosomal dominant simple renal cyst. The lesion is more common in the inferior pole. The cyst originates from the renal tubule and protrudes from the surface of the renal cortex. It is blue in appearance and can also be located in the deep cortex. Or medulla, generally less than 1cm in diameter, may also have 3 ~ 4cm, individual up to 10cm or more, the capsule contains sterile clear amber liquid, 5% is bloody liquid, of which about 1/3 ~ 1/2 Cases have malignant lesions of the cyst wall, thin wall, lining a single layer of squamous epithelium, fibrosis and calcification in the shape of egg shells, and the lower pole cyst can compress the ureter and cause obstructive water and infection.
Prevention
Simple renal cyst prevention
1. Since there is no effective treatment, prevention and treatment of kidney complications and maintenance of renal function are the main preventive purposes.
2. Patients with this disease should avoid close contact activities, especially collision and squeezing to prevent cyst rupture.
3. Patients with this disease are prone to urinary tract infections, especially women, who must be active in symptomatic and supportive treatment.
Complication
Simple renal cyst complications Complications
The cyst is located at the renal gate to compress the renal artery, causing an increase in plasma renin, which can lead to high blood pressure; or secondary infection of the renal pelvis obstruction.
Symptom
Simple renal cyst symptoms common symptoms abdominal pain lower abdominal mass cyst hematuria
Simple renal cysts often occur in adulthood, generally have no clinical symptoms, do not affect renal function, and occasionally see because of hematuria. Most patients are accidentally found when performing B-mode ultrasound or CT examination, urine examination is normal, hematuria Rare, but kidney cysts can cause abdominal pain and find abdominal mass, high blood pressure, etc., such as cysts break into the renal pelvis and renal pelvis system, may have hematuria, cysts can also lead to renal pelvis, renal pelvis obstruction symptoms.
Examine
Simple renal cyst examination
Urine examination combined with infection may have pyuria, hematuria, but generally no renal insufficiency.
1. Imaging examination
(1) B-ultrasound is the preferred method of examination. The typical B-ultrasound is characterized by no echo in the lesion area, smooth wall and clear boundary. When the wall shows irregular echo or limited echo enhancement, it should be vigilant against malignant lesions; secondary infection The wall of the capsule is thickened, and there is a fine echo in the lesion area; the echo is enhanced with the bloody liquid.
(2) CT is valuable for the diagnosis of B-ultrasound. When the cyst is accompanied by hemorrhage or infection, it is heterogeneous and the CT value increases. When CT shows cyst characteristics, it is not necessary to make a diagnostic puncture.
(3) IVU can show the extent to which the cyst compresses the renal parenchyma or ureter.
(4) MRI can help determine the nature of the cyst fluid.
2. Cyst puncture and cyst fluid examination
When B-ultrasound, CT, etc. can not be diagnosed or suspected of malignant lesions, the cyst can be puncture under the guidance of B-ultrasound, and the cystic fluid test can be taken. When the cyst is secondary to the tumor, the cystic fluid is bloody or dark brown, and the fat and other components are obviously increased. The cytology was positive, the tumor marker CA-50 level was increased, the cystic fluid was dark turbid, the fat and protein content increased moderately, the amylase and LDH were significantly increased, and the cytological examination had inflammatory cells. The cyst culture could be determined. After the pathogen is extracted, the contrast medium and/or gas are injected to show the condition of the capsule wall. If the wall of the capsule is smooth, no tumor exists.
Diagnosis
Diagnosis and diagnosis of simple renal cyst
According to the clinical manifestations of hypertension, secondary urinary tract infection caused by renal pelvis obstruction, and B-ultrasound, CT and MRI, liquid examination in renal cysts, and after the exclusion of other types of renal cystic diseases, the diagnosis of this disease can be made. The diagnosis of this disease mainly depends on B-mode ultrasound or CT examination.
Differential diagnosis
Hydronephrosis
Severe hydronephrosis may have lumbar pain, and can reach cystic mass in the waist and abdomen, but IVU and retrograde pyelography show enlargement of renal pelvis and renal pelvis; B-ultrasound, CT examination shows liquid dark area in the central part of the kidney, thinning of renal parenchyma The kidney map is obstructed.
2. Renal diverticulum
B-ultrasound can detect cystic masses in the kidney. Excretory urography can be seen in the sputum. However, if the channel of the diverticulum is connected with the renal pelvis or renal pelvis, it is feasible to retrograde angiography to visualize the channel. .
3. Multi-atrial renal cyst
Mainly manifested as abdominal discomfort, abdominal mass, occasional hematuria, B-ultrasound and CT see cystic mass in the renal parenchyma, but the inside of the cyst is divided into multiple liquid dark areas.
4. Renal cystic changes
B-ultrasound, IVU and CT examinations can be seen similar to changes in renal cysts, but the wall of the capsule is thick, the inner wall is irregular, papillary bulge into the cyst, renal angiography can be seen in the renal parenchyma around the cyst with dense proliferating blood vessels, intraoperative frozen section Can help with diagnosis.
5. Kidney abscess
Generally there are systemic manifestations of acute infection, such as high fever, chills, etc., severe pain in one kidney area, muscle tension, obvious snoring pain in the rib angle, increased white blood cells, white blood cells in the urine, positive bacterial culture, IVU shows renal pelvis under pressure or filling defects, B-ultrasound shows the dark area of the kidney area and the primary lesions that can cause renal empyema. Puncture can extract pus.
