Renal cyst is a general term for cystic masses of different sizes in the kidney that do not communicate with the outside world. Renal cysts include solitary renal cysts, congenital polycystic kidney and congenital multiple renal cysts. Patients usually have no symptoms, and only one or several cysts grow on the kidney through B-ultrasound examination. A few people can also have multiple cysts, but it is rare to have cysts on both sides. The wall of this cyst is very thin, and the cyst is a transparent yellowish liquid. Most cysts are as big as walnuts. The etiology of renal cyst is not very clear, and it is generally considered to belong to renal degeneration, so the patients are mostly elderly. Small cysts do not cause any symptoms. Recently, due to the extensive development of B-ultrasound examination, the number of renal cysts has also increased. Adult polycystic kidney disease: Adult polycystic kidney disease is a congenital hereditary renal cyst disease. The renal parenchyma of polycystic kidney is filled with numerous circular cysts of different sizes, which are not connected with the outside world. Cyst contains fluid as small as several centimeters, so it is called polycystic kidney. It is characterized by increased nocturia, low back pain and hypertension. Urine test has hematuria and a small amount of proteinuria, which often develops slowly into chronic renal failure. Polycystic kidney complicated with kidney calculi accounted for 10%, and polycystic liver patients accounted for 30%. Experienced doctors can diagnose this renal cyst with the help of B-ultrasound and intravenous pyelography. Simple renal cyst: Simple renal cyst may be a kind of congenital abnormal nephropathy, which is unilateral or bilateral, and one or several circular cavities of different sizes are not connected with the outside world, mostly unilateral, so it is called simple renal cyst. The incidence of simple renal cyst can increase with age. People over 50 years old can find this kind of renal cyst by B-ultrasound. The disease can be diagnosed by B-ultrasound and CT. Acquired renal cyst: Acquired renal cyst mainly occurs after uremia or dialysis treatment. It has nothing to do with age, but with the time of hemodialysis. There are no renal cysts in the kidney. According to the literature, if the dialysis time exceeds 3 years, most patients will have cysts. A kidney has at least four cysts, most of which are 2-3 cm in diameter. Some cysts can be infected or even cancerous, and the disease can be diagnosed by B-ultrasound or CT examination. Experts from Polycystic Kidney Research Center of Nephrology Hospital have found that there are many factors leading to polycystic kidney disease in many years of clinical practice. Therefore, the prevention of polycystic kidney disease and the resistance to polycystic kidney disease need patients to strengthen prevention. In particular, improve the vigilance of the eight factors that induce polycystic kidney disease! 1. Congenital dysplasia can produce many diseases. For cystic nephropathy, it can mainly cause medullary sponge kidney and hypoplastic polycystic kidney disease. The genes of congenital dysplasia are generally normal, so they are different from gene inheritance or gene mutation. 2. Gene mutation (non-hereditary) For polycystic kidney disease, most of them are inherited by parents, which are divided into autosomal dominant inheritance and autosomal recessive inheritance. However, some patients with polycystic kidney disease are neither inherited by their parents nor belong to congenital dysplasia polycystic kidney disease, but are genetic mutations during embryonic formation. In the process of embryo formation, due to various factors, gene mutation occurred, forming polycystic kidney disease. Although this situation is rare, it can still happen. Therefore, some patients with polycystic kidney disease can have no parental genetic history. 3. Various infections can cause abnormal changes in the internal environment of the organism, thus creating environmental conditions conducive to the change of cyst genes, enhancing the activity of internal factors of cysts, and thus promoting the generation and growth of cysts; Any infection in any part of the body will enter the kidney through the blood, thus affecting the cyst. If the cyst is infected, it will not only aggravate the clinical symptoms, but also accelerate the growth of the cyst and aggravate the renal function damage. Common infections include upper respiratory tract infection (including cold), urinary tract infection, gastrointestinal tract infection, skin infection, trauma infection, instrument infection, etc., that is, bacterial infection and virus infection can have a great impact on cysts. 4. Toxins can cause damage to various cells, tissues and organs, leading to diseases and even life-threatening, and it is also one of the main reasons for gene mutation and congenital dysplasia. Common toxins such as pesticides, certain chemicals, radiation, pollution, etc. In particular, some drugs are also nephrotoxic, which can easily cause renal damage if used improperly. These drugs include western medicines such as kanamycin, gentamicin, sulfonamides, rifampicin and indomethacin, as well as Chinese medicines such as centipede and nux vomica. 5, diet may not be known to everyone, bad eating habits may not be known to everyone, bad eating habits may cause many diseases, of course, it is also an important factor in the emergence, development and change of cystic diseases. Among them, there are mainly: (1) insufficient diet and insufficient nutrition when hungry; Oversatiety is easy to damage the digestion and absorption function of the spleen and stomach, causing qi and blood circulation disorder; Eating too much fat and sweet is easy to turn into getting angry. (2) unclean diet is easy to cause gastrointestinal diseases, and in severe cases, it is poisoned or even life-threatening. (3) A partial diet. If you eat too much cold food, it is easy to hurt the yang of the spleen and stomach. If you eat too much spicy, warm and hot food, you will accumulate heat in the gastrointestinal tract. If you have five flavors, it is easy to hurt your internal organs for a long time. The influence of the above eating habits on the body is obvious. They also directly or indirectly affect the development of cystic diseases. As for cystic diseases, we especially emphasize the following aspects in clinic: irritation, irritation: such as pepper, alcohol, smoking (including passive smoking), chocolate, coffee, marine fish, shrimp, crab and other "hair"; Salty food, especially pickled food; Contaminated food, such as unsanitary food, rotten food, leftovers, etc. ; Barbecue food; In addition, animals with high protein, high fat and greasy food should be restricted, that is, the fat, sweet and thick taste mentioned above; Restricting beans and bean products, especially patients with renal insufficiency, needs more attention. The vast majority of renal cysts are asymptomatic, and some patients may have the following symptoms due to the increased pressure and infection of cysts themselves: ① Lumbar and abdominal discomfort or pain: the reason is that the kidney is swollen and expanded, the tension of renal capsule is increased, the renal pedicle is pulled, or the adjacent organs are compressed. In addition, polycystic kidney disease leads to high water content in the kidney, which becomes very heavy and can also cause low back pain. Pain is manifested as dull pain and dull pain. Fixed on one side or both sides, radiating to the lower and rear. If there is intra-capsular bleeding or secondary infection, the pain will suddenly increase. If stones or blood clots block the urinary tract after bleeding, renal colic may occur. ② Hematuria: It can be manifested as microscopic hematuria or gross hematuria. The attack is periodic, and the low back pain is often aggravated during the attack. Strenuous exercise, trauma and infection can all be induced or aggravated. The cause of bleeding is that there are many arteries under the capsule wall. Due to pressure increase or infection, the blood vessels in the capsule wall rupture and bleed due to overstretching. ③ Abdominal mass: Sometimes it is the main reason for patients to seek medical treatment, and 60%-80% of patients can touch swollen kidneys, generally speaking. The bigger the kidney, the worse the renal function. ④ Proteinuria: Generally, the amount is not much, and the urine output per hour will not exceed 2g. Nephrotic syndrome rarely occurs. ⑤ Hypertension: The solid cyst compresses the kidney, causing renal ischemia and increasing renin secretion, causing hypertension. When the renal function is normal, more than 50% patients have developed hypertension, but when the renal function decreases. The incidence of hypertension is high. ⑥ Decreased renal function: Due to the occupation and oppression of cysts, the normal renal tissue decreased obviously, and the renal function decreased in youth.
Renal cyst-There is no specific method to treat renal cyst in medicine at present. For small renal cysts, there is no need to do any treatment when they are asymptomatic, but they should be reviewed regularly to see if the cysts continue to grow. Asymptomatic people should have regular urine tests, including routine urine tests and urine culture, and do renal function once every six months to 1 year. Examination, including endogenous creatinine clearance rate. Because infection is an important cause of the deterioration of the disease, it is not necessary to have a traumatic examination of the urinary tract. Renal cyst puncture has little effect, which is not only easy to relapse, but also can not delay the occurrence of renal function damage after observation. Surgical removal of cysts is not an easy task, because cysts on the surface of the kidney can be removed, but cysts buried in the deep part of the kidney are quite difficult to remove. When the tumor is large and may become malignant, surgical exploration can be carried out. If it is proved to be a benign cyst, the cyst wall on the surface of the kidney can be removed, and the edge of the cyst can be sutured continuously with catgut, and the remaining cyst wall can be coated with iodine tincture. Nephrectomy is feasible if the renal parenchyma on one side is extensively destroyed and the renal function on the other side is normal. If it is bilateral polycystic kidney, a healthy kidney needs to be transplanted, and then two polycystic kidneys need to be cut off. With the development of medicine, this may be the best way to treat severe polycystic kidney disease. First, renal cysts with a diameter less than 4cm are generally treated, and there is no obvious compression on the renal pelvis and calyx, no infection, malignant transformation, high blood pressure, or no obvious symptoms. It only needs close follow-up observation and regular B-ultrasound review. Second, western medicine treatment (a) puncture drainage+sclerosing agent treatment 1. Indications This method is suitable for symptomatic patients with cyst diameter greater than 4cm, and malignant infection is excluded after examination. 2. Commonly used hardener, tetracycline, phosphate lock, 95% alcohol, 50% glucose. 3. Contraindications: patients with local skin infection and severe bleeding tendency. 4. Complications such as bleeding, infection, hemopneumothorax, renal laceration, arteriovenous fistula, traumatic urinary cyst and sclerosing agent extravasation stimulate and damage the tissues around the kidney. (2) Puncture drainage plus antibiotics is 1. Indications: Renal cyst with a diameter of 4 cm with intracapsular infection. After puncture and drainage under the guidance of B-ultrasound, sensitive antibiotics were injected according to the possible infected strains. 2. Contraindications and complications are the same as puncture plus sclerosing agent. Renal cyst-surgical treatment (3) surgical treatment 1. Indications (methods include open surgery and laparoscopy) (1) Cyst complicated with infection, puncture and drainage plus antibiotic treatment is ineffective. (2) The cyst became malignant. (3) Puncture plus sclerosing agent to treat insomnia. (4) Giant renal cyst. 2. Contraindications: Severe heart, lung, liver and renal insufficiency can not tolerate surgery, and the malignant cyst has distant metastasis. 3.( 1) cyst unroofing is suitable for most patients with renal cysts; (2) Nephrectomy is suitable for cystic malignant transformation or cystic renal carcinoma. 4. Postoperative complications are often infection, bleeding and urinary fistula. Anti-complications after laparoscopic surgery include gas examination, subcutaneous and mediastinal emphysema, intestinal bleeding, infection and so on. (4) Non-surgical treatment is mainly suitable for cyst complicated with infection and bleeding. Western medicines for treating cyst infection include penicillins, cephalosporins and quinolones. Use nephrotoxic antibiotics with caution. Hemostatic drug: reptilase 1ku, intramuscular injection once a day, which is safe for elderly patients and will not cause thrombosis. Special treatment: 1, during excretory urography. Renal tomography. Ultrasound images and CT still fail to make most diagnoses. Angiography is optional. The next diagnosis is percutaneous cyst puncture. This means that this can be done under the monitoring of X-ray fluorescent screen and ultrasonic image. It is an encouraging sign to find clear cystic fluid, but the aspiration fluid should still be examined by cytology. The fat content should also be determined, and the increase of fat content is consistent with the diagnosis of tumor. Then the cystic fluid is completely discharged and replaced by contrast agent. Then take photos at different positions to show the smoothness of the capsule wall and whether there are any vegetation. Injecting ml iodine ester into the capsule cavity before extracting the contrast agent will reduce the changes caused by liquid accumulation. 2, renal cyst-puncture, 198 1 year to introduce 95% alcohol into the empty capsule, in this way, he only found patients with recurrent cases. If the cyst is simply emptied, most of it will recur. If the aspirate contains blood, surgical exploration can be considered. Therefore, the lesion is serious and even cancerous. If the diagnosis is clear, we can consider keeping the cyst. After all, it is rare for cysts to damage the kidneys. 3. When the diagnosis is still in doubt, surgical exploration can be considered. Most cysts were diagnosed at 197 1 year. Still prefer surgical exploration. In the operation they performed. Cancerous cases were diagnosed, accounting for 9%. Usually only the extrarenal part of the cyst is removed. Nephrectomy is also an indication if the kidney is seriously damaged, but this is rare. Management of complications: When cyst is complicated with infection, antibiotic treatment should be strengthened. 1980 found that the concentration of antibiotics in cyst fluid was very low. So it is often necessary to drain through this puncture. If puncture drainage fails, the extrarenal part of the cyst wall should be surgically removed and drained. It also proves that the curative effect is quite good, when hydronephrosis occurs. Removal of the cyst wall that causes obstruction can relieve ureteral obstruction. Pyelonephritis involving the kidney suggests urinary tract obstruction, and then ureteral drainage is not smooth. Naturally, it reduces urinary tract pressure and makes antibacterial treatment more effective.