Kidney cyst - what to do? About the causes of appearance, clinical picture, diagnosis of symptoms

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Urology
Kidney cyst

A kidney cyst is a benign, thin-walled, voluminous formation that develops from the kidney parenchyma and usually contains serous fluid. A kidney cyst is a spherical cavity. Most often, patients are diagnosed with single renal cysts, up to 3 cm in diameter, located subcapsularly in the renal parenchyma. Cysts occur with approximately the same frequency in both the right and left kidneys. Large single cysts, renal sinus cysts, and multiple renal cysts are quite rare.

Symptoms, signs and clinical picture of kidney cysts

The most characteristic symptoms of a simple kidney cyst are:

dull pain in the hypochondrium or lower back, intensifying after physical activity;
palpable mass formation in the lumbar region;
persistent rise in blood pressure without dynamics;
total hematuria.

A simple kidney cyst does not have typical clinical signs, and in 70% of patients it is asymptomatic and does not cause any clinical manifestations for years or even decades. That is why it cannot be reliably diagnosed based on clinical symptoms alone. Often, a simple cyst is accidentally discovered when examining a patient for a disease that has nothing to do with it (other urological or neurological diseases, etc.). With an increase in the size of the cyst and compression of the parenchyma of the kidney or urinary system, characteristic clinical manifestations appear.

The intensity of pain depends on the size of the cyst, its location, and the condition of the ligamentous apparatus of the kidney. A palpable formation in the kidney area can only serve as a presumptive sign of a simple cyst, since a true kidney tumor or the lower segment of a displaced kidney can be mistaken for a cyst.

Diagnosis of kidney cyst

Rice. 1. The number of punctures in the abdominal wall at the site of trocar insertion during excision of a cyst on the right. Position of the patient and the operating team.

The diagnosis of a kidney cyst is made based on the patient’s complaints, clinical picture and instrumental examination data. If a renal cyst is suspected, it is necessary to perform an ultrasound examination of the kidneys, intravenous excretory pyelography and radioisotope renal scintigraphy.

When determining the indications for surgery (especially in the case of a multi-chamber cyst or the presence of septa) and choosing a surgical procedure for a kidney cyst, in addition to ultrasound and excretory pyelography, it is necessary to conduct a computed tomography of the retroperitoneal organs with contrast to exclude oncological disease.

Diagnostics

Survey and excretory urography
Ultrasound, Dopplerography
CT (computed tomography)
Diagnostic puncture and cystography

X-ray methods: It is not possible to establish an accurate diagnosis of a simple renal cyst only on the basis of survey and excretory urography. With the help of excretory urography, it is possible to identify the “sickle” symptom or the “open mouth” symptom, which are characterized by the spreading of the kidney calyces without their “amputation”.

Ultrasound examination (ultrasound) reveals a simple renal cyst as an echo-negative formation of a round or oval shape, with clear, even, continuous contours and thin walls. Ultrasound allows for dynamic observation and use as a screening test. Dopplerography is a method that allows you to study the blood supply to the kidney. This diagnostic method is especially important for the combination of kidney cysts and arterial hypertension.

Computed tomography (CT) in some cases cannot provide 100% confidence in the accuracy of the diagnosis, especially with parapelvic cysts and tumors in the cyst. This somewhat reduces its diagnostic value. The CT scanning criteria for cystic renal lesions are similar to those used in echography: sharp, thin, distinct, smooth walls and edges; round or oval shape; homogeneous content. Density ranges from -10 to +20 HU, similar to that of water, and no enhancement should occur after intravenous injection of contrast medium.

Percutaneous puncture cystography is currently not the main diagnostic method, but can be used in the process of percutaneous puncture treatment of a simple cyst to clarify the location of the cyst and determine its relationship with the pyelocaliceal system.

Treatment of kidney cyst

What to do if a kidney cyst is detected? There are no therapeutic methods for treating kidney cysts. Until the mid-90s, before the widespread introduction of endoscopic kidney surgery methods into medicine, patients with single or multiple kidney cysts were under dynamic observation and received only symptomatic treatment. In the case of small single cysts, patients underwent surgery for sclerosis of the kidney cyst under ultrasound guidance. When the kidney cyst grew rapidly, patients underwent open kidney surgery.

Since, unlike a tumor, a kidney cyst is a benign disease, a cyst can be monitored in 70% of cases without resorting to active surgery. Patients whose kidney cyst does not exceed 5 cm in diameter, is located on the periphery of the kidney and does not cause disturbances in the kidney’s blood circulation and urine outflow, usually require dynamic monitoring using ultrasound once every 6–12 months.

Surgical treatment of a kidney cyst is not performed in cases where the cyst does not bother the patient, does not cause a disturbance in the outflow of urine from the kidney, as well as in severe concomitant conditions of the patient and blood clotting disorders.

To determine the type of kidney cyst, its localization to the main structures of the organ and indications for surgery, as well as choosing the correct surgical treatment tactics, you need to send me a complete description of the kidney ultrasound, MSCT data of the kidneys with contrast, indicate your age and main complaints to your personal email address. Then I will be able to give a more accurate answer to your situation.

Indications for surgical treatment for kidney cysts:

Organ-preserving surgery - laparoscopy of a kidney cyst. More than 250 operations were performed.

compression of the kidney cyst of the urinary tract
compression of the cystic tissue of the kidney parenchyma
infection of the cyst cavity and abscess formation
rupture of kidney cyst
large cyst sizes and/or rapid growth of the kidney cyst
pain caused by a cyst
hematuria from the kidney from the side of the cyst
arterial hypertension
erythremia
the presence of blood in the punctate from the cyst or hemorrhage into the cyst
cyst rupture or danger thereof
cancer in the cyst (based on radio-radiological, echographic data or examination of puncture fluid from the cyst).

During the surgical treatment of a kidney cyst, interventions of varying scope can be performed:

percutaneous therapeutic and diagnostic puncture of a kidney cyst with sclerosis;
enucleation of the cyst (husking);
cyst resection;
kidney resection with cyst;
nephrectomy.

Watch a video of operations performed by Professor K.V. Puchkov. You can visit the website “Video of operations of the best surgeons in the world.”

Renal puncture is currently the first step in the treatment of simple single (solitary) uncomplicated kidney cysts with a diameter of up to 3–5 cm and located subcapsularly in the renal parenchyma. Currently, percutaneous therapeutic and diagnostic puncture of a kidney cyst is carried out only with sclerosing, since puncture of a kidney cyst without the use of a sclerosing agent in most cases leads to recurrence of the cyst and the need for repeated intervention. In some cases, there may even be an increase in the volume of the cyst compared to its original size. Percutaneous therapeutic and diagnostic puncture of a kidney cyst is carried out under ultrasound control, evacuation of the contents and introduction of an adhesive substance into its cavity.

Simple and peripelvic cysts of the kidneys

DOI: https://dx.doi.org/10.18565/urology.2020.3.121-127

ON THE. Gerasimenko, V.A. Zhmakin, G.E. Krupinov, A.V. Amosov
1) Institute of Urology and Human Reproductive Health of the Federal State Autonomous Educational Institution of Higher Education “First Moscow State Medical University named after. I. M. Sechenov" Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia; 2) Institute of Clinical Medicine named after. N.V. Sklifosofsky Federal State Autonomous Educational Institution of Higher Education “First Moscow State Medical University named after. I. M. Sechenov" Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia; 3) International School “Medicine of the Future” Federal State Autonomous Educational Institution of Higher Education “First Moscow State Medical University named after. I. M. Sechenov" Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia

The article covers the topic of cystic kidney formations. The localization and structure of solitary, parapelvical and multiple renal sinus cysts are described. The Bosniak classification (1986) is presented, as well as the updated Bosniak classification, which in 2021 received a number of additions. Modern diagnostic methods and factors that allow you to adhere to the tactics of dynamic observation are described. Modern methods of surgical treatment are presented.

Key words: dynamic observation, BOSNIAK classification, cystic kidney formations, modern diagnostic methods, surgical treatment

The full text of the article is available in the Doctor's Library

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About the authors / For correspondence

AUTHORIZATION: N.A. Gerasimenko – 6th year student, Institute of Clinical Medicine named after. N.V. Sklifosofsky Federal State Autonomous Educational Institution of Higher Education “First Moscow State Medical University named after. I. M. Sechenov" Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia; e-mail: [email protected]