Acquired Cystic Kidney Disease Follow-up
- Author: Dwarakanathan Ranganathan, MD, DM, FRCP, FRACP; Chief Editor: Vecihi Batuman, MD, FACP, FASN more...
Further Outpatient Care
See the list below:
If the cyst is less than 3 cm in diameter and no bleeding has occurred, follow up with imaging studies.
If tumor enlargement is present with associated persistent hematuria, consider surgery if the patient's status permits.
Further Inpatient Care
See the list below:
Patients admitted with cyst bleeding need further investigation for malignancy.
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.
Cysts do not develop in other organs, in contrast to autosomal dominant polycystic kidney disease (ADPKD).
Acquired renal cystic disease can be progressive if the patient is on dialysis for an extended period; malignant transformation may also occur. The 5-year survival rates after diagnosis of malignancy are comparable to those observed in renal cell carcinoma in the general population. Death is usually associated with metastasis and accounts for 2% of the deaths in renal transplant patients.
Kuroda N, Ohe C, Mikami S, Hes O, Michal M, Brunelli M, et al. Review of acquired cystic disease-associated renal cell carcinoma with focus on pathobiological aspects. Histol Histopathol. 2011 Sep. 26(9):1215-8. [Medline].
Srigley JR, Delahunt B, Eble JN, Egevad L, Epstein JI, Grignon D, et al. The International Society of Urological Pathology (ISUP) Vancouver Classification of Renal Neoplasia. Am J Surg Pathol. 2013 Oct. 37(10):1469-89. [Medline].
Paudice N, Zanazzi M, Agostini S, Bertelli E, Caroti L, Carta P, et al. Contrast-enhanced ultrasound assessment of complex cystic lesions in renal transplant recipients with acquired cystic kidney disease: preliminary experience. Transplant Proc. 2012 Sep. 44(7):1928-9. [Medline].
Rule AD, Sasiwimonphan K, Lieske JC, Keddis MT, Torres VE, Vrtiska TJ. Characteristics of renal cystic and solid lesions based on contrast-enhanced computed tomography of potential kidney donors. Am J Kidney Dis. 2012 May. 59(5):611-8. [Medline]. [Full Text].
Takase Y, Kodama K, Motoi I, Saito K. Cyst Infection in Unilateral Renal Cystic Disease and the Role of Diffusion-weighted Magnetic Resonance Imaging. Urology. 2012 Nov. 80(5):e61-2. [Medline].
Mühlfeld AS, Lange C, Kroll G, Floege J, Krombach GA, Kuhl C, et al. Pilot study of non-contrast-enhanced MRI vs. ultrasound in renal transplant recipients with acquired cystic kidney disease: a prospective intra-individual comparison. Clin Transplant. 2013 Nov-Dec. 27(6):E694-701. [Medline].
Scandling JD. Acquired cystic kidney disease and renal cell cancer after transplantation: time to rethink screening?. Clin J Am Soc Nephrol. 2007 Jul. 2(4):621-2. [Medline].
Schwarz A, Vatandaslar S, Merkel S, et al. Renal cell carcinoma in transplant recipients with acquired cystic kidney disease. Clin J Am Soc Nephrol. 2007 Jul. 2(4):750-6. [Medline].
Acquired cystic kidney disease in children undergoing continuous ambulatory peritoneal dialysis. Kyushu Pediatric Nephrology Study Group. Am J Kidney Dis. 1999 Aug. 34(2):242-6. [Medline].
Cohen EP, Elliott WC Jr. The role of ischemia in acquired cystic kidney disease. Am J Kidney Dis. 1990 Jan. 15(1):55-60. [Medline].
Dunnill MS, Millard PR, Oliver D. Acquired cystic disease of the kidneys: a hazard of long-term intermittent maintenance haemodialysis. J Clin Pathol. 1977 Sep. 30(9):868-77. [Medline].
Dwarakanathan S. Acquired renal cystic disease. Nephrology. 2003. 8:A62-A63.
Fleming S, O'Donnell M. Surgical pathology of renal epithelial neoplasms: recent advances and current status. Histopathology. 2000 Mar. 36(3):195-202. [Medline].
Grantham JJ. Acquired cystic kidney disease. Kidney Int. 1991 Jul. 40(1):143-52. [Medline].
Gulanikar AC, Daily PP, Kilambi NK, et al. Prospective pretransplant ultrasound screening in 206 patients for acquired renal cysts and renal cell carcinoma. Transplantation. 1998 Dec 27. 66(12):1669-72. [Medline].
Hayakawa M, Nakajima F, Tsuji A, et al. Cytokine levels in cystic renal masses associated with renal cell carcinoma. J Urol. 1998 May. 159(5):1459-64. [Medline].
Ishikawa I. Hemorrhage versus cancer in acquired cystic disease. Semin Dial. Jan-Feb 2000. 13(1):56.
Ishikawa I. Hemorrhage versus cancer in acquired cystic disease. Semin Dial. 2000 Jan-Feb. 13(1):56. [Medline].
Levine E. Acquired cystic kidney disease. Radiol Clin North Am. 1996 Sep. 34(5):947-64. [Medline].
Levine E, Slusher SL, Grantham JJ, et al. Natural history of acquired renal cystic disease in dialysis patients: a prospective longitudinal CT study. AJR Am J Roentgenol. 1991 Mar. 156(3):501-6. [Medline].
Liu JS, Ishikawa I, Horiguchi T. Incidence of acquired renal cysts in biopsy specimens. Nephron. 2000 Feb. 84(2):142-7. [Medline].
Moskowitz DW, Bonar SL, Liu W, et al. Epidermal growth factor precursor is present in a variety of human renal cyst fluids. J Urol. 1995 Mar. 153(3 Pt 1):578-83. [Medline].
Nahm AM, Ritz E. Acquired renal cysts. Nephrol Dial Transplant. 2001 Jul. 16(7):1506-8. [Medline].
Rubenstein I, Zanier J, Moraes E, et al. Renal cell carcinoma in patients with acquired renal cystic disease. Br J Urol. 1997. 80:118-9.
Stewart JH, Buccianti G, Agodoa L, et al. Cancers of the kidney and urinary tract in patients on dialysis for end-stage renal disease: analysis of data from the United States, Europe, and Australia and New Zealand. J Am Soc Nephrol. 2003 Jan. 14(1):197-207. [Medline].
Takebayashi S, Hidai H, Chiba T, et al. Using helical CT to evaluate renal cell carcinoma in patients undergoing hemodialysis: value of early enhanced images. AJR Am J Roentgenol. 1999 Feb. 172(2):429-33. [Medline].
Todd TD, Dhurandhar B, Mody D, et al. Fine-needle aspiration of cystic lesions of the kidney. Morphologic spectrum and diagnostic problems in 41 cases. Am J Clin Pathol. 1999 Mar. 111(3):317-28. [Medline].
Truong LD, Krishnan B, Cao JT, et al. Renal neoplasm in acquired cystic kidney disease. Am J Kidney Dis. 1995 Jul. 26(1):1-12. [Medline].
Vaseemuddin M, Kraus MA. Quiz page. Acquired kidney disease (ACKD) with associated bilateral renal cell carcinoma. Am J Kidney Dis. 2005 Oct. 46(4):A48, e47-9. [Medline].
|Kidney size||Usually not increased; may be decreased because of the advanced renal disease||Increased|
|Location of cysts||Cortex and medulla||Cortex and medulla|
|Corticomedullary differentiation*||Possible||Not possible|
|Normal parenchyma between cysts*||Yes||No|
|Extrarenal cysts (eg, liver, pancreas)||No||Yes|
|Positive family history||No||Yes|