Nephrology Specialist Dr. Kadir Gökhan ATILGAN gave information about Acquired Kidney Cyst Disease.
Nephrology Specialist Dr. According to the information given by Kadir Gökhan Atılgan, “The term kidney cyst disease has a wide definition range. Because it has a variety that can develop in any period after birth, which is defined in medicine as hereditary, developmental, acquired. Cysts are located in the outer part of the kidney, which we call the cortex in all types of kidney cyst disease. It can cover both regions in the inner layer of the kidney, which we call the medullary region, or close to the border between the kidney layers, which we can call the corticomedullary region. There is no underlying kidney disease or kidney failure in acquired cystic kidney disease. It usually tends to involve both kidneys. In the form of fluid-filled sacs It is defined by the presence of more than one cyst. No signs or symptoms are encountered. Most of the time, it is diagnosed in examinations such as ultrasonography, computerized tomography, magnetic resonance imaging, which are performed for check-up purposes or for any other reason, and are referred to nephrology
With this However, although it is stated that the patients do not have a history of kidney disease in the past, its incidence increases in direct proportion to the duration of hemodialysis treatment in patients receiving hemodialysis treatment. The provoking feature of situations in which blood urea value is higher than normal, which we call uremic state, is reported in the literature.
Although a clear mechanism cannot be described in the disease, the assumptions in the literature are as follows:
1- Renal tubular block: The renal tubule forms a part of the smallest structure that we define as the nephron that forms our kidney. A block that may occur here triggers cyst formation.
2- Compensatory growth: The development of hypertrophy and hyperplasia in the surviving parts due to the loss of kidney tissue in the chronic kidney failure process also occurs in tubular tissues. Transepithelial fluid migration during tubular exchange results in the development of cysts. The most prominent of the provoking factors are growth factors and oncogenes.
3- Ischemia: Primary or secondary (after end-stage renal failure and dialysis process) occlusion developing in the vessels feeding the kidney and as a result, secondary developing tissue acidosis state in a vicious circle with the death of the tissue and its building block cells. results. It is thought that this process will cause the development of cysts with the process of change in epithelial structures.
The frequency of the disease varies. According to the national data registration system of the United States, this rate is between 7-22% in the predialysis period. In the group receiving dialysis, it increases according to the duration of the dialysis treatment. This rate is 44% in patients receiving dialysis treatment for less than 3 years, 79% in patients receiving dialysis for more than 3 years, and 90% in patients receiving hemodialysis treatment for more than 10 years. It is more common in men than women.
Patients usually survive without symptoms, but rarely, intra-abdominal or intra-renal bleeding, hematuria, blood in the urine, flank pain, colic-like pain, cyst infection can be seen. Although there are reports that the cystic formation does not recur in the post-kidney transplant period, there are also case reports stating that the cystic change continues in the native kidney.
In the physical examination of acquired kidney cyst disease, the kidneys are palpable, as in polycystic kidney disease, only if there is intrarenal hemorrhage. Usually not palpable. In histological evaluation, normal kidney tissue between the cysts was preserved.
The diagnostic method in the diagnosis of cystic kidney disease is imaging techniques. Ultrasonography will be our first choice because it is inexpensive and does not require any interventional method. In ultrasonography, we can evaluate whether the cysts are complicated or uncomplicated, whether they cause an increase in kidney size, whether there is involvement in other organs, kidney echogenicity, and if complicated, intracystic echogenicity. What is meant by a complicated cyst is fluid accumulation within the cyst and is seen with isodense or increased echogenicity on ultrasonography. If there is blood and coagulation in this cyst, it presents with a hyperechoic appearance. Dynamic computed tomography is needed to differentiate between clot formation or cancer development. Contrast-enhanced computed tomography is superior to ultrasonography in terms of early evaluation and detection of kidney cancer. It is not primarily preferred in predialysis patients due to the results of contrast material use and the small size of the cysts in this period. Magnetic resonance imaging is another imaging modality for patients who cannot tolerate computed tomography. Diffusion MR is significant in the differentiation of infected cysts, especially in multicystic kidney disease.
Another method for diagnosis is cyst aspiration biopsy to exclude kidney cancer in patients with suspected bleeding and clot formation in fluid-filled cysts.
Narcotic (morphine, codeine) or non-narcotic (paracetamol, etc.) pain relievers can be used in patients suffering from flank pain or colic pain. The use of aspirin and especially heparin in dialysis patients should be avoided.
Conditions requiring surgical treatment:
1. Treatment in patients with severe bleeding episodes is embolectomy or nephrectomy.
2. Nephrectomy is recommended if the cyst diameter is greater than 3 cm or for complicated cysts smaller than 3 cm in the presence of suspicion of kidney cancer by advanced imaging methods.
There is no special drug group for treatment and there is no special formula for diet. Our only recommendation for exercise is bed rest during bleeding episodes.
Complications:
1-The rate of conversion to kidney cancer in acquired cystic kidney disease has increased 40 times compared to the normal population.
2- Cystic bleeding can sometimes be accompanied by hematuria. Depending on the rupture of the cyst, retroperitoneal intra-abdominal bleeding or intrarenal bleeding, which we call perinephric, can be seen. Bleeding is rarely sufficient to cause hypovolemic shock. Calcifications, which we call calcification, can be seen in or around the cyst.
3- Cyst infection, abscess formation or a general condition disorder can be seen with the mixing of the infection we call sepsis into the blood.
