Acquired Cystic Kidney Disease Follow-up

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

Further Inpatient Care

  • Patients admitted with cyst bleeding need further investigation for malignancy.
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Further Outpatient Care

  • 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.
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Complications

  • Malignant transformation
    • The risk of renal cell carcinoma is increased 40-fold in patients with acquired renal cystic disease as compared to the general population. Most patients are asymptomatic, but about 15% of patients manifest with pain, hemorrhage, and metastasis (lumbar pain). Risk factors include male sex (male-to-female ratio is 7:1), long duration of dialysis, black race, and severe acquired renal cystic disease with marked organomegaly.
    • Renal cancers from acquired renal cystic disease are multicentric in at least 50% of cases and bilateral in about 10% of cases; they are predominantly of the papillary subtype.
  • Cystic hemorrhage: Hemorrhage is sometimes associated with hematuria. Bleeding may evolve into cyst rupture, with subsequent retroperitoneal or perinephric hemorrhage (Wunderlich syndrome). Rarely, bleeding can be severe enough to cause hypovolemic shock. Calcification can occur in or around cysts.
  • Cyst infection, abscess formation, and/or sepsis
  • Erythrocytosis
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Prognosis

  • 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.
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Patient Education

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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.

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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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