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22-25: Cystic Diseases of the Kidney

Tonja C. Dirkx; Tyler B. Woodell

Renal cysts are epithelium-lined cavities filled with fluid or semisolid material that develop primarily from renal tubular elements. One or more simple cysts are found in 50% of individuals over the age of 50 years. They are rarely symptomatic and have little clinical significance. In contrast, generalized cystic diseases are associated with cysts scattered throughout the cortex and medulla of both kidneys and can progress to ESKD (Table 22–10).

Table 22–10.Clinical features of renal cystic disease.
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Table 22–10. Clinical features of renal cystic disease.
  Simple Renal Cysts Acquired Renal Cysts Autosomal Dominant Polycystic Kidney Disease Medullary Sponge Kidney Medullary Cystic Kidney
Prevalence Common Dialysis patients 1:1000 1:5000 Rare
Inheritance None None Autosomal dominant None Autosomal dominant
Age at onset … … 20–40 years 40–60 years Adulthood
Kidney size Normal Small Large Normal Small
Cyst location Cortex and medulla Cortex and medulla Cortex and medulla Collecting ducts Corticomedullary junction
Hematuria Occasional Occasional Common Rare Rare
Hypertension None Variable Common None None
Associated complications None Adenocarcinoma in cysts Hepatic cysts, urinary tract infections, renal calculi, cerebral aneurysms Renal calculi, urinary tract infections Polyuria, salt wasting
Kidney failure Never Always Frequently Never Always

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