Acquired cystic kidney disease (ACKD) is a condition that occurs in patients with end-stage kidney disease (ESKD), especially when on dialysis treatment, and who do not have a history of other cystic renal disease.
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 6. It is equally common with haemodialysis as with peritoneal dialysis 2.
Usually asymptomatic. Cyst haemorrhage may cause flank pain and haematuria 2.
Although uraemia is associated with an eventual development of acquired cystic kidney disease, the pathogenesis is currently unknown. Some theories suggest that toxins or accumulation of growth factors, such as epidermal growth factor.
The hyperplastic renal cysts in ARCD have been considered a possible source of dialysis-associated renal cell carcinoma.
Classical imaging features include bilateral small renal cysts, occurring in both the cortex and medulla, with both kidneys typically being small in size (refer to the chronic kidney disease (CKD) article for a broad discussion on the condition's correlated imaging findings).
Diagnostic criteria include:
- patients with chronic renal failure
- kidneys are usually decreased in size
- >3-5 cysts in each kidney
- cysts are mostly cortical, but may also be medullary
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.
- haemorrhage into cysts, which occurs occasionally
- development of renal cell carcinoma in ~7%
- imaging screening for these patients is controversial 3,4,5 ; one screening strategy images patients <55 years old who have been on dialysis for three years 3
History and etymology
ACKD was first described in 1977 by MS Dunnil et al. 3,4.
- 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. Levine E. Acquired cystic kidney disease. Radiol. Clin. North Am. 1996;34 (5): 947-64. Pubmed citation
- 3. 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
- 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. 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
- 6. 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. ISBN:1416069119. Read it at Google Books - Find it at Amazon