KEY FACTS
Terminology
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Presence of 3 or more renal cysts per kidney in patients with chronic kidney disease (CKD) who do not have hereditary cystic disease
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Occurs predominantly in patients on long-term dialysis (peritoneal or hemodialysis)
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In up to 13% of patients with CKD prior to dialysis
Imaging
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Ultrasound: Study of choice for establishing diagnosis in patients on dialysis
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Multiple bilateral small cysts in normal-sized or atrophic, echogenic kidneys
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Cysts are usually simple; may be complicated by hemorrhage, leading to internal fluid, solid avascular debris and septa
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Hemorrhagic cysts
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Malignant transformation of cysts typically manifests as papillary growth within the cyst
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Cysts scattered in both renal cortex and medulla
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Kidneys may be enlarged due to cysts
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CEUS, CT, or MR are required to fully evaluate complex cysts and distinguish from renal cell carcinoma
Top Differential Diagnoses
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Multiple simple cysts
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Adult polycystic kidney disease
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von Hippel-Lindau disease
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Tuberous sclerosis
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Medullary cystic disease
Clinical Issues
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Most patients are asymptomatic
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Hematuria, flank pain, fever if complications such as hemorrhage or infection occur
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Renal cell carcinoma occurs in up to 7% of patients
Scanning Tips
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Look for solid components
with multiple small cortical and medullary cysts 
. Many of these contain peripheral calcifications 
, more common in ACKD than in age-related simple renal cysts. One of these is entirely calcified 
.
and medullary 
cysts in a patient with chronic kidney disease, not yet on dialysis. The kidney is hyperechoic.
within an echogenic right kidney 
. There is cortical atrophy. The inferior cyst has internal echoes 
and lack of color flow, consistent with a hemorrhagic cyst, common in patients with cystic kidney disease of dialysis.Related posts:
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