Cystic Diseases of the Kidney Medication

  • Author: Thomas Patrick Frye, DO; Chief Editor: Bradley Fields Schwartz, DO, FACS   more...
 
Updated: Dec 15, 2010
 

Medication Summary

No specific medical therapies are available for the renal cysts themselves. Complications of cystic renal diseases, such as hypertension, infection, and pain, are treated with standard medical therapy. Some examples are listed below.

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Angiotensin-converting enzyme inhibitors

Class Summary

These agents reduce aldosterone secretion.

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Lisinopril (Zestril, Prinivil)

 

Prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, resulting in lower aldosterone secretion.

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Angiotensin II receptor antagonists

Class Summary

These agents antagonize the effects of angiotensin II.

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Losartan (Cozaar)

 

Nonpeptide angiotensin II receptor antagonist that blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II. May induce a more complete inhibition of the renin-angiotensin system than ACE inhibitors, does not affect the response to bradykinin, and is less likely to be associated with cough and angioedema. For patients unable to tolerate ACE inhibitors.

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Calcium channel blockers

Class Summary

In specialized conducting and automatic cells in the heart, calcium is involved in the generation of the action potential. The calcium channel blockers inhibit movement of calcium ions across the cell membrane, depressing both impulse formation (automaticity) and conduction velocity.

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Diltiazem (Cardizem, Dilacor, Tiazac)

 

During depolarization, inhibits calcium ions from entering the slow channels and voltage-sensitive areas of vascular smooth muscle and myocardium.

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Antimicrobials

Class Summary

These agents are used to treat renal parenchymal infection (to be used in combination with gentamicin) and infected renal cysts.

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Ampicillin (Principen, Omnipen, Marcillin)

 

Bactericidal activity against susceptible organisms. Alternative to amoxicillin when patients are unable to take medication orally. Used to treat parenchymal infection.

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Gentamicin (Garamycin, Gentacidin)

 

Aminoglycoside antibiotic for gram-negative coverage. Used in combination with both an agent against gram-positive organisms and one that covers anaerobes. Not the DOC, but consider if penicillins or other less toxic drugs are contraindicated, when clinically indicated, and in mixed infections caused by susceptible staphylococci and gram-negative organisms. Dosing regimens are numerous; adjust dose based on CrCl and changes in volume of distribution. May be administered IV/IM.

Sulfamethoxazole and trimethoprim (Bactrim, Bactrim DS, Septra, Septra DS)

 

Inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid. Antibacterial activity of TMP-SMZ includes common urinary tract pathogens, except Pseudomonas aeruginosa. Used to treat infected renal cyst.

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Ciprofloxacin (Cipro)

 

Fluoroquinolone with activity against pseudomonads, streptococci, MRSA, S epidermidis, and most gram-negative organisms, but no activity against anaerobes. Inhibits bacterial DNA synthesis and, consequently, growth. Trovafloxacin (Trovan) overcomes many of these limitations. Continue treatment for at least 2 d (7-14 d typical) after signs and symptoms have disappeared.

Used to treat infected renal cyst either in patients intolerant to or not adequately covered by trimethoprim-sulfasalazine.

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Thiazide diuretics

Class Summary

These agents are beneficial in the treatment of fluid retention.

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Hydrochlorothiazide (Microzide, Esidrix, HydroDIURIL)

 

Inhibits reabsorption of sodium in distal tubules, increasing excretion of sodium and water, as well as potassium and hydrogen ions.

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Analgesics

Class Summary

Pain control is essential to quality patient care. Analgesics ensure patient comfort and have sedating properties, which are beneficial for patients who experience pain.

Oxycodone and acetaminophen (Percocet, Roxicet, Roxilox, Tylox)

 

Drug combination indicated for the relief of moderate-to-severe pain.

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Contributor Information and Disclosures
Author

Thomas Patrick Frye, DO  Resident

Disclosure: Nothing to disclose.

Coauthor(s)

Alex Gorbonos, MD  Assistant Professor, Division of Urology, Director, Robotic Surgery, Southern Illinois University School of Medicine

Alex Gorbonos, MD is a member of the following medical societies: Alpha Omega Alpha, American Urological Association, Endourological Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Edmund S Sabanegh Jr, MD  Director, Center for Male Fertility, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation

Edmund S Sabanegh Jr, MD is a member of the following medical societies: American Medical Association, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, Society for the Study of Male Reproduction, Society of Reproductive Surgeons, and Southwest Oncology Group

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

J Stuart Wolf Jr, MD, FACS  The David A Bloom Professor of Urology, Director, Division of Endourology and Stone Disease, Department of Urology, University of Michigan Medical School

J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology

Disclosure: Baxter Healthcare Consulting fee Consulting

Chief Editor

Bradley Fields Schwartz, DO, FACS  Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists

Disclosure: Nothing to disclose.

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Cut surface of a nephrectomy specimen from a patient with a multicystic dysplastic kidney (MCDK).
Nephrectomy specimen from a patient with a large benign simple cyst.
External surface of a nephrectomy specimen from a patient with autosomal dominant polycystic kidney disease (ADPKD).
Cut surface of the same nephrectomy specimen from a patient with autosomal dominant polycystic kidney disease (ADPKD).
Cut section of nephrectomy specimen demonstrating renal cell carcinoma (RCC), with an adjacent simple cyst.
Close-up photograph of the cut surface of the same nephrectomy specimen demonstrating a simple cyst adjacent to a renal cell carcinoma (RCC).
A prenatal sonogram of a fetus with a multicystic dysplastic kidney. The right kidney is appreciated as a large multicystic paraspinal mass. The left kidney and bladder are normal, and a normal amount of amniotic fluid is present.
CT examination of the abdomen of a 70-year-old woman with autosomal dominant polycystic kidney disease (ADPKD) is shown. The kidneys are bilaterally enlarged with multiple cysts.
CT scan of the same patient (70-year-old woman with autosomal dominant polycystic kidney disease [ADPKD]) demonstrating multiple hepatic cysts.
This CT scan demonstrates acquired renal cystic disease (ARCD) in a 70-year-old man who is dialysis-dependent. The CT scan demonstrates bilateral atrophic kidneys with multiple renal cysts.
A CT scan of a 38-year-old man with von Hippel-Lindau syndrome (VHLS). The patient previously underwent resection of multiple bilateral renal cell carcinomas (RCCs). CT scan demonstrates multiple cysts in the kidneys and pancreas, as well as solid renal lesions suggestive of malignancy.
 
 
 
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