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Medication

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.

Class Summary

These agents reduce aldosterone secretion.

Lisinopril (Zestril, Prinivil, Qbrelis)

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

Class Summary

These agents antagonize the effects of angiotensin II.

Losartan (Cozaar)

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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.

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.

Diltiazem (Cardizem, Tiazac, Matzim LA, Taztia XT, Cartia XT)

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

Class Summary

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

Ampicillin

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

Gentamicin

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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)

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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.

Ciprofloxacin (Cipro)

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Fluoroquinolone with activity against pseudomonas, streptococci, MSSA, S epidermidis, and most gram-negative organisms, but no activity against anaerobes. Inhibits bacterial DNA synthesis and, consequently, growth.

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

Class Summary

These agents are beneficial in the treatment of fluid retention.

Hydrochlorothiazide (Microzide)

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

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, Endocet, Xartemis XR, Primlev)

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

Follow-up

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Bergmann C. ARPKD and early manifestations of ADPKD: the original polycystic kidney disease and phenocopies. Pediatr Nephrol. 2015 Jan. 30(1):15-30. [Medline]. [Full Text].
Erger F, Brüchle NO, Gembruch U, Zerres K. Prenatal ultrasound, genotype, and outcome in a large cohort of prenatally affected patients with autosomal-recessive polycystic kidney disease and other hereditary cystic kidney diseases. Arch Gynecol Obstet. 2017 Apr. 295 (4):897-906. [Medline].
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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].
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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].
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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].
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].
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].
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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].
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Li, G.,, et al. CA9 molecular marker for differential diagnosis of cystic renal tumors. Urologic Oncology. Sept. 3, 2010.
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[Guideline] Levels of neonatal care. Pediatrics. 2012 Sep. 130(3):587-97. [Medline].
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Media Gallery

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.

of 11

Author

Thomas Patrick Frye, DO Clinical Fellow, Urologic Oncology Branch, National Cancer Institute, National Institutes of Health

Disclosure: Nothing to disclose.

Coauthor(s)

Steven Abboud Research Fellow, Medical Research Scholars Program, National Cancer Institute, National Institutes of Health

Steven Abboud is a member of the following medical societies: American Medical Association, American Medical Student Association/Foundation

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, Society of University Urologists

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: AUA Journal of Urology<br/>Serve(d) as a speaker or a member of a speakers bureau for: Cook Medical; Olympus, .

Additional Contributors

Edmund S Sabanegh, Jr, MD Chairman, Department of Urology, 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 of Andrology, Society of Reproductive Surgeons, Society for the Study of Male Reproduction, American Society for Reproductive Medicine, American Urological Association, SWOG

Disclosure: Nothing to disclose.

Acknowledgements

John M Corman, MD Clinical Associate Professor of Urology, University of Washington at Seattle; Consulting Staff, Department of Urology, Virginia Mason Medical Center

Disclosure: Nothing to disclose.

Alex Gorbonos, MD Assistant Professor, Department of Urology, Loyola 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.

Justin A Siegal, MD Radiologist, Department of Radiology, Virginia Mason Medical Center

Disclosure: Nothing to disclose.

Andrew T Trout, MD Resident Physician, Department of Radiology, University of Michigan Medical School

Andrew T Trout is a member of the following medical societies: American Medical Association, Phi Beta Kappa, Radiological Society of North America, and Sigma Xi

Disclosure: Nothing to disclose.

Cystic Diseases of the Kidney Medication

Medication Summary

Angiotensin-converting enzyme inhibitors

Class Summary

Lisinopril (Zestril, Prinivil, Qbrelis)

Lisinopril (Zestril, Prinivil, Qbrelis)

Angiotensin II receptor antagonists

Class Summary

Losartan (Cozaar)

Losartan (Cozaar)

Calcium channel blockers

Class Summary

Diltiazem (Cardizem, Tiazac, Matzim LA, Taztia XT, Cartia XT)

Diltiazem (Cardizem, Tiazac, Matzim LA, Taztia XT, Cartia XT)

Antimicrobials

Class Summary

Ampicillin

Ampicillin

Gentamicin

Gentamicin

Sulfamethoxazole and trimethoprim (Bactrim, Bactrim DS)

Sulfamethoxazole and trimethoprim (Bactrim, Bactrim DS)

Ciprofloxacin (Cipro)

Ciprofloxacin (Cipro)

Thiazide diuretics

Class Summary

Hydrochlorothiazide (Microzide)

Hydrochlorothiazide (Microzide)

Analgesics

Class Summary

Oxycodone and acetaminophen (Percocet, Endocet, Xartemis XR, Primlev)

Oxycodone and acetaminophen (Percocet, Endocet, Xartemis XR, Primlev)

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Cystic Diseases of the Kidney Medication

Medication Summary

Angiotensin-converting enzyme inhibitors

Class Summary

Lisinopril (Zestril, Prinivil, Qbrelis)

Angiotensin II receptor antagonists

Class Summary

Losartan (Cozaar)

Calcium channel blockers

Class Summary

Diltiazem (Cardizem, Tiazac, Matzim LA, Taztia XT, Cartia XT)

Antimicrobials

Class Summary

Ampicillin

Gentamicin

Sulfamethoxazole and trimethoprim (Bactrim, Bactrim DS)

Ciprofloxacin (Cipro)

Thiazide diuretics

Class Summary

Hydrochlorothiazide (Microzide)

Analgesics

Class Summary

Oxycodone and acetaminophen (Percocet, Endocet, Xartemis XR, Primlev)

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