Acquired cystic kidney disease

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 small renal cysts, occurring in both the cortex and medulla, which are found bilaterally, with both kidneys typically being small in size (refer to the chronic kidney disease (CKD) article for a broad discussion on its correlated imaging findings).

Diagnostic criteria includes:

  • 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

Renal transplantation has been thought to resolve acquired renal cysts, but there is still a risk of RCC in the native kidneys.

  • haemorrhage into cysts, which occurs occasionally
  • development of renal cell carcinoma, which occurs 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

ACKD was first described in 1977 by MS Dunnil et al. 3,4.

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Article Information

rID: 26747
System: Urogenital
Section: Pathology
Synonyms or Alternate Spellings:
  • ACKD
  • Acquired cystic kidney disease (ACKD)
  • ARCD
  • Acquired renal cystic disease (ARCD)

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