What should I do if I have a renal cyst?

Renal cyst is a general term for cystic masses of varying sizes in the kidney that are not connected to the outside world. Renal cysts include single renal cyst, congenital polycystic kidney disease and congenital multiple renal cysts. The patient usually has no symptoms, and only one or several cysts are found 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 kind of cyst is very thin, and the inside of the cyst is clear yellow liquid. Most of the cysts are the size of walnuts. The cause of renal cysts is not very clear, but it is generally believed to be due to renal degeneration, so most of the patients are elderly. Small cysts do not cause any symptoms. Recently, due to the widespread implementation of B-ultrasound examinations, an increase in the number of patients with renal cysts has been discovered. Adult polycystic kidney disease: Adult polycystic kidney disease is a congenital hereditary kidney cyst disease. The kidney parenchyma of polycystic kidney is filled with countless round cysts of varying sizes that are not connected to the outside world. The cysts contain fluid. The small ones are invisible to the naked eye and the large ones can be several centimeters, so they are called polycystic kidneys. Symptoms include increased nocturia, low back pain, high blood pressure, etc. Urine tests show hematuria and a small amount of proteinuria, which often slowly develop into chronic renal failure. 10% of patients with polycystic kidney disease are accompanied by kidney stones, and 30% are accompanied by polycystic liver. 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 congenital abnormal renal lesion. It is a unilateral or bilateral kidney with one or several round cysts of varying sizes that are not connected to the outside world. Most are unilateral. , so it is called simple renal cyst. The incidence of simple renal cysts can increase with age. If people over 50 years old do B-ultrasound, 50% of them can find this kind of renal cyst. This disease can be diagnosed with the help of 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 kidneys originally. According to literature reports, most patients who undergo dialysis for more than 3 years will develop cysts. There are at least 4 cysts in one kidney, most of which are 2-3 cm in diameter. Some cysts can become infected or even become cancerous. B-ultrasound or CT examination can confirm the disease. During many years of clinical practice, experts from the Polycystic Kidney Research Center of Shijiazhuang Kidney Hospital have discovered that there are many factors leading to the development of polycystic kidney disease. Therefore, to prevent polycystic kidney disease and resist polycystic kidney disease, patients themselves need to take more precautions. In particular, we should be vigilant about the eight major factors that induce polycystic kidney disease! 1. Congenital dysplasia can cause a variety of diseases. For cystic kidney disease, it can mainly cause medullary sponge kidney and dysplastic polycystic kidney disease. Etc., the genes for congenital developmental abnormalities generally have no abnormalities, so they are different from genetic inheritance or genetic mutations. 2. Gene mutation (non-hereditary) For polycystic kidney disease, it is mostly inherited through parental genes, which is divided into autosomal dominant inheritance and autosomal recessive inheritance. However, some patients with polycystic kidney disease neither inherit it from their parents nor inherit it from their parents. It is not congenital dysplastic polycystic kidney disease, but a genetic mutation during embryogenesis. During the embryogenesis process, due to the action of various factors, the gene mutates and forms polycystic kidney disease. Although this is rare, it can still happen. Therefore, some patients with polycystic kidney disease may have no parental genetic history. . 3. Various infections. Infections can cause abnormal changes in the body's internal environment, resulting in environmental conditions that are conducive to changes in cyst genes, and enhance the activity of internal factors in cysts, which can promote the formation and growth of cysts; and the growth of cysts in any part of the body Any infection will enter the kidneys through the blood and affect the cysts. If the cyst becomes infected, in addition to aggravating the clinical symptoms, it will further accelerate the growth rate of the cyst and worsen renal function damage. Common infections include upper respiratory tract infections (including colds), urinary tract infections, gastrointestinal tract infections, skin infections, trauma infections, device infections, etc. That is, whether they are bacterial infections or viral infections, they can have a great impact on cysts. 4. Toxins Toxins act on the human body and can cause damage to various cells, tissues and organs, leading to diseases and even life-threatening conditions. They are also one of the main causes of genetic mutations, congenital developmental abnormalities and other phenomena. Common toxins include pesticides, certain chemicals, radiation, pollution, etc. In particular, it should be pointed out that some drugs are also nephrotoxic and can easily cause kidney damage if used improperly. These drugs include: kanamycin, gentamicin, sulfonamides, rifampicin, indomethacin, and other Western drugs, as well as centipede, Nux vomica and other traditional Chinese medicines. 5. Diet Maybe everyone doesn’t know that bad eating habits may cause many diseases. Of course, they are also an important factor in the occurrence and development of cystic disease. The main ones are: (1) Improper diet. If you are too hungry, you will suffer from nutritional deficiencies; if you are too full, you will easily damage the digestion and absorption functions of the spleen and stomach and cause qi and blood circulation disorders; if you eat too much fat, sweet and thick flavor, it will easily produce internal heat. (2) Unclean food may easily lead to gastrointestinal diseases in mild cases, poisoning or even life-threatening in severe cases. (3) Food preference, such as eating too much raw and cold food, can easily damage the Yang Qi of the spleen and stomach; eating too much pungent, warm, dry and hot food can cause heat accumulation in the gastrointestinal tract, and if you have a preference for the five flavors, it can easily damage the internal organs for a long time. The impact of the above-mentioned eating habits on the body is obvious. They also directly or indirectly influence the progression of cystic disease.

For cystic disease, we particularly emphasize the following aspects in clinical practice: spicy and irritating foods: such as chili peppers, alcohol, smoking (including passive smoking), chocolate, coffee, marine fish, shrimp, crab and other "fatty foods"; Salty food, especially pickled food; contaminated food such as unhygienic food, rotten food, leftovers, etc.; barbecue food; in addition, animal high-protein, high-fat and Greasy foods, that is, the above-mentioned fat, sweet and thick flavors; limit beans and soy products, especially patients with renal insufficiency need to pay more attention. The vast majority of renal cysts are asymptomatic. Some patients may develop the following symptoms due to the cyst itself, increased pressure within the cyst, infection, etc.: ① Discomfort or pain in the waist and abdomen: The reason is due to the enlargement and expansion of the kidneys, which increases the tension of the renal capsule. Enlargement of the kidney pedicle is caused by traction or pressure on adjacent organs. In addition, polycystic kidneys cause the kidneys to contain a large amount of water and become heavy, falling and pulling, which can also cause waist pain. The pain is characterized by dull, dull pain. Fixed on one or both sides, radiating to the lower part and lower back. If there is intracystic bleeding or secondary infection, the pain will suddenly intensify. If combined with stones or blood clots blocking the urinary tract after bleeding, renal colic may occur. ② Hematuria: It can manifest as microscopic hematuria or gross hematuria. The attacks are cyclical, and low back pain often worsens during attacks. Strenuous exercise, trauma, and infection can induce or aggravate it. The cause of bleeding is that there are many arteries under the cyst wall. Due to increased pressure or infection, the blood vessels in the cyst wall rupture and bleed due to excessive traction. ③ Abdominal mass: Sometimes it is the main reason for patients to seek medical treatment. In 60%-80% of patients, enlarged kidneys can be palpated. Generally speaking. The larger the kidney, the worse the kidney function. ④Proteinuria: Generally, the amount is not large and does not exceed 2g in urine per hour. Most of the symptoms of nephrotic syndrome will not occur. ⑤ Hypertension: Solid cysts compress the kidneys, causing renal ischemia, increasing renin secretion, and causing hypertension. When renal function is normal, more than 50% of patients develop hypertension, and when renal function decreases, hypertension occurs. The incidence of high blood pressure is higher. ⑥ Decreased renal function: Due to the cyst’s space occupation and compression, the normal renal tissue is significantly reduced, and the renal function undergoes youthful decline

Renal cyst--Treatment There is currently no specific medical method for the treatment of renal cysts. For small renal cysts, no treatment is required when they are asymptomatic, but regular review is required to observe whether the cyst continues to grow. Asymptomatic patients should undergo frequent urine tests, including routine urine and urine culture, and renal function tests every six months to one year. Examination, including endogenous creatinine clearance. Since infection is an important reason for the worsening of the disease, traumatic examination of the urinary tract should not be performed unless absolutely necessary. Renal cyst puncture has little effect. Not only is it prone to infection and recurrence, but it is also unable to delay the occurrence of renal damage after observation. Surgical removal of cysts is not an easy task, because cysts on the surface of the kidney can be removed, but it is quite difficult to remove cysts buried deep in the kidney. If the tumor is large and may become malignant, surgical exploration can be performed. If it is confirmed to be a benign cyst, the cyst wall on the kidney surface can be excised, the edges are continuously sutured with catgut and the renal parenchyma, and the remaining cyst wall is coated with iodine tincture. If the renal parenchyma on one side is extensively destroyed but the contralateral renal function is normal, nephrectomy is feasible. If it is bilateral polycystic kidney disease, a healthy kidney needs to be transplanted and the two polycystic kidneys need to be removed. With the development of medicine to this day, this may be the best way to treat severe polycystic kidney disease. 1. General treatment: If the diameter of the renal cyst is less than 4cm, there is no obvious compression of the renal pelvis or calyces, there is no infection, malignant transformation, hypertension, or the symptoms are not obvious, only close follow-up observation and regular B-ultrasound review are required. 2. Western medicine treatment (1) Puncture and drainage + sclerotherapy 1. Indications This method is suitable for patients with cysts larger than 4cm in diameter, symptomatic, and malignant transformation and infection have been ruled out after examination. 2. Commonly used hardeners, tetracycline, phosphate lock, 95% alcohol, and 50% glucose. 3. Contraindications: Patients with local skin infection and patients with severe bleeding tendency. 4. Complications include bleeding, infection, hemopneumothorax, renal laceration, arteriovenous fistula, damaging allantois, and irritation and damage to perirenal tissues caused by extravasation of sclerosing agent. (2) Puncture, drainage and antibiotic treatment: 1. Indications: Renal cyst with intracystic infection when the diameter is 4cm. After puncture and drainage under the guidance of B-ultrasound, sensitive antibiotics are injected according to the possible bacterial strains of infection. 2. The contraindications and complications are the same as puncture plus sclerotherapy. Renal cyst - surgical treatment (3) Surgical treatment 1. Indications (methods include open surgery and laparoscopy) (1) The cyst is complicated by infection and fails to be treated by puncture, drainage and antibiotics. (2) Malignant transformation of cyst. (3) Puncture and sclerotherapy are used to treat insomnia. (4) Huge renal cyst. 2. Contraindications: Severe heart, lung, liver and kidney dysfunction that cannot tolerate surgery, or malignant cysts with distant metastasis. 3. Surgical selection: (1) Cyst deroofing, suitable for most patients with renal cysts; (2) Nephrectomy, suitable for malignant transformation of cysts or cystic renal cancer. 4. Postoperative complications often include infection, bleeding, and urinary fistula. Anti-complications after laparoscopy include gas examination, subcutaneous and mediastinal emphysema, intestinal injury and bleeding, infection, etc. (4) Non-surgical treatment is mainly suitable for cysts complicated by infection and bleeding. Western medicines used to treat cyst infection include penicillins, cephalosporins, quinolone antibiotics, etc. Use nephrotoxic antibiotics with caution. Hemostatic drugs: 1 ku of Hemostasis, intramuscular injection, once a day, safe for elderly patients and will not produce blood clots. Three special treatments: 1. Perform excretory urography. Renal tomography.

Ultrasound imaging and CT still failed to make the final diagnosis. Angiography is an option. Percutaneous cyst aspiration is the next step in diagnosis. Means This can be done under X-ray fluorescent screen monitoring or ultrasound image monitoring. Finding clear cystic fluid is an encouraging sign, but aspirates should still be examined for cytology. The fat content should also be measured. Increased fat content is consistent with the diagnosis of tumor. The cyst fluid is then fully drained and replaced with contrast medium. Then take pictures in different positions to show the smoothness of the cyst wall and the presence of vegetations. Before withdrawing the contrast medium, inject ml of iodoester lipid into the cyst cavity, which will reduce changes caused by fluid reaccumulation. 2. Renal cyst - puncture In 1981, he introduced injecting 95% alcohol into the empty cyst. Using this method, he only found 10 recurrences in 100 patients. If the cysts are simply evacuated, most of them will recur. If the aspirated fluid is bloody, surgical exploration may be considered. Therefore, the lesions are serious at this time and may even become cancerous. If the diagnosis is confirmed, preservation of the cyst may be considered, as it is rare for cysts to damage the kidneys. 3. When the diagnosis is still in doubt, surgical exploration can be considered. In 1971, most of the cases were diagnosed as cysts. Still prefer surgical exploration. during their routine surgeries. 9% of cases were confirmed to have cancer. Usually only the extrarenal portion of the cyst is removed. Nephrectomy is also indicated if the kidneys are severely damaged, but this is rare. Treatment of complications: When a cyst is complicated by infection, antibiotic treatment should be strengthened. In 1980, it was found that the concentration of antibiotics in the cyst fluid was very low. Therefore, it is often necessary to perform drainage through this puncture. If drainage through this puncture fails, surgery is required to remove the extrarenal part of the cyst wall and drain it. It has also been proven to be quite effective when hydronephrosis occurs. Resection of the obstructing cyst wall can relieve ureteral obstruction. Pyelonephritis involving the kidneys suggests urinary tract obstruction and subsequent obstruction of ureteral drainage after removal of the cyst. Naturally relieves urinary tract pressure and makes antibacterial treatment more effective.