Cystic Diseases of the Kidney Medication
- Author: Thomas Patrick Frye, DO; Chief Editor: Bradley Fields Schwartz, DO, FACS more...
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.
Angiotensin-converting enzyme inhibitors
These agents reduce aldosterone secretion.
Prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, resulting in lower aldosterone secretion.
Angiotensin II receptor antagonists
These agents antagonize the effects of angiotensin II.
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.
Calcium channel blockers
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.
During depolarization, inhibits calcium ions from entering the slow channels and voltage-sensitive areas of vascular smooth muscle and myocardium.
These agents are used to treat renal parenchymal infection (to be used in combination with gentamicin) and infected renal cysts.
Bactericidal activity against susceptible organisms. Alternative to amoxicillin when patients are unable to take medication orally. Used to treat parenchymal infection.
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.
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.
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.
These agents are beneficial in the treatment of fluid retention.
Inhibits reabsorption of sodium in distal tubules, increasing excretion of sodium and water, as well as potassium and hydrogen ions.
Pain control is essential to quality patient care. Analgesics ensure patient comfort and have sedating properties, which are beneficial for patients who experience pain.
Drug combination indicated for the relief of moderate-to-severe pain.
Xu HW, Yu SQ, Mei CL, Li MH. Screening for intracranial aneurysm in 355 patients with autosomal-dominant polycystic kidney disease. Stroke. 2011 Jan. 42(1):204-6. [Medline].
Bisceglia M, Galliani CA, Senger C, Stallone C, Sessa A. Renal cystic diseases: a review. Adv Anat Pathol. 2006 Jan. 13(1):26-56. [Medline].
Kalyoussef E, Hwang J, Prasad V, Barone J. Segmental multicystic dysplastic kidney in children. Urology. 2006 Nov. 68(5):1121.e9-11. [Medline].
Avner ED, Sweeney WE. Renal cystic disease: new insights for the clinician. Pediatr Clin North Am. 2006 Oct. 53(5):889-909, ix. [Medline].
Wilson PD. Polycystic kidney disease. N Engl J Med. 2004 Jan 8. 350(2):151-64. [Medline].
Gunay-Aygun M, Avner ED, Bacallao RL, Choyke PL, Flynn JT, Germino GG, et al. Autosomal recessive polycystic kidney disease and congenital hepatic fibrosis: summary statement of a first National Institutes of Health/Office of Rare Diseases conference. J Pediatr. 2006 Aug. 149(2):159-64. [Medline].
Gusmano R, Caridi G, Marini M, Perfumo F, Ghiggeri GM, Piaggio G, et al. Glomerulocystic kidney disease in a family. Nephrol Dial Transplant. 2002 May. 17(5):813-8. [Medline].
Guay-Woodford LM. Renal cystic diseases: diverse phenotypes converge on the cilium/centrosome complex. Pediatr Nephrol. 2006 Oct. 21(10):1369-76. [Medline].
Saunier S, Salomon R, Antignac C. Nephronophthisis. Curr Opin Genet Dev. 2005 Jun. 15(3):324-31. [Medline].
Mostov KE. mTOR is out of control in polycystic kidney disease. Proc Natl Acad Sci U S A. 2006 Apr 4. 103(14):5247-8. [Medline].
Shillingford JM, Murcia NS, Larson CH, Low SH, Hedgepeth R, Brown N, et al. The mTOR pathway is regulated by polycystin-1, and its inhibition reverses renal cystogenesis in polycystic kidney disease. PNAS. 2006 Apr 4. 103:5466-5471. [Medline].
Baradhi KM, Abuelo GJ. Unilateral renal cystic disease. Kidney Int. 2012 Jan. 81(2):220. [Medline].
Thomsen HS, Levine E, Meilstrup JW, Van Slyke MA, Edgar KA, Barth JC, et al. Renal cystic diseases. Eur Radiol. 1997. 7(8):1267-75. [Medline].
Choyke PL. Acquired cystic kidney disease. Eur Radiol. 2000. 10(11):1716-21. [Medline].
Wetmore JB, Calvet JP, Yu AS, Lynch CF, Wang CJ, Kasiske BL, et al. Polycystic kidney disease and cancer after renal transplantation. J Am Soc Nephrol. 2014 Oct. 25(10):2335-41. [Medline]. [Full Text].
Siqueira Rabelo EA, Oliveira EA, Silva JM, Oliveira DS, Colosimo EA. Ultrasound progression of prenatally detected multicystic dysplastic kidney. Urology. 2006 Nov. 68(5):1098-102. [Medline].
Welch TR, Wacksman J. The changing approach to multicystic dysplastic kidney in children. J Pediatr. 2005 Jun. 146(6):723-5. [Medline].
Grantham JJ, Torres VE, Chapman AB, Guay-Woodford LM, Bae KT, King BF, et al. Volume progression in polycystic kidney disease. N Engl J Med. 2006 May 18. 354(20):2122-30. [Medline].
Cornec-Le Gall E, Audrézet MP, Chen JM, Hourmant M, Morin MP, Perrichot R, et al. Type of PKD1 mutation influences renal outcome in ADPKD. J Am Soc Nephrol. 2013 May. 24(6):1006-13. [Medline]. [Full Text].
Hogan MC, Abebe K, Torres VE, Chapman AB, Bae KT, Tao C, et al. Liver Involvement in Early Autosomal-Dominant Polycystic Kidney Disease. Clin Gastroenterol Hepatol. 2014 Aug 9. [Medline].
Guay-Woodford LM, Desmond RA. Autosomal recessive polycystic kidney disease: the clinical experience in North America. Pediatrics. 2003 May. 111(5 Pt 1):1072-80. [Medline].
Onal B, Kogan BA. Natural history of patients with multicystic dysplastic kidney-what followup is needed?. J Urol. 2006 Oct. 176(4 Pt 1):1607-11. [Medline].
Torres, Vicente, Harris, Peter, Yves, Pirson. Autosomal dominant polycystic kidney disease. The Lancet. April 14, 2007. 369:1287-1301.
Mercado-Deane MG, Beeson JE, John SD. US of renal insufficiency in neonates. Radiographics. 2002 Nov-Dec. 22(6):1429-38. [Medline].
Bae KT, Zhu F, Chapman AB, Torres VE, Grantham JJ, Guay-Woodford LM, et al. Magnetic resonance imaging evaluation of hepatic cysts in early autosomal-dominant polycystic kidney disease: the Consortium for Radiologic Imaging Studies of Polycystic Kidney Disease cohort. Clin J Am Soc Nephrol. 2006 Jan. 1(1):64-9. [Medline].
[Guideline] Guay-Woodford LM, Bissler JJ, Braun MC, Bockenhauer D, Cadnapaphornchai MA, Dell KM, et al. Consensus expert recommendations for the diagnosis and management of autosomal recessive polycystic kidney disease: report of an international conference. J Pediatr. 2014 Sep. 165(3):611-7. [Medline].
Chaumoitre K, Brun M, Cassart M, Maugey-Laulom B, Eurin D, Didier F, et al. Differential diagnosis of fetal hyperechogenic cystic kidneys unrelated to renal tract anomalies: A multicenter study. Ultrasound Obstet Gynecol. 2006 Dec. 28(7):911-7. [Medline].
Hawkins JS, Dashe JS, Twickler DM. Magnetic resonance imaging diagnosis of severe fetal renal anomalies. Am J Obstet Gynecol. 2008 Mar. 198(3):328.e1-5. [Medline].
Zaretsky M, Ramus R, McIntire D, Magee K, Twickler DM. MRI calculation of lung volumes to predict outcome in fetuses with genitourinary abnormalities. AJR Am J Roentgenol. 2005 Nov. 185(5):1328-34. [Medline].
Borges Oliva MR, Hsing J, Rybicki FJ, Fennessy F, Mortele KJ, Ros PR. Glomerulocystic kidney disease: MRI findings. Abdominal Imaging. 2003 Nov. 28:889-892. [Medline].
Song C., et al. Differential Diagnosis of Complex Cystic Renal Mass Using Multiphase Computerized Tomography. Journal of Urology. 2009/06. 181:2446-2450.
Ellimoottil C, Greco KA, Hart S, Patel T, Sheikh MM, Turk TM, et al. New Modalities for Evaluation and Surveillance of Complex Renal Cysts. J Urol. 2014 Dec. 192(6):1604-1611. [Medline].
Linguraru MG, Yao J, Gautam R, Peterson J, Li Z, Linehan WM, et al. Renal Tumor Quantification and Classification in Contrast-Enhanced Abdominal CT. Pattern Recognit. 2009 Jun 1. 42(6):1149-1161. [Medline]. [Full Text].
Kim WB, Lee SW, Doo SW, Yang WJ, Song YS, Jeon JS, et al. Category migration of renal cystic masses with use of gadolinium-enhanced magnetic resonance imaging. Korean J Urol. 2012 Aug. 53(8):573-6. [Medline]. [Full Text].
Bosniak MA. The use of the Bosniak classification system for renal cysts and cystic tumors. J Urol. 1997 May. 157(5):1852-3. [Medline].
Garcia-Rojo, D. Comparison of Contrast-Enhanced Ultrasound (CE-US) and Computed Tomography (CT) in the Evaluation of Complex Cystic Renal Masses. Journal of Urology. May 31, 2010. 183:e243.
Smith AD, Remer EM, Cox KL, et al. Bosniak category IIF and III cystic renal lesions: outcomes and associations. Radiology. 2012 Jan. 262(1):152-60. [Medline].
Li, G.,, et al. CA9 molecular marker for differential diagnosis of cystic renal tumors. Urologic Oncology. Sept. 3, 2010.
Torres VE, Harris PC. Mechanisms of Disease: autosomal dominant and recessive polycystic kidney diseases. Nat Clin Pract Nephrol. 2006 Jan. 2(1):40-55; quiz 55. [Medline].
Zerem, E. Simple renal cysts and arterial hypertension: does their evacuation decrease the blood pressure?. Journal of Hypertension. Oct. 27, 2009. 10:2074-2078.
[Guideline] Levels of neonatal care. Pediatrics. 2012 Sep. 130(3):587-97. [Medline].
Guay-Woodford L. Other Cystic Diseases. Johnson R, Feehally J. Comprehensive Clinical Nephrology. 4th. London: Mosby; 2010. 543-559.
Rheault MN, Rajpal J, Chavers B, Nevins TE. Outcomes of infants 11111111111Pediatr Nephrol</i>. 2009 Oct. 24(10):2035-9. [Medline].
Wühl E, Trivelli A, Picca S, Litwin M, Peco-Antic A, Zurowska A, et al. Strict blood-pressure control and progression of renal failure in children. N Engl J Med. 2009 Oct 22. 361(17):1639-50. [Medline].
Serra A., et al. Sirolimus and kidney growth in autosomal dominant polycystic kidney disease. New England Journal of Medicine. Aug. 26, 2010. 9:820-829.
Wüthrich RP, Mei C. Pharmacological management of polycystic kidney disease. Expert Opin Pharmacother. 2014 Jun. 15(8):1085-95. [Medline].
Torres VE, Chapman AB, Devuyst O, Gansevoort RT, Grantham JJ, Higashihara E, et al. Tolvaptan in patients with autosomal dominant polycystic kidney disease. N Engl J Med. 2012 Dec 20. 367(25):2407-18. [Medline]. [Full Text].
Chang MY, Ong AC. Mechanism-based therapeutics for autosomal dominant polycystic kidney disease: recent progress and future prospects. Nephron Clin Pract. 2012. 120(1):c25-34; discussion c35. [Medline].
Aguiari G, Catizone L, Del Senno L. Multidrug therapy for polycystic kidney disease: a review and perspective. Am J Nephrol. 2013. 37(2):175-82. [Medline].
Rane, A. Laparoscopic management of symptomatic simple renal cysts. International Urology Nephrology. 2004. 36:5-9.
Emre, H. "Stepped procedure" in laparoscopic cyst decortications during the learning period of laparoscopic surgery: Detailed evaluation of initial experiences. Journal of Minimal Access Surgery. Apr 6, 2010. 2:37-41.
Kilciler, M. Finger assisted laparoscopic renal cyst excision: a simple technique. Urology Journal. Jun 10, 2010. 7:90-94.
Busato, W. Percutaneous endocystolysis, a safe and minimally invasive treatment for renal cysts: a 13-year experience. Journal of Endourology. Sept. 2010. 24:1405-1410.
Lucas, S. Staged Nephrectomy Versus Bilateral Laparoscopic Nephrectomy in Patients with Autosomal Dominant Polycycstic Kidney Disease. Journal of Urology. Nov. 2010. 184:2054-2059.
Agarwal M, Agrawal MS, Mittal R, Sachan V. A randomized study of aspiration and sclerotherapy versus laparoscopic deroofing in management of symptomatic simple renal cysts. J Endourol. 2012 May. 26(5):561-5. [Medline].
Webster, W. Surgical Resection Provides Excellent Outcomes for Patients with Cystic Clear Cell Renal Cell Carcinoma. Urology. May 2007. 900-904.
Bloom DA, Brosman S. The multicystic kidney. J Urol. 1978 Aug. 120(2):211-5. [Medline].
Bonsib SM. Non-neoplastic diseases of the kidney. Bostwick DG. Urologic Surgical Pathology. St Louis, Mo: Mosby-Year Book; 1997.
Bosniak MA. How does one deal with a renal cyst that appears to be Bosniak class II on a CT scan but that has sonographic features suggestive of malignancy (e.g., nodularity of wall or a nodular, irregular septum)?. AJR Am J Roentgenol. 1994 Jul. 163(1):216. [Medline].
Bosniak MA. The current radiological approach to renal cysts. Radiology. 1986 Jan. 158(1):1-10. [Medline].
Brook-Carter PT, Peral B, Ward CJ, Thompson P, Hughes J, Maheshwar MM, et al. Deletion of the TSC2 and PKD1 genes associated with severe infantile polycystic kidney disease--a contiguous gene syndrome. Nat Genet. 1994 Dec. 8(4):328-32. [Medline].
Chapman T. Fetal genitourinary imaging. Pediatr Radiol. 2012 Jan. 42 Suppl 1:S115-23. [Medline].
Chauveau D, Duvic C, Chretien Y, Paraf F, Droz D, Melki P, et al. Renal involvement in von Hippel-Lindau disease. Kidney Int. 1996 Sep. 50(3):944-51. [Medline].
Clarke A, Hancock E, Kingswood C, Osborne JP. End-stage renal failure in adults with the tuberous sclerosis complex. Nephrol Dial Transplant. 1999 Apr. 14(4):988-91. [Medline].
Davidson AJ, Hartman DS, Choyke PL, Wagner BJ. Radiologic assessment of renal masses: implications for patient care. Radiology. 1997 Feb. 202(2):297-305. [Medline].
Fick GM, Johnson AM, Hammond WS, Gabow PA. Causes of death in autosomal dominant polycystic kidney disease. J Am Soc Nephrol. 1995 Jun. 5(12):2048-56. [Medline].
Freire M, Remer EM. Clinical and radiologic features of cystic renal masses. AJR Am J Roentgenol. 2009 May. 192(5):1367-72. [Medline].
Grantham JJ. Clinical practice. Autosomal dominant polycystic kidney disease. N Engl J Med. 2008 Oct 2. 359(14):1477-85. [Medline].
Grantham JJ, Nair V, Winklhofer F. Cystic disease of the kidney. Brenner BM, ed. Brenner and Rector's the Kidney. 6th ed. Philadelphia, Pa: WB Saunders Co; 2000. 1171-1200.
Harris PC, Bae KT, Rossetti S, Torres VE, Grantham JJ, Chapman AB, et al. Cyst number but not the rate of cystic growth is associated with the mutated gene in autosomal dominant polycystic kidney disease. J Am Soc Nephrol. 2006 Nov. 17(11):3013-9. [Medline].
Israel GM, Bosniak MA. Follow-up CT of moderately complex cystic lesions of the kidney (Bosniak category IIF). AJR Am J Roentgenol. 2003 Sep. 181(3):627-33. [Medline].
Israel GM, Hindman N, Bosniak MA. Evaluation of cystic renal masses: comparison of CT and MR imaging by using the Bosniak classification system. Radiology. 2004 May. 231(2):365-71. [Medline].
Lang EK, Macchia RJ, Gayle B, Richter F, Watson RA, Thomas R. CT-guided biopsy of indeterminate renal cystic masses (Bosniak 3 and 2F): accuracy and impact on clinical management. Eur Radiol. 2002 Oct. 12(10):2518-24. [Medline].
Laube M, Hess B, Terrier F, Vock P, Jaeger P. [Prevalence of medullary sponge kidney in patients with and without nephrolithiasis]. Schweiz Rundsch Med Prax. 1995 Oct 24. 84(43):1224-30. [Medline].
Levine E, Slusher SL, Grantham JJ, Wetzel LH. 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].
Lonergan GJ, Rice RR, Suarez ES. Autosomal recessive polycystic kidney disease: radiologic-pathologic correlation. Radiographics. 2000 May-Jun. 20(3):837-55. [Medline].
Matson MA, Cohen EP. Acquired cystic kidney disease: occurrence, prevalence, and renal cancers. Medicine (Baltimore). 1990 Jul. 69(4):217-26. [Medline].
Miller MA, Brown JJ. Renal cysts and cystic neoplasms. Magn Reson Imaging Clin N Am. 1997 Feb. 5(1):49-66. [Medline].
Ohlson L. Normal collecting ducts: visualization at urography. Radiology. 1989 Jan. 170(1 Pt 1):33-7. [Medline].
Ravine D, Gibson RN, Walker RG, Sheffield LJ, Kincaid-Smith P, Danks DM. Evaluation of ultrasonographic diagnostic criteria for autosomal dominant polycystic kidney disease 1. Lancet. 1994 Apr 2. 343(8901):824-7. [Medline].
Siegel CL, McFarland EG, Brink JA, Fisher AJ, Humphrey P, Heiken JP. CT of cystic renal masses: analysis of diagnostic performance and interobserver variation. AJR Am J Roentgenol. 1997 Sep. 169(3):813-8. [Medline].
Silverman SG, Israel GM, Herts BR, Richie JP. Management of the incidental renal mass. Radiology. 2008 Oct. 249(1):16-31. [Medline].
Tsatsaris V, Gagnadoux MF, Aubry MC, Gubler MC, Dumez Y, Dommergues M. Prenatal diagnosis of bilateral isolated fetal hyperechogenic kidneys. Is it possible to predict long term outcome?. BJOG. 2002 Dec. 109(12):1388-93. [Medline].
Wolf JS Jr. Evaluation and management of solid and cystic renal masses. J Urol. 1998 Apr. 159(4):1120-33. [Medline].
Yent ER. Medullary sponge kidney. Schrier RE, Gottschalk CW. Disease of the Kidney. 5th ed. Little Brown: Boston, Mass; 1993. 525-32.