eMedicine Specialties > Nephrology > Cystic Diseases of the Kidney

Acquired Cystic Kidney Disease: Treatment & Medication

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
Contributor Information and Disclosures

Updated: Sep 15, 2008

Treatment

Medical Care

Bleeding episodes (mild) with flank pain are treated with analgesics (eg, morphine, codeine, acetaminophen). Avoid aspirin, meperidine, and propoxyphene. Avoid heparin during hemodialysis.

Surgical Care

  • Severe bleeding episodes are treated by embolization or nephrectomy.
  • If carcinoma is suspected (from CT scan findings), then consider nephrectomy (cysts >3 cm in diameter and cysts <3 cm but with complications).
  • Prophylactic contralateral nephrectomy is controversial; bilateral nephrectomy may be considered in those patients likely to receive kidney transplantation.

Consultations

If carcinoma is suspected in acquired renal cystic disease, consult a urologist.

Diet

No specific dietary intervention is required.

Activity

During a bleeding episode, bed rest is required.

Medication

No specific drugs are indicated in the management of acquired renal cystic disease, except analgesics for the treatment of pain. Drugs for underlying disease are required.

Analgesics

These agents act at the central nervous system (CNS) mu receptors and are the criterion standards for the treatment of pain resulting from kidney disease. They are inexpensive and proven effective. Disadvantages include sedation, respiratory depression, smooth muscle spasm, and the potential for abuse and addiction.


Acetaminophen (Tylenol, Aspirin Free Anacin, Feverall)

DOC for pain in patients with documented hypersensitivity to aspirin or NSAIDs, with upper GI disease, or who are taking oral anticoagulants.
Effective in relieving mild to moderate acute pain; however, has no peripheral anti-inflammatory effects. May be preferred in elderly patients because of fewer GI and renal adverse effects.

Adult

325-650 mg PO/PR q4-6h or 1000 mg tid/qid; not to exceed 4 g/d

Pediatric

<12 years: 10-15 mg/kg/dose PO q4-6h prn; not to exceed 2.6 g/d
>12 years: 325-650 mg PO q4h; not to exceed 4 g/d

Rifampin can reduce analgesic effects of acetaminophen; coadministration with barbiturates, carbamazepine, hydantoins, and isoniazid may increase hepatotoxicity

Documented hypersensitivity; known G-6-PD deficiency

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Hepatotoxicity possible in chronic alcoholics following various dose levels; severe or recurrent pain or high or continued fever may indicate a serious illness; contained in many OTC products and combined use with these products may result in toxicity due to cumulative doses exceeding recommended maximum dose


Codeine

Indicated for moderate to severe pain. Binds to opiate receptors in CNS, causing inhibition of ascending pain pathways, altering perception and response to pain.

Adult

10-60 mg/dose PO/IM/SC q4-6h prn; not to exceed 360 mg/d

Pediatric

0.5 mg/kg/dose PO/IM/SC q4-6h prn; not to exceed 60 mg/dose

Toxicity increases with concurrent administration of tricyclic antidepressants, MAO inhibitors, neuromuscular blockers, CNS depressants, phenothiazines, and narcotic analgesics

Documented hypersensitivity; high altitude cerebral edema (HACE) diagnosis; elevated intracranial pressure (ICP)

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Use to treat cough in HACE diagnosed patients only if absolutely necessary; may depress hypoxic ventilatory rate and respiratory drive during sleep


Morphine (MS Contin, MSIR, Oramorph, Duramorph)

DOC for analgesia because of reliable and predictable effects, safety profile, and ease of reversibility with naloxone. Various IV doses are used; commonly titrated until desired effect obtained.

Adult

Starting dose: 0.1 mg/kg IV/IM/SC
Maintenance dose: 5-20 mg/70 kg IV/IM/SC q4h
Relatively hypovolemic patients: Start with 2 mg IV/IM/SC; reassess hemodynamic effects of dose

Pediatric

Infants and children: 0.1-0.2 mg/kg dose IV/IM/SC q2-4h prn; not to exceed 15 mg/dose; may initiate at 0.05 mg/kg/dose

Phenothiazines may antagonize analgesic effects of opiate agonists; tricyclic antidepressants, MAO inhibitors, and other CNS depressants may potentiate adverse effects of morphine

Documented hypersensitivity; hypotension; potentially compromised airway where establishing rapid airway control would be difficult

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Caution in hypotension, respiratory depression, nausea, emesis, constipation, urinary retention, atrial flutter, and other supraventricular tachycardias; has vagolytic action and may increase ventricular response rate

More on Acquired Cystic Kidney Disease

Overview: Acquired Cystic Kidney Disease
Differential Diagnoses & Workup: Acquired Cystic Kidney Disease
Treatment & Medication: Acquired Cystic Kidney Disease
Follow-up: Acquired Cystic Kidney Disease
Multimedia: Acquired Cystic Kidney Disease
References
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References

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Further Reading

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Keywords

acquired cystic kidney disease, acquired renal cystic disease, renal cystic disease, renal cysts, kidney cysts, renal cell carcinoma, ACKD, ARCD

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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.

Medical Editor

James W Lohr, MD, Fellowship Program Director, Professor, Department of Internal Medicine, Division of Nephrology, State University of New York at Buffalo
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: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

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.

CME Editor

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 Osteopathic Internists, 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: Abbott Grant/research funds Speaking and teaching; Genzyme Honoraria Consulting; Roche Honoraria Consulting

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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