Acquired Cystic Kidney Disease Treatment & Management

Updated: Mar 13, 2020
  • Author: Manish Suneja, MD, FASN, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Treatment

Medical Care

Bleeding episodes (mild) with flank pain are treated with analgesics (eg, acetaminophen, codeine, morphine) with careful dosing consideration related to underlying kidney dysfunction. Avoid aspirin and meperidine. Avoid heparin during hemodialysis. Patients whose bleeding does not resolve spontaneously should undergo renal embolization or nephrectomy, in particular if the cyst is more than 3 cm in diameter. [25]

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Surgical Care

See the list below:

  • Severe bleeding episodes are treated with embolization or nephrectomy.

  • If carcinoma is suspected (from CT scan findings; cysts > 3 cm in diameter and cysts < 3 cm but with complications), then consider nephrectomy.

  • Prophylactic contralateral nephrectomy is controversial; bilateral nephrectomy may be considered in those patients likely to receive kidney transplantation.

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Long-Term Monitoring

Although patients with end-stage renal disease (ESRD) and acquired cystic kidney disease (ACKD) are at increased risk for renal cell carcinoma (RCC), routine screening for RCC is not recommended for most of these patients, given the relatively low incidence of RCC in the setting of ACKD and the low expected patient survival with ESRD. However, screening may be advisable and required for patients on transplant waiting lists. [26] The screening schedule varies based on individual provider preferences and can range from yearly to once every 5 years.

Schwarz et al studied RCC in renal transplant recipients with ACKD and recommended the following screening and management protocol, incorporating the Bosniak renal cyst classification system (see DDx) [27, 9] :

  1. All recipients: Yearly ultrasound screening of the native kidneys.

  2. ACKD and Bosniak category I or II cysts (benign simple cysts): Twice yearly ultrasound screening, computed tomography (CT) scan if progression is evident

  3. ACKD and Bosniak category IIF (F for follow-up) cysts (moderately complex cysts): Quarterly ultrasound screening and yearly CT or magnetic resonance imaging scan; nephrectomy if progression is evident, even if the condition does not reach Bosniak category III or IV

  4. ACKD and Bosniak category III (“indeterminate” cystic masses) or IV (clearly malignant cystic masses): Nephrectomy

 

 

 

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