Lipoma Of The Kidney - Causes, Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Lipoma of the kidney

A kidney lipoma is a benign tumor made up of adipose tissue, muscles, and blood vessels. The neoplasm originates from the original connective tissue of the organ (mesenchyme). The lipoma is surrounded by a capsule of fibrous membrane, this capsule separates the tumor from the kidney itself. Since the lipoma of the kidney, unlike most lipomas of other localization, has blood vessels, it is called angiolipoma.

The tumor can be microscopic, or it can reach a very impressive size (up to 20 cm in diameter). More often, kidney lipoma is diagnosed in women than in men. In 75% of cases, the neoplasm affects only one organ.

Lipoma can develop on the kidney as a single neoplasm, or it can be combined with other tumors or pathologies of the urinary system.

In 88% of cases, kidney lipomas spread beyond the fibrous capsule of the organ. They are able to grow into the renal vein, into the perirenal lymph nodes, into the inferior vena cava.

If the lipoma is growing rapidly, then this is an indication for its urgent removal. Such tumors can be life-threatening. In most cases, the patient learns about a kidney lipoma by chance, during an ultrasound scan. Until the moment, until the tumor reaches a large size, it will exist absolutely asymptomatic.

Content:

• Reasons for the formation of kidney lipoma
• Kidney lipoma symptoms
• Diagnostics
• Kidney lipoma treatment
• Disease prognosis

Reasons for the formation of kidney lipoma

Until now, scientists have not figured out the exact cause of the formation of a lipoma on the kidney. Experts tend to consider this pathology multifactorial, that is, multiple causes will lead to its occurrence.

There are two forms of kidney lipoma:

• An isolated tumor that occurs in 90% of cases.
• A tumor associated with tuberous sclerosis, which occurs in 10% of cases. This pathology is also called Bourneville-Pringle disease. If the reasons for the formation of an isolated lipoma of the kidney remain in question, then the lipoma of the kidney against the background of Bourneville-Pringle disease is a genetic disease. It is inherited in an autosomal dominant manner. The prevalence of the disease among newborns varies from 5 to 7 cases per 100 thousand children. At the same time, patients have multiple bilateral small lipomas on the kidneys, which consist of connective tissues, fat and epithelium. Large lipomas in Bourneville-Pringle disease are less commonly diagnosed.

Scientists suggest that the following factors can play a role in the formation of an isolated kidney lipoma:

• Chronic inflammatory diseases of the genitourinary system.
• Cancer of the kidneys.
• Pregnancy. Angiolipomas in pregnant women develop due to a sharp increase in the level of estrogen and progesterone in the blood.
• Radiation exposure.
• Smoking, drug use, alcoholism.
• Obesity and diabetes.

Kidney lipoma symptoms

At the initial stages of development, the kidney lipoma does not give itself out in any way. Moreover, a person can live for many years without knowing about the tumor existing in his body. Nevertheless, a lipoma, like other benign neoplasms, tends to grow slowly, and upon reaching a certain size, it begins to give a certain set of symptoms. As a rule, this occurs after the lipoma exceeds 4 cm in diameter.

In this case, up to 80% of patients complain of characteristic symptoms:

• Dull back pain bothers up to 44% of them. The pain is caused by the pressure of the tumor on the nerve fibers that penetrate the surrounding tissue.
• Sharp, sudden pain in the abdomen and in the lumbar region are observed in 56% of patients.
• If the tumor reaches an impressive size, it can be palpated.
• There may be blood in the urine. Most often, hematuria develops due to the clamping of the growing tumor of the ureter. At the same time, a person begins to experience pain when emptying the bladder.
• Swelling of the limbs.
• Increased blood pressure. Against the background of surges in blood pressure, dizziness, general weakness, and short-term loss of consciousness are observed. A persistent increase in blood pressure is caused by compression of the veins and arteries that feed the kidney tissue.
• When a tumor ruptures, a clinic of acute abdomen with hemorrhagic shock (severe pain, hematuria, a complex of gastrointestinal symptoms) is observed.
• Acute unbearable pain may indicate a kidney infarction or hemorrhage in a lipoma.

Lipoma of the kidney can be complicated by rupture of its vessels. This is due to the fact that muscles grow faster than blood vessels, although damage to the integrity of the neoplasm capsule is not excluded, even with its small size.

Diagnostics

Lipoma can be found on kidney ultrasound. It is this method that plays a leading role in identifying neoplasms. During the examination, the doctor visualizes a homogeneous tumor that is limited to the renal parenchyma. The structure of the renal renal pelvis will be disrupted. The degree of abnormality depends on the size of the tumor.

Computed tomography for the diagnosis of kidney lipoma is a more informative method. The doctor gets the opportunity to objectively assess the neoplasm. The picture will show the structure of the tumor, all the vessels feeding it, areas of high and low density.

MRI of the kidneys is one of the more expensive research methods, so it is used less often when the doctor has doubts about the correctness of the diagnosis. MRI allows you to examine the lipoma in detail in different planes.

Angiography is performed to clarify tumor vascularization. The picture will clearly show the vessels that feed the lipoma. This research is necessary before the forthcoming operation.

Puncture biopsy is the only method that makes it possible to make a 100% correct diagnosis. The collection of tumor tissues for histological analysis allows to reveal the nature of cells and exclude the presence of a malignant tumor. A biopsy is taken only during lipoma removal surgery.

Kidney lipoma treatment

Kidney lipoma does not always require surgery. Often, the doctor chooses a wait and see approach. Small neoplasms do not disrupt the functioning of the organ, do not provoke the development of complications. Therefore, under the condition of slow growth of the lipoma, dynamic observation is possible. To do this, the patient must undergo an ultrasound of the kidneys at least once every six months. It is also important to take a urine test to determine if it contains blood impurities. The patient must independently control blood pressure. Patients with kidney lipoma need to undergo CT scan once a year.

As for drug therapy, it is ineffective in terms of treating kidney lipoma. If the patient is being prepared for the operation, then before it is possible to take drugs that reduce the intensity of pain, as well as drugs that lower blood pressure.

The operation is resorted to when the tumor exceeds 4 cm in diameter.

Other indications for surgical removal of the neoplasm:

• The rapid increase in lipoma in size.
• Development of renal failure.
• Lipoma rupture or kidney infarction.
• High risk of developing internal bleeding.

Surgical intervention is the only method that allows you to get rid of the tumor permanently.

Types of operations that can be performed to remove a neoplasm:

• Resection. During the operation, the surgeon removes only the lipoma itself and part of the organ. Resection can be performed using the classic method, when the doctor makes an incision in the back with a scalpel to gain access to the affected kidney. This procedure is associated with high risks of bleeding and requires a long rehabilitation period. Also, resection can be performed using endoscopic equipment. This is a less traumatic operation in which several small incisions are made.
• Nephrectomy. Nephrectomy involves the complete removal of the kidney along with the tumor. This operation is performed when the patient arrives in a serious condition, for example, with a ruptured lipoma of a large size or with a kidney infarction.
• Embolization. It is a new treatment for renal lipoma, which is supplied with blood vessels. During the operation, the doctor blocks the vessel feeding the tumor. For this, he injects a special drug into the artery that blocks the lumen of the vessel. Lipoma ceases to receive the substances necessary for its growth and development, which leads to its gradual decrease in size.

Embolization is not used when the kidney lipoma is mainly represented by fat cells and has a weak blood supply. In general, as an independent method of treating lipoma, embolization is rarely used. It is indicated for patients with large neoplasms as a preparatory stage for the upcoming resection. By overlapping the supply, the tumor will decrease in size, and then a radical operation can be carried out with less losses for the patient.

Disease prognosis

The prognosis for patients with kidney lipoma is favorable. The tumor is benign and incapable of malignancy. Most often, it tends to grow slowly, which avoids lifelong surgery.

As for the prevention of neoplasms, there are no specific recommendations on this matter, since the exact cause of the formation of renal lipoma has not yet been established. Therefore, all the advice that experts give on this matter comes down to maintaining a healthy lifestyle, giving up bad habits and timely treatment of diseases of the urinary system.

The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist

Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.