Renal cysts and cancer: Clinical (To be retired)
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Renal cysts and cancer: Clinical (To be retired)
Subspeciality surgery
Cardiothoracic surgery
Coronary artery disease: Clinical (To be retired)
Valvular heart disease: Clinical (To be retired)
Pericardial disease: Clinical (To be retired)
Aortic aneurysms and dissections: Clinical (To be retired)
Chest trauma: Clinical (To be retired)
Pleural effusion: Clinical (To be retired)
Pneumothorax: Clinical (To be retired)
Lung cancer: Clinical (To be retired)
Anatomy clinical correlates: Thoracic wall
Anatomy clinical correlates: Heart
Anatomy clinical correlates: Pleura and lungs
Anatomy clinical correlates: Mediastinum
Adrenergic antagonists: Beta blockers
ACE inhibitors, ARBs and direct renin inhibitors
cGMP mediated smooth muscle vasodilators
Lipid-lowering medications: Statins
Lipid-lowering medications: Fibrates
Miscellaneous lipid-lowering medications
Antiplatelet medications
Plastic surgery
Benign hyperpigmented skin lesions: Clinical (To be retired)
Skin cancer: Clinical (To be retired)
Blistering skin disorders: Clinical (To be retired)
Bites and stings: Clinical (To be retired)
Burns: Clinical (To be retired)
ENT (Otolaryngology)
Anatomy clinical correlates: Olfactory (CN I) and optic (CN II) nerves
Anatomy clinical correlates: Trigeminal nerve (CN V)
Anatomy clinical correlates: Facial (CN VII) and vestibulocochlear (CN VIII) nerves
Anatomy clinical correlates: Glossopharyngeal (CN IX), vagus (X), spinal accessory (CN XI) and hypoglossal (CN XII) nerves
Anatomy clinical correlates: Skull, face and scalp
Anatomy clinical correlates: Ear
Anatomy clinical correlates: Temporal regions, oral cavity and nose
Anatomy clinical correlates: Bones, fascia and muscles of the neck
Anatomy clinical correlates: Vessels, nerves and lymphatics of the neck
Anatomy clinical correlates: Viscera of the neck
Antihistamines for allergies
Neurosurgery
Stroke: Clinical (To be retired)
Seizures: Clinical (To be retired)
Headaches: Clinical (To be retired)
Traumatic brain injury: Clinical (To be retired)
Neck trauma: Clinical (To be retired)
Brain tumors: Clinical (To be retired)
Lower back pain: Clinical (To be retired)
Anatomy clinical correlates: Olfactory (CN I) and optic (CN II) nerves
Anatomy clinical correlates: Oculomotor (CN III), trochlear (CN IV) and abducens (CN VI) nerves
Anatomy clinical correlates: Trigeminal nerve (CN V)
Anatomy clinical correlates: Facial (CN VII) and vestibulocochlear (CN VIII) nerves
Anatomy clinical correlates: Glossopharyngeal (CN IX), vagus (X), spinal accessory (CN XI) and hypoglossal (CN XII) nerves
Anatomy clinical correlates: Vertebral canal
Anatomy clinical correlates: Spinal cord pathways
Anatomy clinical correlates: Cerebral hemispheres
Anatomy clinical correlates: Anterior blood supply to the brain
Anatomy clinical correlates: Cerebellum and brainstem
Anatomy clinical correlates: Posterior blood supply to the brain
Anticonvulsants and anxiolytics: Barbiturates
Anticonvulsants and anxiolytics: Benzodiazepines
Nonbenzodiazepine anticonvulsants
Migraine medications
Osmotic diuretics
Antiplatelet medications
Thrombolytics
Ophthalmology
Eye conditions: Refractive errors, lens disorders and glaucoma: Pathology review
Eye conditions: Retinal disorders: Pathology review
Eye conditions: Inflammation, infections and trauma: Pathology review
Anatomy clinical correlates: Olfactory (CN I) and optic (CN II) nerves
Anatomy clinical correlates: Oculomotor (CN III), trochlear (CN IV) and abducens (CN VI) nerves
Anatomy clinical correlates: Eye
Orthopedic surgery
Joint pain: Clinical (To be retired)
Lower back pain: Clinical (To be retired)
Anatomy clinical correlates: Clavicle and shoulder
Anatomy clinical correlates: Axilla
Anatomy clinical correlates: Arm, elbow and forearm
Anatomy clinical correlates: Wrist and hand
Anatomy clinical correlates: Median, ulnar and radial nerves
Anatomy clinical correlates: Bones, joints and muscles of the back
Anatomy clinical correlates: Hip, gluteal region and thigh
Anatomy clinical correlates: Knee
Anatomy clinical correlates: Leg and ankle
Anatomy clinical correlates: Foot
Trauma surgery
Traumatic brain injury: Clinical (To be retired)
Neck trauma: Clinical (To be retired)
Chest trauma: Clinical (To be retired)
Abdominal trauma: Clinical (To be retired)
Urology
Penile conditions: Pathology review
Prostate disorders and cancer: Pathology review
Testicular tumors: Pathology review
Kidney stones: Clinical (To be retired)
Renal cysts and cancer: Clinical (To be retired)
Urinary incontinence: Pathology review
Testicular and scrotal conditions: Pathology review
Anatomy clinical correlates: Male pelvis and perineum
Anatomy clinical correlates: Female pelvis and perineum
Anatomy clinical correlates: Other abdominal organs
Anatomy clinical correlates: Inguinal region
Androgens and antiandrogens
PDE5 inhibitors
Adrenergic antagonists: Alpha blockers
Vascular surgery
Peripheral vascular disease: Clinical (To be retired)
Leg ulcers: Clinical (To be retired)
Aortic aneurysms and dissections: Clinical (To be retired)
Anatomy clinical correlates: Anterior and posterior abdominal wall
Adrenergic antagonists: Beta blockers
Lipid-lowering medications: Statins
Lipid-lowering medications: Fibrates
Miscellaneous lipid-lowering medications
Antiplatelet medications
Thrombolytics
Assessments
Renal cysts and cancer: Clinical (To be retired)
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Transcript
Content Reviewers
Rishi Desai, MD, MPHContributors
Anca-Elena Stefan, MD
Evan Debevec-McKenney
Tanner Marshall, MS
Renal masses can develop in both adults and children, and sometimes, they’re due to genetic mutations.
These masses may be either cysts or tumors, and they can be discovered incidentally during an abdominal ultrasound or a CT-scan or when an individual has symptoms like abdominal or flank pain.
Renal cysts can be simple or complex, and they can also be solitary - meaning there’s just one cyst, or there can be multiple cysts - sometimes affecting both kidneys.
Simple cysts are the most common type of renal mass, and they typically occur in adults with otherwise healthy kidneys.
On an abdominal ultrasound, they’re usually smaller than 1 centimeter, but can be up to 4 centimeters. They’re round and have a thin regular wall and are filled with liquid which makes them anechoic - so it basically looks like a small balloon filled with black fluid.
Additionally, there can also be some fine septa and calcifications within the simple cyst.
Usually they’re asymptomatic, and don’t need treatment.
On the other hand, complex cysts are larger than 1 centimeter. On an ultrasound, they have thick, irregular walls and are multilocular- meaning they have septations within, that separate the cyst cavity into compartiments.
Complex cysts can cause symptoms like flank pain, and they can cause complications like infections, hemorrhage, and hypertension.
An infected cyst can cause symptoms like fever and fatigue.
Sometimes, the infection can spread to the renal parenchyma, causing an acute pyelonephritis with symptoms like fever, acute flank pain or diffuse abdominal tenderness.
A CBC shows leukocytosis and neutrophilia, and the ESR and CRP are elevated.
If the infection is limited to the cyst, then the urinalysis may be normal, whereas if the cyst causes acute pyelonephritis then pyuria, bacteriuria and proteinuria are present.
Blood cultures may be positive with both a simple cyst infection and acute pyelonephritis, whereas urine cultures are typically positive only with acute pyelonephritis.
An ultrasound can show a thick cystic wall.
The ultrasound can show a clear separation between urine, which is a low density fluid, and pus, which is a high-density fluid.
The initial treatment of an infected cyst is empirical. If the symptoms are mild, then an oral fluoroquinolone like ciprofloxacin or trimethoprim-sulfamethoxazole is given for 4 to 6 weeks.
Summary
Renal cysts refer to fluid-filled sacs that can develop in the kidneys. They can be simple, or complex. Simple renal cysts are typically asymptomatic and appear as enveloped round small masses filled with anechoic fluid on ultrasound. Simple cysts often need no treatment. Complex cysts on ultrasound appear as larger masses with irregular walls and septations. Complex cysts can cause symptoms like flank pain, and complications like infections, hemorrhage, and hypertension. So, all these complications might need to be managed accordingly.
On the other hand, there is renal cancer, specifically renal cell carcinoma (RCC). RCC originates in the renal cortex and can cause a triad of symptoms: flank pain, hematuria, and abdominal mass. An ultrasound and a CT scan can be done to diagnose and classify the tumors, and people with no metastasis are often treated with surgical tumor resection alone. People with metastases will need biopsies of the metastatic sites and may need chemotherapy in addition to surgery.
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