The diagnosis of renal cyst

First, the basic inspection
1. Urine normal urine routine inspection, if capsule of oppression associated with renal parenchyma or intracapsular infection, urine, there will be a small amount of erythrocytes and leukocytes.
2. B-understand cyst number, size, wall situation. And renal tumor and substantive phase identification, as the preferred method. B-typical lesions showed no echo, smooth wall, the border clearly shows that when the wall or irregular echo echo enhanced limitations, should be vigilant against malignant transformation; secondary infection wall thickening, lesions district Fine echo, echo intracystic hemorrhage, increased. When there are multiple cysts imaging tips, and the room should be cysts, polycystic kidney disease with distinction.
3. IVP (ivp) can show parenchymal cysts the extent of oppression, and with the identification of hydronephrosis.

Second, further examination
CT, on the B-scan can identify those valuable, cyst with hemorrhage, infection, malignant, showed no heterogeneity, CT values increase, when CT showed characteristics of the cyst, the cyst can no longer be puncture.

Third, diagnosis
1. Early this disease generally asymptomatic, often in the physical overtime B was found, cyst diameter> 10 cm, caused symptoms. Lumbar mainly abdominal cramping pain intracapsular infection hemorrhage increase.
2. Even in the investigation of the abdomen to the lumbar cystic mass.
3. B extraordinary definitive diagnosis can be suspected when a malignant transformation could be further examination of the methods listed.
4. The disease should be kidney, hydronephrosis, renal cysts room, multi-cystic differential phase.

Polycystic kidney disease and congenital renal cyst

Renal cyst is based on the image of a group of kidney found no echo of the dark liquid. That is what is commonly known as vesicles. Two below that renal cysts, two more than called polycystic kidney, renal capsule were a number of blocks as the first consideration should be given to congenital polycystic kidney disease. Polycystic kidney disease and congenital renal cysts, regardless of age and gender were visible.
Renal cysts: If it is found that timely, in accordance with its different parts, surgical, conservative treatment can be. Of course, the same result should be a better drug treatment. General surgery not to condition the development of drug control, not in tissue damage and functional changes.
Hydronephrosis is the renal pelvis or renal collecting system and the expansion of the site have a liquid anomalies. More common in middle-aged men and women, more than from the disease urinary bladder disease or poor, as well as other reasons. If not treated in time will lead to kidney damage and kidney function.

Humble renal cysts

Renal cysts including single renal cysts, congenital polycystic kidney disease and congenital multiple renal cysts, and other. Patients usually no symptoms, only the B-scan found on a kidney or a few months cyst. Few people can be more than a long cyst, but the existence of bilateral cysts are rare at the same time. This cyst wall thin, intracapsular to clarify with yellow liquid, mostly cyst the size of walnut. Is not the cause of renal cyst is very clear, generally considered to belong to kidney degeneration, which are more disease for the elderly. Small cyst not cause any symptoms. The recent B-inspection carried out extensive, found that renal cysts were also increased.

Renal cysts the main clinical symptoms
The vast majority of renal cysts and asymptomatic. Some patients may cyst itself and increased intraluminal pressure, infection and the following symptoms:
① lumbar, abdominal pain or discomfort: The reason is because of kidney enlargement and expansion so that the renal capsule Tension increased by renal pedicle traction or pressure from the neighbouring organs. In addition, polycystic kidney lead to kidney water, become heavy, fall traction, and will lead to the waist pain. The characteristics of pain for pain, Duntong fixed in unilateral or bilateral, the Department of lumbar back downward radiation. For intracystic hemorrhage or secondary infection, the pain will suddenly intensified. If the merger stones or urinary tract obstruction clot after bleeding can be a renal colic.
② hematuria: for the performance of microscopic hematuria or gross hematuria. Attack cyclical. Low back pain often exacerbated attack, strenuous exercise, trauma, infection may induce or aggravate. Bleeding reason is because there are many arterial wall below, as with infection or increased pressure to vascular wall stretch and due to excessive bleeding.
③ abdominal mass: sometimes the main reason for attending patients, 60% to 80% of the patients can be touched enlarged kidney. Generally speaking, the greater the kidney, renal function worse.
④ proteinuria: general level is low, 24-hour urine, does not exceed 2 g. More nephrotic syndrome will not happen.
⑤ hypertension: Solid oppression kidney cyst, causing renal ischemia, increased renin secretion caused hypertension. In normal renal function, have more than 50 percent of patients with hypertension, renal dysfunction, the higher the incidence of hypertension.
⑥ renal dysfunction: As cyst placeholder, oppression, so that normal renal tissue significant decrease in renal function of the decline.

Renal cysts screening method
More reliable methods of X-ray angiography, kidney B-mode ultrasonography examination, radionuclide scan and CT scan. In the renal cysts, urinary tract X-ray angiography may have pyelonephritis and renal calyceal compression deformation, but smooth edge, no damage. Renal cysts are not cancer, but easily confused with the tumor, renal cysts and renal cancer differential important. Identification of the two methods can be used PET or renal parenchymal renal angiography. Parenchymal tomography, cyst site imaging shallow, deep imaging tumor site; renal angiography, vascular sparse cyst site, no contrast agent concentration, renal vascular rich due to malignant tumors, a contrast agent concentration. Suspected malignant cyst, the cyst could puncture, allantoic fluid out of a routine inspection and exfoliated cells checks to the cyst can also be injected contrast agents to check whether tumor wall. B-mode ultrasonography and CT it is easy to renal parenchymal renal cysts and tumors separately, therefore, is the ideal method.

The treatment of renal cysts
The current level of medical treatment of renal cysts no effect method. For small renal cysts, asymptomatic, no need for any treatment, but should be reviewed regularly, it will continue to increase observation cyst. Asymptomatic should be regular urine checks, including urine, urine culture, every six months to one year to conduct a renal function test, including the creatinine clearance rate. Because of the deterioration of the infection is an important reason, if necessary, to refrain from urinary tract trauma of the inspection. Renal cyst puncture of little use, not only vulnerable to infection, easy to relapse, and the long-term observation, the operation can not delay the occurrence of renal damage. Surgical resection cyst is not an easy task, because the surface of renal cysts can be cut off, but to cut off buried deep in the kidney cyst on the very difficult. Malignant tumors larger and there is possible, surgical exploration can be carried out, if confirmed to be a benign cyst, renal surface can be wall resection edge with catgut suture and the renal parenchyma consecutive residual wall covered with iodine. Broad side of renal parenchymal damage, the contralateral normal renal function, viable nephrectomy.

Ureteral stones

[Summary]
The vast majority of ureteral stones from the kidney, including kidney stones or stones after extracorporeal shock wave caused by fragments landed. As more urine salt crystals into the urine of bladder, the primary ureteral stones rarely see. A ureteral strictures, diverticula, foreign bodies, such as predisposing factor, urinary retention and infection will lead to a ureteral stones. Ureteral stones are mostly single, the left side of the incidence broadly similar bilateral ureteral stones about 2 ~ 6%. Clinical more common in young adults, 20 to 40 years old the highest incidence of male and female ratio of 4.5:1, lower ureteral stones at the most, accounting for about 50 to 60 per cent. Ureteral stones on the urinary obstruction and expansion can cause stagnant water, and threaten suffering from kidney, serious renal function can gradually lose.

[Diagnosis]
The correct diagnosis of ureteral stones is not only sure whether stones, stones to determine the size, location, both sides of kidney function and the degree of hydronephrosis, whether infection. Typical of renal colic and hematuria is an important clue to the diagnosis. Pain in the ribs attack ridge area tenderness, Kouji pain. Women greater distal ureteral stones in the vaginal fornix to the touch. More than 90% of ureteral stones in the urinary tract film can be displayed, showed that calcium oxalate best, and subject to the abdominal lymph node calcification, pelvic vein stone, and appendectomy, bezoar differential phase angle of the island. Intravenous urography is mainly aimed at understanding the site of stones and renal function with the availability of stagnant water, if necessary, to large dose urography and radionuclide renography inspection, renal function can be further understand the situation. Cystoscopy and ureteral stones intubation in the disruption, and plain film shoot in the shadow of calcification catheter in the same plane, which can be sure that the diagnosis of ureteral stones. Air stone for the negative contrast agent for retrograde contrast radiography may show that the existence of stone. Another B-mode ultrasonography and CT examinations were helpful for the X-ray image is not stone diagnosis.

[Treatment]
Treatment of ureteral stones including symptomatic treatment, Chinese medicine treatment, extracorporeal shock wave lithotripsy and stone extraction by endoscopy, surgery and other stones.
(1) symptomatic treatment is mainly for controlling the renal colic, and can be used in the diagnosis after 0.5 mg atropine and dolantin 50 mg intramuscular injection, the pain can heat or district to acupuncture, waist sensitive areas can be closed for subcutaneous procaine (produced skin test). Can also be used nifedipine or indomethacin Cypriot anal suppositories.
(2) TCM Paishi suitable for the treatment within 1 cm in diameter, oval shape, smooth surface of the stone, pyelography were without water. Governance and administration are: Qingre Lishi, such as Lysimachia christinae Hance, such as the Jinsha. Qingrejiedu, such as Mr Wong, Yinhua, such as Hypericum perforatum. Blood Circulation, Ruanjian Huashi, such as Spartina, Ezhu such. Bushen such as cinnamon, Aconite, Cistanche, etc.. Air Dangshen such as blood, such as astragalus. There are various kinds of Paishi granules, and convenient.
(C) The use of extracorporeal shock wave lithotripsy Dornier X-ray positioning of the treatment has been expanded upper ureteral stones in the ureter, the calculi. Upper ureteral stones should adopt the semi-supine Chace, the iliac wing overlapping parts of stones should be used prone position under half of the available seats, the upgrade can be made certain of success. Although the total length of the various parts of ureteral stones can be crushed Extracorporeal Shock Wave, but in smaller stones, body fat patients sometimes difficult existence location, location deep, and so more energy, and crush kidney stones compared to the difficulty of ureteral stones to smash the relatively higher , the overall effect worse than kidney stones. Therefore, we must strengthen the positioning accuracy of the shock wave, there are difficulties, at the same time for excretion of urinary bladder angiography or do endoscopic retrograde catheterization and angiography, to help positioning. If stones can be pushed into the renal pelvis waves again, the most ideal. Contrast agent can often easily shattered stones, which emit. On the contrary, even if not stones, and significantly above water, especially with ureteral periimplantitis, retrograde intubation or inaccessible beneath stones, shock wave lithotripsy effects often poor.
The Lower Ureteral smaller stones, can be carried out by cystoscopy ureter expansion sets of stone, cut the mouth. In recent years, under the application of ureteroscopy peep stones or laser, ultrasonic lithotripsy, although there are reports of 40 to 78 per cent success rate, but it is worth noting that operation can cause perforation, tearing, and other serious complications.
(D) Operation and stone removal indications: ① there ureter stenosis; ② bilateral or unilateral ureteral stones incarcerated with urinary infection caused closure; ③ larger stones, hydronephrosis serious, poor renal function; ④ extracorporeal shock wave or waves can not positioning losers; ⑤ clinical tumor or not, except tuberculosis; ⑥ economic factors. Two hours before surgery urinary-ray film to be positioning.

As for the larger female Lower Ureteral stones, and sometimes touched by transvaginal Konglongbu inspection stone, the stone from the massage.

[Clinical]
Ureteral stones and kidney stones similar symptoms. Stones and the size of obstruction, hematuria and not necessarily proportional to the degree of pain. In the ureter, on the site of the stone or stones plug incarcerated in the downward course of a typical side often caused renal colic and microscopic hematuria. To the thigh pain, testicular or labia minora radiotherapy. Accompanied nausea, vomiting, and sometimes for hematuria visible to the naked eye. Ureter and bladder intramural most of the narrow, stone easy to stay. Because the muscles of the lower ureter and bladder linked triangle, and directly attached to the posterior urethra, it accompanied the frequency, urgency and the unique Niaotong symptoms. Not be affected by the larger urinary calculi, only pain, hematuria also light. In the solitary kidney or ureter stones blocking bilateral ureteral obstruction or obstructive ureteral calculi side contralateral to a reflex anuria, and so on, can be acute anuria, and even renal failure.

Dietary fat and there is no relationship between renal calculi

Abstract: and contrary to previous studies, dietary fat on the urinary tract calculi formation of calcified almost no impact.

In the Journal of Urology (Urology), the article pointed out that, contrary to previous studies, dietary fat in the urinary system on the formation of calcified stones almost no impact. Halifax, Nova Scotia’s Dalhousie University Dr. greg G. Bailly and his colleagues studied the intake of fat and 24-hour urine volume, PH value, as well as magnesium, citrate, oxalate, uric acid and calcium the relationship between the output.

Scientists total of 476 patients (305 men, 171 women) were studied within four days to record their food intake. Analysis of these records, and that total fat intake as well as saturated fat, monounsaturated saturated fat, not more than the amount of saturated fat.

The researchers found that the average daily fat intake for men 105.6 grams, 78.1 grams for women, the two are significantly different. On the age and sex researchers compared found that the fat content in the diet and urinary system diseases and risk factors unrelated. Only found in the female group and urinary uric acid content of risk factors among a very weak positive correlation. The researchers pointed out that this correlation is not aware of whether there were significant.

The author pointed out that the fat in the diet may increase the incidence of kidney stones concept will be mainly based on the incidence of kidney stones among the reasons for the increase attributable to the dietary factors research. In Japan for example, the incidence of kidney stones gradually increased, and people think it is the Japanese diet increased the content of animal fat.

What diabetic nephropathy associated with coronary heart disease?

In recent decades gradually realize that insulin-dependent diabetic nephropathy easily die of coronary heart disease. Insulin-dependent diabetes and non-insulin-dependent diabetes, the results suggested that there proteinuria cardiovascular disease increased the risk of death five times. WHO further study showed that many countries in the non-insulin-dependent diabetes mellitus, microalbuminuria is forecast die of cardiovascular disease targets. A study shows that long-term follow-up of 73 patients with non-insulin-dependent diabetes, 15 died after the 39 cases, all started urinary albumin excretion greater than 10 μ g / min, except one survived, the rest have been killed.

Diabetic nephropathy

Diabetic nephropathy is a diabetic microangiopathy important, and is one of the major causes of death for diabetes. In the course of more than 15 years in IDDM people will be 30% -40% in diabetic nephropathy; NIDDM in people occurred in 25% of diabetic nephropathy. Generalized diabetic kidney disease include diabetes combined with acute pyelonephritis and renal papillary necrosis, acute renal papillary necrosis relatively rare. Narrow diabetic nephropathy is caused by diabetes and renal glomerular capillary vascular sclerosis caused by the normal excretion and filtration reduction, which eventually led to renal failure.

[Causes]
Diabetic nephropathy is made up of different etiology and pathogenesis of insulin caused in absolute and relative shortage of sugar that protein and fat metabolism disorders, and chronic high blood sugar is the main clinical manifestations of systemic disease. Diabetes can damage the kidneys of these different channels can damage the structure of all involved kidneys, but only glomerular sclerosis and diabetes have a direct relationship, also known as diabetic nephropathy and diabetic microvascular complications systemic one. Diabetic patients kidney damage in the event of persistent proteinuria is often irreversible condition to the development of end-stage renal failure. Diabetic nephropathy has become diabetic patients leading causes of death.

[Clinical performance and staging]
Ⅰ period: increased glomerular filtration rate and renal volume increased features. This early lesions consistent with the high blood glucose levels, but reversible, after insulin treatment can be resumed, but may not be able to return fully to normal.
Ⅱ period: The period of normal urinary albumin excretion rate of glomerular but there has been structural change.
Ⅲ period: called early diabetic nephropathy. Urinary albumin excretion rate of 20 - 200 μ g / min, the patient’s blood pressure increased slightly, and began to glomerular abandoned.
Ⅳ period: Clinical diabetic nephropathy or overt diabetic nephropathy. This period is characterized by macroalbuminuria (more than 3.5 grams per day), edema and hypertension. Diabetic nephropathy more serious edema, poor response to diuretics.
Ⅴ period: end-stage renal failure. Diabetic patients in the event of persistent urinary protein for clinical development of diabetic nephropathy, as widely glomerular basement membrane thickening of the glomerular capillary cavity narrow and more abandoned glomerular kidney filtration function of the decline , resulting in renal failure.

[Treatment]
(A) medical treatment
1. Diabetes treatment:
(1) diet therapy: current advocates of early diabetic nephropathy that should limit the intake of protein (0.8 g / kg.d). To have edema and renal insufficiency patients, in addition to diet restrictions on the sodium intake, protein intake to be taken on the principle of streamlined (0.6 g / kg.d), if necessary, appropriate amino acid and plasma transfusion . Insulin can be guaranteed in the appropriate increase in carbohydrate intake to ensure adequate calories. Fat to use vegetable oil.
(2) drug treatment: oral hypoglycemic agent. For simple diet and oral hypoglycemic drug control has been poor and renal insufficiency patients using insulin should be as soon as possible. Insulin, blood glucose monitoring to timely adjust dosage.
2. Antihypertensive treatment:
Hypertension can accelerate the progress of diabetic nephropathy and deterioration to control the blood pressure level of diabetes than non-diabetic patients with hypertension lower diastolic blood pressure less than 75 mmHg. Should limit sodium intake, smoking, alcohol restrictions, reducing body weight and adequate exercise. First advocated more antihypertensive drug use of angiotensin-converting enzyme inhibitors, often combined with calcium antagonists, can be used as α1 receptor antagonist prazosin. Under appropriate conditions can be added using diuretics.

(B) dialysis treatment:
End-stage diabetic nephropathy patients can only receive dialysis treatment, there are two main ways: long-term hemodialysis and continuous ambulatory peritoneal dialysis. Recently the vast majority of end-stage patients with diabetic nephropathy to peritoneal dialysis, because it does not increase the heart load and stress, can better control of extracellular fluid volume and high blood pressure. Also intraperitoneal injection of insulin, convenient operation cost savings, but some long-term peritoneal dialysis patients absorb large amounts of glucose caused obesity and hyperlipidemia. On dialysis to the timing of earlier in the non-diabetic patients.

(C) renal or kidney pancreas transplantation:
Only a few patients can receive such treatment. Therefore diabetic nephropathy is the most fundamental measures to control diabetes, as far as possible to prevent the occurrence of diabetic nephropathy and development.
On the prevention and treatment of this disease, focusing on prevention, prevention lies in prevention, and correction of all risk factors, including blood glucose and blood pressure control, smoking cessation. In the stage of microalbuminuria, strict control of blood sugar can prevent the occurrence of nephropathy.

Hydronephrosis diagnosis based on clinical manifestations

1. Symptoms of the disease, such as pain stones, tumors hematuria, a urethral stricture voiding difficulties.

2. Water side of the waist pain.

3. Infection with chills, fever, pyuria.

4. Side waist cystic mass.

5. Bilateral obstruction in chronic renal insufficiency, and uremia.

Diagnosis

1. Low back pain, waist cystic mass.

2.B super: kidney volume increased cortical thinning, the real size of the dark areas.

3.X line Intravenous urography showed hydronephrosis.

4. Radionuclide renography, obstructive kidney Fig.

5. Ureteral retrograde intubation by angiography showed hydronephrosis.

Hydronephrosis

Since the beginning of urinary tract kidney until urethra, is a continuous pipeline system. Urine from the urinary tract depends on the pipeline open, and normal urinary function. Urinary any part of the pipeline, as well as stenosis or obstruction of the normal neuromuscular dysfunction, urine through obstacles can arise, causing urinary obstruction, urinary obstruction due to the above location from the sluggish pressure gradually increased lumen expansion, which eventually led to Renal water, and expansion of renal parenchymal thinning, renal dysfunction, if bilateral obstruction, a uremia serious consequences. Lead to urinary obstruction has many causes, can be congenital, such as the kidney, ureteropelvic junction stenosis, urethral valve, horseshoe kidney, acquired diseases such as stones, tumors, benign prostatic hyperplasia, such as bladder neck contracture. It can also be a urinary tract, or the fiber with obstruction caused mass oppression, such as retroperitoneal fibrosis, such as lymphoma. It can also be a urinary tract neuromuscular obstacles, such as megaureter disease. Obstruction and the acute and chronic, acute renal obstruction to complete loss of function in a short period of time, and hydronephrosis not very obvious. Chronic obstructive hydrocephalus can kidneys than 1000 ml. Once infected with hydronephrosis, obstruction if not promptly removed and difficult to cure infection, kidney infection and speed up the destruction of a vicious circle, and even renal abscess formation.

The prognosis of renal tuberculosis

The prognosis in renal tuberculosis widely used anti-TB drugs before and after the not the same. In the past era of free anti-TB drugs, if not renal tuberculosis drugs, not surgery cases from the clinical symptoms, the five-year survival of less than 30% survive 10 years less than 10 per cent and for the treatment of renal patients 55 ~ 60% of cases is expected to heal. In the application of anti-TB drugs after treatment the mortality rate has been less than 4%.

Affect the prognosis of renal tuberculosis following several factors:

(1) general condition and the urinary tract, renal tuberculosis TB situation if the body in good shape, tuberculosis, urinary tract stability, better treatment of renal tuberculosis. If the whole situation is not, the other organs are serious tuberculosis, renal tuberculosis mortality rate after surgery was significantly higher.

(B) the availability of bladder tuberculosis and tuberculosis change the severity of the bladder tuberculosis prognosis of the severity of the impact of the great. TB in the affected renal lesions of the bladder before nephrectomy, or ureteral obstruction in the early days of TB cases with renal kidney disease, the patient can resume all, not the sequels left urinary complications or cake. Himman that nephrectomy violations before the bladder is not tuberculosis, the five-year cure rate of 100 per cent, if and when the bladder was hacked, the 5-year survival rate dropped to 60%. According to the Shanghai Zhongshan Hospital renal tuberculosis follow-up of 207 cases observed nephrectomy, kidney disease resection of the bladder inflammation tuberculosis dissatisfaction after one year, 68.7% with satisfactory results, and has reached an inflammation to 6 years who are not satisfied with the situation after 53.6% . Clearly, TB cystitis time and the existence of the prognosis also has a great relationship. Actually suggested that the duration of inflammation inflammation of the bladder wall deep depth, representing bladder contraction opportunities.

(C) whether the contralateral kidney function and change the situation of TB TB nephrectomy patients, the contralateral kidney situation on the vital prognosis. In the use of anti-tuberculosis drugs before a group of 1,131 cases of TB cases nephrectomy statistics, the contralateral kidney normal urine microscopy, 65.2% in the five years to cure, 20.3 percent died; contralateral kidney animal urine Mycobacterium tuberculosis vaccination negative, 75.2% in the five years to cure, 13.3 percent died; contralateral kidney and urinary tuberculosis positive, while 21.8% in the five years to cure, 41.8% died. And in the application of anti-TB drugs after the situation has changed completely, bilateral renal tuberculosis cases five years mortality rate from 80 per cent to 8 per cent.

(4) the timing and accuracy of treatment with the continuous development of anti-TB drugs, the treatment of renal tuberculosis has changed significantly, the majority of cases can be cured by medication. Early diagnosis and timely treatment of the exact treatment of renal tuberculosis is the key. Treatment must be consistent with the requirements of specific situations can be achieved good results. Many scholars believe that the early urinary tuberculosis almost no long-term use of anti-tuberculosis drugs can not be cured. Foreign rare for urinary tract surgery dealing with tuberculosis, even drug therapy that can replace surgery. But this view is not appropriate. For some cases, such as non-functioning kidney function or renal tuberculosis side of the poor, or poor blood circulation, closed plug of empty, or lesions extensive damage serious lesions, anti-tuberculosis drugs can not enter the cases, surgery is required treatment. It is especially important to control TB cystitis compare the degree of light, inflammation, a relatively short time on the timing of renal tuberculosis STD timely surgical treatment can achieve a satisfactory result. For renal tuberculosis and late complications in the case, must also adopt surgery for treatment.