Renal cell carcinoma

Introduction to renal cell carcinoma Renal cancer is also known as renal cell carcinoma, renal adenocarcinoma, clear cell carcinoma, renal parenchymal carcinoma, etc. Renal parenchymal carcinoma is an adenocarcinoma derived from renal tubular epithelial cells, 85% is clear cell carcinoma, and some is granulosa cell carcinoma. Mixed cell cancer. The main complaints and clinical manifestations of patients with renal cancer are variable and easily misdiagnosed as other diseases. The location of the kidney is concealed, and the main connection with the outside world is urine. Therefore, hematuria is the most common condition for the discovery of renal cancer, but the appearance of hematuria must be possible after the tumor invades the renal pelvis, so it is not an early condition. For many years, hematuria, pain and lumps have been called the triple syndrome of kidney cancer. Most patients have one to two symptoms at the time of treatment, and the triads account for about 10%, and it is rarely possible to cure. basic knowledge The proportion of illness: 0.0002% Susceptible people: no specific population Mode of infection: non-infectious Complications: amyloidosis nephrotic syndrome libido amenorrhea hypercalcemia

Causes of renal cell carcinoma

Smoking (25%):

A large number of prospective observations have found that smoking is positively associated with kidney cancer. Relative risk factors for renal cancer (RR) = 2, and smokers who smoked for more than 30 years and who smoked filterless cigarettes have an increased risk of kidney cancer.

Obesity and high blood pressure (18%):

A prospective study published in the November 2, 2000 issue of the New England Journal of Medicine showed that high body mass index (BMI) and hypertension are two independent factors associated with increased risk of kidney cancer in men.

Environmental factors (15%):

Workers exposed to metal shops, newspaper printers, coke workers, dry cleaning and petrochemical workers have reported increased risk of kidney cancer morbidity and mortality.

The impact of radiation (10%):

There are statistics on 26 cases of 124 tumors caused by a weak alpha particle radiation source confined to the kidney, but there are no reports of radiation exposure and kidney cancer by radiologists and atomic bomb victims.

Genetic (8%):

There are some intra-renal kidney cancers that are found during chromosome examinations. The third pair of chromosomes in people with a high incidence of renal cancer are defective. Most familial renal cancers have an early onset age and tend to be multi-focal and bilateral. In a rare hereditary disease, hereditary canthile hamartoma (VHP), up to 28% to 45% of patients with kidney cancer.

Food and medicine (5%):

The survey found that high intake of dairy products, animal protein, fat, low intake of fruits, vegetables is a risk factor for kidney cancer. The risk that coffee may increase kidney cancer is not related to coffee consumption. In animal experiments, kidney cancer has been proven due to female hormones (estrogen), but there is no direct evidence in the human body. Abuse of antipyretic analgesics, especially those containing phenacetin, may increase the risk of renal cancer. Diuretics may also be a factor in promoting the development of kidney cancer. Through animal experiments, it was concluded that red vine grass, also known as thousand roots, may induce kidney cancer. The Korea Food and Drug Safety Agency has requested domestic companies to stop producing red vine grass food additives.

(two) pathogenesis

Renal cancer is often a single unilateral lesion, about 2% of which are bilateral or multifocal. The incidence of left and right sides is similar. Typical renal cancer is round and disparate. According to a group of 100 cases of renal cell carcinoma, the lesions are: There were 44 cases in the upper part, 41 cases in the lower part, and 15 cases in multiple lesions. The tumor had no histological capsule, but there was a pseudo-envelope formed by the compressed renal parenchyma and fibrous tissue. A few were yellow or brown, most of which were accompanied by hemorrhage and necrosis. Fibrotic plaque, hemorrhage, necrosis can form cystic, tumors can have calcifications in spots or plaques. Adolescent patients have more calcifications than renal cells in older patients. Tumors can destroy the whole kidney and invade adjacent adipose tissue. , muscle tissue, blood vessels, lymphatic vessels, etc., renal cancer is easy to expand into the vein to form a tumor thrombus, can enter the renal vein, inferior vena cava and even the right atrium, the perirenal fascia is a barrier to prevent local tumor spread, ipsilateral adrenal gland involvement 10%, distant metastasis is common in the lungs, brain, bone, liver, skin, thyroid and so on.

Renal cancer tissues and cells are diverse, and the gross specimens can be solid flaky, trabecular, papillary, honeycomb, glandular tubular. The typical kidney cancer cells are transparent cells, which are polygonal, cuboidal or columnar. The cell diameter is 10-40 m. Because the cytoplasm contains glycogen and lipid, HE stains the cytoplasm transparent or vacuole. The lipid contained in the cytoplasm is mainly phosphonate and neutral lipid. Hale colloidal iron staining electron microscopic observation, Visible micro-villi development and cytoplasmic vesicle formation, small and regular nucleus, a few mitosis, kidney cancer as granulosa cells, its cytoplasm is glassy, uniform, cell and nuclear size are different, mitotic figures are more common, Most of the renal cancers are clear cells, and there are also granulosa cells. Some kidney cancers are spindle cells, which are difficult to distinguish from fibrosarcoma. The clear cells in the tumor of kidney cancer, granulosa cells or spindle cells can exist alone or in combination.

Pathological grade of renal cancer: The renal morphological grading system proposed by Fuhrman et al. (1982) has been accepted and adopted by most scholars in the world.

The classification according to the shape and size of the nucleus has the advantages of standard and easy to grasp. When there are different grades of cells in the same tumor or in the same region, the highest grade of cancer cells is the final classification of pathological diagnosis. For example, most cells are G2, and a few tumors with G3 should be designated as G3.

Staging: Renal cancer staging is not uniform, and it is currently widely used in Robson's staging and TNM staging.

Robson staging:

Stage I: The tumor is confined to the renal capsule.

Stage II: The tumor penetrates the renal capsule and invades the fat around the kidney, but is confined to the renal fascia. The renal vein and local lymph nodes are not infiltrated.

Stage III: The tumor invades the renal vein or local lymph nodes, with or without the inferior vena cava, and the fat around the kidney is involved.

Stage IV: distant metastasis or invasion of adjacent organs.

The above is a simplified Robson staging, which is easy to apply. The disadvantage is that the prognosis of II and III is the same. The TNM staging proposed by the International Anticancer Association in 1987 is as follows.

TNM staging:

T0: no primary tumor.

T1: The maximum diameter of the tumor is 2.5 cm, which is confined within the renal capsule.

T2: The maximum diameter of the tumor is >2.5 cm, which is confined within the renal capsule.

T3: The tumor invades the large blood vessels, the adrenal gland and the surrounding tissues of the kidney, and is confined within the renal fascia.

T3a: Invades the periplasmic adipose tissue or adrenal gland.

T3b: Invades the renal vein or inferior vena cava.

T4: Invades the renal fascia.

N0: no lymph node metastasis.

Nl: single, unilateral lymph node metastasis, maximum diameter 2.5 cm.

N2: multiple local lymph node metastasis, or a single lymph node with a maximum diameter of 2 to 5 cm.

N3: The maximum diameter of the locally metastatic lymph nodes exceeds 5 cm.

M1: Transfer in the distance.

Renal cell carcinoma prevention

Primary prevention

Quit smoking and drinking hobbies, establish good living habits, conduct regular and moderate physical exercise, and strictly protect personnel exposed to cadmium industrial environment.

(1) quit smoking, do not drink alcohol.

(2) Use antipyretics with caution, such as phenacetin.

(3) Kidney diseases such as kidney cysts should be actively treated.

(4) Regularly participate in physical exercise, balance diet, increase nutrition, maintain a happy mood, and increase immunity.

(5) Regularly eat foods that have anti-cancer and anti-cancer effects.

2. Secondary prevention

The census is one of the early methods for the detection of renal tumors. It uses a simple B-ultrasound examination method. It has a fast blood sedimentation, high blood calcium, and anemia should be further examined. The main complaints and clinical manifestations of renal cancer patients are variable, and the kidney position is concealed. Self-diagnosis, self-examination caused difficulties, hematuria is the most common symptom of renal tumors, often painless, intermittent whole blood urine, pay attention to the hematuria in the elderly is often considered to be caused by benign prostatic hyperplasia and stones, should be alert to the possibility of kidney cancer Hematuria with low back pain and mass accounted for only 10% of renal tumors. It should be alert to extra-renal manifestations such as fever, hypertension, hypercalcemia, erythrocyte sedimentation rate, anemia, abnormal liver function, weight loss, erythrocytosis and supine position. The left varicocele that does not disappear has renal cancer. It should be treated promptly, and regular health checkups should be made, especially for those who have history of exposure to carcinogenic mutagens, focusing on blood and urine routines, and B-ultrasound examination of the kidneys. Tumors with a diameter of less than 1 cm can be detected early. Once kidney cancer is discovered, surgical resection should be performed as soon as possible. Radical nephrectomy includes resection of the perirenal fascia, fat, adrenal gland. And lymphoid tissue in the ureter, renal vein and inferior vena cava tumor thrombus should be removed, kidney cancer chemotherapy and the use of poor efficacy of radiotherapy, immunotherapy has a certain effect.

3. Three levels of prevention

Patients with advanced stage may have cachexia, local pain is obvious, and intratumoral hemorrhage causes severe anemia. Supportive therapy, blood transfusion, intravenous high nutrition, palliative nephrectomy or selective regional intra-arterial chemotherapy plus embolization may be used for severe bleeding, pain and Extra-tumor syndrome, surrounding organs are stressed, symptomatic treatment such as pain relief reduces patient suffering and prolongs patient life.

Renal cell carcinoma complications Complications amyloid nephrotic syndrome, libido, amenorrhea, hypercalcemia

Often secondary polycythemia occurs. Renal cell tumors often metastasize the lungs, bones, liver, etc. There are also many non-urinary extrarenal manifestations such as high fever, abnormal liver function, anemia, hypertension, polycythemia and high Calcemia, etc., the most serious complication is death.

A small number of kidney cancers are associated with increased gonadotropin, which causes enlargement of the mammary glands in the male, atrophy of the areola and loss of libido, and women with hairy and amenorrhea.

1. Secondary amyloidosis occurs in patients with renal cell carcinoma. Amyloidosis itself can cause renal failure. Patients with renal cell carcinoma secondary to amyloidosis have poor prognosis. Proteinuria and nephropathy can also occur in patients with renal cell carcinoma. Syndrome.

2. Renal cell carcinoma often occurs with multiple organ tumors.

Renal cell cancer symptoms Common symptoms Low back pain with kidney area sputum pain Lower abdomen mass Lower abdomen dull pain and soreness Hypercalcemia Weak hemoptysis Weight loss

1. Hematuria: Hematuria is often a painless intermittent episode of visible hematuria in the whole eye, and the intermittent period is shortened as the lesion progresses. Renal cancer may be accompanied by renal colic for a long time, often caused by a blood clot through the ureter. Blood clots of hematological nephrosis may form strips through the ureter. The degree of hematuria is independent of the size of the kidney cancer. Kidney cancer can sometimes manifest as persistent microscopic hematuria.

2. Low back pain: Low back pain is another common symptom of kidney cancer. Most of them are dull pain, which is limited to the waist. The pain is often caused by the swelling of the tumor and the kidney capsule is inflated. The blood clot can also cause low back pain through the ureter. The tumor is heavier and persistent when it invades the surrounding organs and the psoas.

3. Tumor: The mass is also a common symptom. About 1/3 to 1/4 of patients with kidney cancer can find a swollen kidney when they see a doctor. The position of the kidney is more subtle, and the tumor is difficult to find before the kidney cancer reaches a considerable volume. Generally, the abdomen touched the mass and it is a late symptom.

4. Pain: Pain is found in about 50% of cases, and is also a late symptom, which is caused by a tumor that is gradually growing up in the renal capsule or renal pelvis, or because of tumor invasion, compression of the connective tissue, muscle, lumbar spine or lumbar nerve. Caused by the affected side of the waist sustained pain.

5. Whole body performance:

(1). Fever: a pyrogen in the tumor tissue.

Color blood flow map of kidney cancer (2). Hypertension: tumor compression of blood vessels, tumor short circuit in the tumor, etc.

(3). ESR is accelerated.

(4). Anemia: serum iron and serum transferrin, iron enters cancer cells. The incidence rate is 30~50%.

(5). Polycythemia: Hb>155g/L, hematocrit>50%

(6). Varicocele: There is a tumor thrombus in the renal vein.

6. Other symptoms: fever of unknown cause, or metastasis when just found, fatigue, weight loss, loss of appetite, anemia, cough and hemoptysis. In addition, the role of renal adenocarcinoma is caused by tumor endocrine activity, including polycythemia, hypertension, hypotension, hypercalcemia, and fever syndrome. Although these systemic, toxic, and endocrine effects are non-specific, approximately 30% of patients first have a mixed appearance. This is a valuable clue that is considered a systemic effect of the tumor.

Renal cell carcinoma examination

1. General inspection:

Hematuria is an important symptom, and polycythemia often occurs in 3% to 4%; progressive anemia can also occur. In bilateral renal tumors, total renal function usually does not change and erythrocyte sedimentation rate increases. Some patients with kidney cancer do not have bone metastases, but may have symptoms of hypercalcemia and increased serum calcium levels. Symptoms are quickly relieved after renal cancer resection, and blood calcium returns to normal. Sometimes it can progress to liver dysfunction, such as tumor nephrectomy, can return to normal.

2. X-ray angiography is the main means of diagnosing kidney cancer

(1) X-ray film: X-ray film can see the shape of the kidney is enlarged, the contour is changed, occasional tumor calcification, limited or extensive flocculation in the tumor, can also become a calcification line around the tumor, shell It is more common in young people with kidney cancer.

(2) intravenous urography, intravenous urography is a routine examination method, because it can not show the tumor that has not caused kidney and kidney sputum undeformed, and it is difficult to distinguish whether the tumor is kidney cancer. Renal angiomyolipoma, a renal cyst, is therefore of decreasing importance and must be further identified by ultrasound or CT. However, intravenous urography can understand the function of bilateral kidneys and the ureter and ureter and urinary tract of the renal pelvis, which has important reference value for diagnosis.

(3) renal angiography: renal angiography can be found in urinary tract angiography undeformed tumors, renal cancer showed neovascularization, arteriovenous fistula, contrast pooling (Pooling) envelope vascularization. Angiographic variation is large, and sometimes kidney cancer may not be developed, such as tumor necrosis, cystic changes, arterial embolism, and the like. Renal artery angiography may inject normal adrenaline vasoconstriction into the renal artery and the tumor blood vessels are unresponsive.

In the relatively large kidney cancer. Renal artery embolization can also be performed during selective renal angiography, which can reduce renal hemorrhage in patients with hemorrhagic renal cell carcinoma and can be treated with renal artery embolization as a palliative treatment.

3. Ultrasound scan:

Ultrasound is the easiest and most non-invasive method of examination and can be used as part of a routine physical examination. More than 1cm of mass in the kidney can be found by ultrasound scan. It is important to identify whether the tumor is kidney cancer. Kidney cancer is a solid mass. Because of the possible internal hemorrhage, necrosis and cystic changes, the echo is not uniform, generally low echo, and the state of kidney cancer is not clear. This is different from renal cyst. Intrarenal space-occupying lesions may cause renal pelvis, renal pelvis, renal sinus fat deformation or fracture. Ultrasound examination of renal papillary cystadenocarcinoma resembles a cyst and may have calcification. When kidney cancer and cysts are difficult to identify, they can be punctured. It is safe to puncture under ultrasound guidance. Puncture fluid can be used for cytology and cystoscopy. The cyst fluid is often clear, no tumor cells, low fat, and the smooth wall of the cyst can be definitely a benign lesion. If the puncture fluid is bloody, the tumor should be thought of, and the tumor cells may be found in the extract solution. The tumor wall may be diagnosed as a malignant tumor when the stenosis is not smooth. Renal angiomyolipoma is a solid intratumoral tumor, and its ultrasound manifests as a strong echo of adipose tissue, which is easily differentiated from renal cancer. When ultrasound examination reveals kidney cancer, it should also pay attention to whether the tumor penetrates the capsule, perirenal adipose tissue, with or without enlarged lymph nodes, whether there is a tumor thrombus in the renal vein or inferior vena cava, and whether the liver has metastasis or the like.

4. CT scan:

CT plays an important role in the diagnosis of renal cell carcinoma. It can be found in kidney cancer that does not cause renal pelvis and renal pelvis change. It can accurately measure tumor density and can be performed in outpatient clinics. CT can be accurately staged. Some people have statistically diagnosed the diagnosis: invading the renal vein 91%, spreading around the kidney 78%, lymph node metastasis 87%, and nearby organ involvement 96%. CT examination of renal cancer is characterized by a mass in the renal parenchyma, which can also be prominent in the renal parenchyma. The mass is round, round or lobulated, with clear or blurred borders. Soft tissue blocks with uneven density during plain scan, CT value> 20Hu, often between 30 ~ 50Hu, slightly higher than the normal renal parenchyma, can also be similar or slightly lower, and its internal heterogeneity is caused by hemorrhagic necrosis or calcification. Sometimes it can be expressed as a cystic CT value but with a soft tissue nodule on the wall. After intravenous injection of contrast agent, the CT value of normal renal parenchyma is about 120Hu, and the CT value of the tumor is also increased, but it is significantly lower than the normal renal parenchyma, which makes the tumor boundary clearer. If the CT value of the tumor does not change after the enhancement, it may be a cyst. The CT value before and after the injection of the contrast agent can be used to determine the diagnosis. After necrosis of renal cancer, renal cystic adenocarcinoma, and renal artery embolization, the CT value did not increase after the injection of contrast agent. Renal angiomyolipoma due to its large amount of fat, CT value is often negative, internal unevenness, enhanced CT value, but still showed fat density, eosinophils edge clear CT, internal density Uniform and enhanced CT values increased significantly.

CT examination determines the criteria for the extent of renal cancer invasion.

(1) The mass is confined to the renal capsule: the shape of the kidney is normal or limited, or evenly enlarged. The protruding surface is smooth or slightly rough. For example, the mass protrudes into the renal sac in a nodular shape, and the smooth surface is still considered to be confined in the renal capsule. The fat capsule is clear, and the perirenal fascia has no irregular thickening. Can not use the presence of fat sac to determine whether the tumor is confined within the renal fascia, especially in patients with wasting.

(2) Limited in the peri-renal invasion of the fat sac: the tumor protrudes and replaces the local normal renal parenchyma, the renal surface is rough, and the renal fascia is irregularly thickened. There are soft tissue nodules with unclear borders in the fat sac, and linear soft tissue shadows are not diagnosed.

(3) Intravenous invasion: the renal vein is thickened into a local fusiform bulging, the density is uneven, abnormally increased or decreased, and the density changes are the same as the tumor tissue. The standard for venous thickening, renal vein diameter > 0.5 cm, upper abdominal inferior vena cava diameter > 2.7 cm.

(4) Lymph node invasion: renal pedicle, abdominal aorta, inferior vena cava and a round soft tissue shadow between them. After the enhancement, the density change is not significant, and it can be considered as a lymph node. If the patient is <1cm, no diagnosis is made, and lcm is considered as metastatic cancer.

(5) Invasion of adjacent organs: the boundary between the mass and the adjacent organs disappears and the morphology and density of adjacent organs change. If it is simply manifested as the disappearance of fat line between the tumor and adjacent organs, no diagnosis is made.

(6) Infiltration of renal pelvis: The edge of the tumor into the renal pelvis is smooth and round, and the arc is compressed in half a month. The delayed scanning shows that the edge of the contrast agent in the compressed renal pelvis is smooth and tidy, which is considered to be pyelonephritis. It is simply stressed. If the structure of the renal pelvis and renal pelvis disappears or occludes and is completely occupied by the tumor, it indicates that the tumor has penetrated the renal pelvis.

5. Magnetic resonance imaging (MRI):

MRI is ideal for examining the kidneys. Fat in the renal and perirenal spaces produces high signal intensity. The outer cortex of the kidney is high in signal intensity, and the middle medulla is low in signal intensity. It may be due to different osmotic pressure in the renal tissue. The difference in contrast between the two parts is 50%. This difference can be reduced with the recovery time and hydration. The renal artery And the vein has no intracavitary signal, so it is low intensity. The collection system has urine for low intensity. The MRI variation of renal cell carcinoma is large, determined by tumor blood vessels, size, and necrosis. MRI does not find calcification well because of its low proton density. MRI can be easily found in the extent of renal cancer invasion, surrounding tissue envelope, liver, mesentery and psoas. In particular, renal cancer has renal vein, inferior vena cava tumor thrombus and lymph node metastasis.

Diagnosis and diagnosis of renal cell carcinoma

diagnosis

Diagnosis can be based on medical history, clinical symptoms, and laboratory findings.

Differential diagnosis

1. Renal cysts: Typical renal cysts are easily differentiated from renal cancer from imaging examinations. However, when there is bleeding or infection in the cyst, it is often misdiagnosed as a tumor, and some renal clear cell carcinomas are uniform inside and weak. The low echo is easily misdiagnosed as a very common renal cyst during physical examination screening. Cloix reported 32 cases of complex cystic space of the kidney and found that 41 of them were kidney cancer, irregular thickening of the wall. Benign renal cysts with high central density are difficult to identify by any of the above-mentioned methods. It is often necessary to conduct comprehensive analysis and judgment. If necessary, the biopsy can be performed under the guidance of B-ultrasound, and the follow-up or recklessness can be easily abandoned. Surgery is not advisable, manifested as low back pain, lumps, but no severe hematuria, contact with cystic mass, urinary tract flat film showing eggshell-like or stripe-like calcification, IVU (intravenous urinary angiography) Renal parenchymal space-occupying lesions, renal angiographic lesions are smooth avascular regions, and the surrounding vessels are curved and curved. Ultrasound examination reveals a round, non-echo dark border with clear boundaries in the renal parenchyma. .

2. Renal hamartoma: also known as renal angiomyolipoma, is a relatively common benign tumor of the kidney. With the widespread development of imaging studies, it is more and more common in clinical, typical fatomas due to fat components. The presence of B-ultrasound, CT and MRI images can be qualitatively diagnosed, clinically easy to distinguish with renal cell carcinoma, renal hamartoma B-ultrasound showed a medium-strong echogenic area, CT showed CT value in the mass The area with negative number is still negative after the enhanced scan. Angiography shows that the tumor blood vessels contract with the blood vessels of the kidney itself after injection of adrenaline. The B-ultrasound of renal cell carcinoma is a low-intensity echo, and the CT value of the tumor is lower than that of normal renal parenchyma. After the enhanced scan, the CT value increased, but it was not as obvious as normal kidney tissue. Angiography showed that the kidney itself vasoconstricted after injection of adrenaline, but the tumor blood vessels did not shrink, and the tumor blood vessel characteristics were more obvious.

It can be seen that the distinguishing point between renal cancer and renal hamartoma is that there is no adipose tissue in the renal cancer and adipose tissue in the hamartoma, but in a few cases, the renal cell carcinoma tissue also contains adipose tissue, which causes misdiagnosis. In addition, it is not uncommon for a hamartoma with few fat components to be misdiagnosed as renal cancer. Of the 49 patients with hamartoma admitted to our hospital from 1984 to 1996, 11 were hypoechoic due to preoperative B-mode ultrasound and/or CT is diagnosed as renal cancer for medium-high-density masses. The causes of misdiagnosis are: some hamartomas are mainly composed of smooth muscle, and there are few fat components; intratumoral hemorrhage, covering up fat components, causing B-ultrasound and CT to be indistinguishable; The volume is small, due to the volume effect, CT is difficult to measure the true density of the tumor. In this case, adding a thin layer of CT scan, if necessary, B-ultrasound guided needle cytology can be helpful for diagnosis, and some authors believe that The CT features of hamartomabial hemorrhage masking adipose tissue are significant, but the interference with B-ultrasound results is less.

3. Renal lymphoma: Renal lymphoma is rare but not uncommon. Dimopoulos et al reported that 6 of 210 patients with renal tumors had primary renal lymphoma, and renal lymphoma was characterized by a lack of imaging. Nodular or diffuse moistening of the kidneys, the shape of the kidney is enlarged, and the retroperitoneal lymph nodes are often involved. Of the 4 patients admitted to our hospital in recent years, 3 patients were not diagnosed before surgery, and the other 1 confirmed the disease by preoperative biopsy. .

4. Kidney yellow granuloma: It is a rare type of severe chronic renal parenchymal infection. There are two manifestations in morphology: one is diffuse, the kidney is enlarged, the shape is abnormal, the internal structure is disordered, and it is not easy to Tumor confusion; the other is focal, the kidney has limited localized nodular echo, lack of specificity, sometimes difficult to identify with the tumor, but this part of the patient generally has symptoms of infection, the kidney area can be tender There are a lot of white blood cells or pus cells in the urine. As long as you look closely, the differential diagnosis is not difficult.

5. Renal sputum cancer can also appear intermittent painless full-length gross hematuria, but the degree is heavier and occurs early and frequently. IVU and retrograde angiography show that the renal pelvis has irregular filling defects, and the size and shape of the kidneys have no obvious changes. There is no rotation of the kidney axis, and a new organism that protrudes into the renal pelvis cavity can be seen by a renal pelvis examination. Tumor cells are found in urine exfoliated cells.

6. Renal angiomyolipoma may have low back pain, waist and abdomen mass and hematuria, urinary tract plain film can be seen in irregular low-density area; ultrasonography is a number of evenly distributed intense light spots; renal angiography is due to its tissue density Differently arranged in layers of onion skin, CT examination showed a mass with uneven density, containing more fat, CT value -40 ~ -90Hu, the tumor is prone to spontaneous rupture and bleeding caused by sudden severe hematuria or shock.

7. Adult renal embryonic tumors show low back pain and mass, but the mass grows rapidly. Most of the patients have abdominal mass as the main symptom, and hematuria is less serious. Retrograde pyelography shows that the renal pelvis and renal pelvis often disappear due to tumor destruction. Ultrasound examination It is a small scattered light spot whose brightness is equal to or slightly stronger than the echo of the renal cortex.

8. Perirenal cysts are characterized by low back pain, mass and high blood pressure, but they have a history of lumbar trauma or kidney surgery. The edge of the mass is unclear. IVU shows that the kidney is shrinking, shifting outward and upward, accompanied by poor rotation and renal pelvis shift. The contrast agent spills into the cyst to form a cloud-like image.

9. Polycystic kidney low back pain, mass and hematuria are similar to this disease, but the lesion is bilateral, hypertension and renal function damage are more common, IVU shows a significant increase in renal shadow, renal pelvis is generally separated and stretched with multiple edges Smooth curved indentation, ultrasonography showed that the kidneys were enlarged, the contour was wavy, and the renal parenchyma was scattered in circular liquid dark areas of different sizes, and they did not communicate with each other. CT examination showed that the kidney parenchyma was full of size. a cystic low density zone.

10. Inferior subcapsular hematoma in addition to the tumor, low fever and hematuria, as well as the primary disease such as renal arteriosclerosis, renal infarction, renal trauma, etc., the onset of rapid disease, the bleeding volume can occur in shock, IVU visible The kidney and ureter are under pressure.

11. The clinical manifestations of renal abscess are low back pain, renal enlargement, but fever, obvious sputum pain in the kidney area, increased white blood cells, IVU visible renal pelvis deformation and displacement, but renal angiography without tumor blood vessels, central avascular area The proliferating blood vessels are surrounded, the subcapsular vasodilatation is distorted, and the marginal venous return is seen in the venous phase. The CT examination shows a circular low-density area with clear intrarenal boundary. The CT value is 10~25Hu, and the thick wall can be seen after the enhanced scan. The strengthening ring is the wall of the abscess.

12. Fake spider-like renal pelvis IVU also showed renal enlargement, renal enlargement, widening of the pupil distance, but the patient had no back pain, hematuria, lumps, etc. Ultrasound examination showed no abnormalities except renal long axis growth, kidney Arterial angiography showed normal blood vessels at all levels.

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