Acquired cystic kidney disease
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View Fahad Alabdulghani's current disclosuresAt the time the article was last revised Joshua Yap had no financial relationships to ineligible companies to disclose.
View Joshua Yap's current disclosures- ACKD
- Acquired cystic kidney disease (ACKD)
- ARCD
- Acquired renal cystic disease
- Acquired renal cystic disease (ARCD)
Acquired cystic kidney disease (ACKD) is a condition that occurs in patients with end-stage renal disease (ESRD), especially when on dialysis treatment. They do not have a history of other cystic renal disease.
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Epidemiology
Its incidence increases with the amount of time a patient is azotemic and has been estimated at 44% after three years of dialysis and 90% after ten years of dialysis 5. It is equally common with haemodialysis as with peritoneal dialysis 3.
Diagnosis
The diagnostic criteria include:
-
patients with chronic renal failure
kidneys usually decreased in size
>3-5 cysts in each kidney
cysts are mostly cortical, but may also be medullary
Clinical presentation
Usually asymptomatic. Cyst hemorrhage may cause flank pain and hematuria 3.
Pathology
Although uremia is associated with an eventual development of acquired cystic kidney disease, the pathogenesis is currently unknown. Some theories suggest that tubular epithelial hyperplasia from accumulation of growth factors, such as epidermal growth factor may play a role 7.
The hyperplastic renal cysts in acquired cystic kidney disease have been considered a possible source of dialysis-associated renal cell carcinoma 8.
Radiographic features
The classic imaging appearance is multiple bilateral small renal cysts, occurring in both the cortex and medulla, with both kidneys typically small in size (refer to the chronic kidney disease (CKD) article for a broad discussion on the condition's correlated imaging findings).
Treatment and prognosis
Renal transplantation has been thought to resolve acquired renal cysts, but there is still a risk of renal cell carcinoma in the native kidneys.
Complications
hemorrhage into cysts, which occurs occasionally
-
development of renal cell carcinoma in ~7%
-
imaging screening for these patients is controversial 2,4,6
one screening strategy images patients <55 years old who have been on dialysis for three years 3
-
History and etymology
Acquired cystic kidney disease was first described in 1977 by M S Dunnil et al. 4,6.
References
- 1. Thomson BJ, Jenkins DA, Allan PL et-al. Acquired cystic disease of the kidney in patients with end-stage chronic renal failure: a study of prevalence and aetiology. Nephrol. Dial. Transplant. 1987;1 (1): 38-43. Pubmed citation
- 2. Sarasin FP, Wong JB, Levey AS et-al. Screening for acquired cystic kidney disease: a decision analytic perspective. Kidney Int. 1995;48 (1): 207-19. Pubmed citation
- 3. Levine E. Acquired cystic kidney disease. Radiol. Clin. North Am. 1996;34 (5): 947-64. Pubmed citation
- 4. Scandling JD. Acquired cystic kidney disease and renal cell cancer after transplantation: time to rethink screening?. Clin J Am Soc Nephrol. 2007;2 (4): 621-2. doi:10.2215/CJN.02000507 - Pubmed citation
- 5. Wein AJ MD FACS, Kavoussi LR, Novick AC et-al. Campbell-Walsh Urology: Expert Consult Premium Edition: Enhanced Online Features and Print, 4-Volume Set. Saunders. 4th ed (2011) ISBN:1416069119. Read it at Google Books - Find it at Amazon
- 6. Degrassi F, Quaia E, Martingano P et-al. Imaging of haemodialysis: renal and extrarenal findings. Insights Imaging. 2015;6 (3): 309-21. doi:10.1007/s13244-015-0383-3 - Free text at pubmed - Pubmed citation
- 7. Wood CG, Stromberg LJ, Harmath CB et-al. CT and MR imaging for evaluation of cystic renal lesions and diseases. (2015) Radiographics : a review publication of the Radiological Society of North America, Inc. 35 (1): 125-41. doi:10.1148/rg.351130016 - Pubmed
- 8. Chunduri S, Desai T, Vachharajani TJ. Acquired cystic kidney disease and renal tumor. (2018) Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia. 29 (3): 732-734. doi:10.4103/1319-2442.235199 - Pubmed
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