miércoles, 1 de enero de 2020

Diagnosis and Treatment of Acquired Cystic Kidney Disease

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By Deborah Fields, B.Sc.Reviewed by Dr. Tomislav Meštrović, MD, Ph.D.

Acquired cystic kidney disease represents a condition where fluid-filled sacs (also known as renal cysts) develop in the kidney. These cysts tend to develop in the cortex and medulla regions of the kidneys, which are areas that are particularly active in the filtration of the blood.

Acquired cystic kidney disease is fairly asymptomatic, so there are unlikely to be many signs that a patient has the condition. However, several complications can ensue. A patient with chronic kidney disease and end-stage renal disease who suddenly starts to see blood in their urine, develops a fever and has back pain should be further investigated for the condition.

Establishing a diagnosis with ultrasound technique

Medical imaging can help doctors to diagnose the condition by seeing what is happening in the body. Initially the medical team may opt for ultrasound, as this represents a non-invasive and safe form of imaging which will provide some indication of what is going on in the patient’s kidneys.

Ultrasound creates an image from sound waves bouncing back from specific regions of the body. This medical system usually has a transducer which is an electronic device that sends out sound waves and receives them back to help create a structural image. Furthermore, the system usually includes a screen and a computer to help convert the information into a useful image.

When the clinician examines a person with suspected acquired cystic kidney disease, they smear the areas of the abdomen where the kidneys are located with a special gel. The gel helps to prevent air getting in the way of the transducer and affecting the transmission and detection of the sound waves.

When the transducer is moved around the skin and over the gel, an image is instantly produced on a connected screen which provides automatic structural information about the kidneys.

Using CT and MRI

If the images that are produced by the ultrasound suggest that further investigation is required, the patient may then undergo a computed tomography (CT) scan. This is an imaging technology that uses X-ray radiation. The patient may also need to use a contrast agent so that the images that are transmitted will be clearer.

The medical team will take care to make sure that the patient does not have an allergy to the contrast agent used in the process. The chemical may be swallowed or passed into the patient through their anus. The doctor may also be able to inject it into a specific blood vessel.

CT can provide more detail than an ultrasound, and it can also show the difference between whether a structure in the kidney is, for instance, a tumor rather than a cyst. This is particularly useful as some cysts in acquired cystic kidney disease actually do become cancerous.

The other imaging technique that can be used is magnetic resonance imaging (MRI) which is particularly useful for viewing the soft tissues in the body. This technique employs radio waves and magnets to provide the medical team with good images. Similar to a CT scan, the patient may need to use a contrast agent to enhance the image from the MRI.

During this diagnostic procedure the patient will lie on a table and slide into a tunnel structure for scanning. The waves will be passed through the kidney areas to obtain the information that will contribute to their diagnosis. Nevertheless, the results from this imaging technique are unlikely to be instantly available.

Treatment

Acquired cystic kidney disease can result in different complications. If a cyst causes an infection in the body, the patient may have to take antibiotics. Large cysts can be drained without the need for a large-scale surgery. The medical team can use a long needle to reach the specific area and drain the cyst of its liquid.

If a kidney cyst bursts and it causes severe bleeding in the body, doctors may wish to carry out surgery to stop the flow. The medical team may also use surgery to remove any potentially cancerous growths. Acquired cystic kidney disease has more chance to develop into renal cell cancer the longer a patient has been undergoing dialysis.

If a patient goes on to have a transplant, it is not always necessary to remove the original kidneys. However, the cysts that had developed in the kidneys tend to shrink and disappear after a successful transplant procedure.