Acquired Cystic Kidney Disease Clinical Presentation

  • Author: Dwarakanathan Ranganathan, MD, FRCP, FRACP; Chief Editor: Vecihi Batuman, MD, FACP, FASN   more...
 
Updated: Nov 22, 2010
 

History

Acquired renal cystic disease has been described in nearly every type of renal disease that causes progressive renal insufficiency, with the exception of hereditary cystic disorders. The incidence, the number, and the size correlate to the number of years the patient is on dialysis.

Acquired renal cystic disease is reversible in some patients after successful renal transplantation. Some native kidneys continue to develop cysts after transplantation, and in these patients, renal function conceivably remains significantly compromised, thereby maintaining the cystogenic state.

Occasionally, the disease manifests with severe retroperitoneal or intrarenal hemorrhage, with or without hematuria, flank pain, renal colic, cyst infection, erythrocytosis, or distant metastasis from a malignant renal neoplasm.

Renal cell carcinoma is the most serious complication of acquired renal cystic disease. Cysts do not develop in other organs, in contrast to autosomal dominant polycystic kidney disease (ADPKD).

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Physical

Acquired renal cystic disease is usually bilateral. The kidneys are rarely palpable but may become palpable after a bleed.

Table. Comparison of Findings in ARCD Versus ADPKD (Open Table in a new window)

Findings ARCD ADPKD
Kidney sizeUsually not increased; may be decreased because of the advanced renal diseaseIncreased
Location of cystsCortex and medullaCortex and medulla
Corticomedullary differentiation*PossibleNot possible
Normal parenchyma between cysts*YesNo
Extrarenal cysts (eg, liver, pancreas)NoYes
Positive family historyNoYes
*On ultrasonography
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Causes

The severity and the duration of azotemia appear to be the critical factors in determining the extent of cyst development.

The causes of multiple renal cysts include the following:

  • Autosomal dominant polycystic kidney disease
  • Autosomal recessive polycystic kidney disease
  • Multicystic renal dysplasia
  • Acquired renal cystic disease
  • Simple renal cysts
  • Medullary sponge kidney
  • Familial juvenile nephronophthisis/medullary cystic disease
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Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Dwarakanathan Ranganathan, MD, FRCP, FRACP  Senior Lecturer, Graduate Medical School, Department of Renal Medicine, University of Queensland; Senior Consultant Nephrologist, Royal Brisbane and Women's Hospital, Australia

Dwarakanathan Ranganathan, MD, FRCP, FRACP is a member of the following medical societies: American Society of Nephrology, Australia and New Zealand Society of Nephrology, Indian Society of Nephrology, International Society for Peritoneal Dialysis, International Society of Nephrology, and Transplantation Society

Disclosure: Nothing to disclose.

Specialty Editor Board

James W Lohr, MD  Professor, Department of Internal Medicine, Division of Nephrology, Fellowship Program Director, University of Buffalo State University of New York School of Medicine and Biomedical Sciences

James W Lohr, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Society of Nephrology, and Central Society for Clinical Research

Disclosure: Genzyme Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

George R Aronoff, MD  Director, Professor, Departments of Internal Medicine and Pharmacology, Section of Nephrology, Kidney Disease Program, University of Louisville School of Medicine

George R Aronoff, MD is a member of the following medical societies: American Federation for Medical Research, American Society of Nephrology, Kentucky Medical Association, and National Kidney Foundation

Disclosure: Nothing to disclose.

Rebecca J Schmidt, DO, FACP, FASN  Professor of Medicine, Section Chief, Department of Medicine, Section of Nephrology, West Virginia University School of Medicine

Rebecca J Schmidt, DO, FACP, FASN is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Nephrology, International Society of Nephrology, National Kidney Foundation, Renal Physicians Association, and West Virginia State Medical Association

Disclosure: Renal Ventures Ownership interest Other

Chief Editor

Vecihi Batuman, MD, FACP, FASN  Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Medicine Service, Southeast Louisiana Veterans Health Care System

Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, and International Society of Nephrology

Disclosure: Nothing to disclose.

References

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Acquired cystic kidney disease. Patient with end-stage renal disease (ESRD) on maintenance hemodialysis presented with macrohematuria. Ultrasonogram showing numerous cysts in the right kidney and previous cysts in the left kidney.
Acquired cystic kidney disease. A 39-year-old man on dialysis for longer than 10 years with acquired renal cystic disease (ARCD). CT scan showed a mass in the lower pole of the right kidney. Fine-needle aspiration cytology (FNAC) of the lesion showed renal cell carcinoma. The patient underwent nephrectomy.
Acquired cystic kidney disease. A 66-year-old man with acquired renal cystic disease (ARCD) had a mass in the lower pole of the right kidney. CT-guided biopsy proved the mass to be renal cell carcinoma. This patient also had type II dissection of the aorta.
Table. Comparison of Findings in ARCD Versus ADPKD
Findings ARCD ADPKD
Kidney sizeUsually not increased; may be decreased because of the advanced renal diseaseIncreased
Location of cystsCortex and medullaCortex and medulla
Corticomedullary differentiation*PossibleNot possible
Normal parenchyma between cysts*YesNo
Extrarenal cysts (eg, liver, pancreas)NoYes
Positive family historyNoYes
*On ultrasonography
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