Cystic kidney diseases

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Cystic kidney diseases, also cystic renal diseases, are a group of medical kidney diseases characterized by multiple cysts.

Polycystic kidneys. (WC/CDC)

Renal neoplasms, e.g. renal cell carcinoma, may be cystic. They are dealt with in kidney tumours.

Overview

Adult

Pediatric

Specific diseases

Benign cortical cysts of the kidney

General

  • Very common.
  • Benign.

Gross

  • Thin-walled cyst - usually filled with serous fluid.
  • Usually unilocular.

Microscopic

Features:

  • Simple epithelial lining without atypia.
  • May have clear cells.

Note:

  • Do not have clear cells within the wall of the cyst.[1]

DDx:

Autosomal dominant polycystic kidney disease

  • Abbreviated ADPKD.

General

Etiology

  • Mutation in PKD1 gene or PKD2 gene.
  • Is classified in a large group of diseases - ciliopathies.

PKD1 related disease:[2]

  • Encodes polycystin.
  • Death at ~53 years.
  • Assoc. with cerebral aneurysms.

PKD2 related disease:[2]

Liver cysts and PKD

General

Features:

  • Most common extra-renal manifestation of PKD; dependent on age, sex and renal function:[3]
    • Age dependence:
      • 10-17% <40 years old have liver cysts.
      • 70-75% >60 years old have liver cysts.
    • Renal function:
    • Females more often affected.
  • Hepatic function usu. preserved.

Complications:[2]

  1. Infected cyst.
  2. Cholangiocarcinoma.
Microscopic

Features:

  • Von Meyenburg complexes:
    • Cluster of dilated ducts with "altered" bile.
    • Surrounded by collagenous stroma.

See: Medical liver disease.

Gross

Features:

  • Thin walled cysts.
    • Number of cysts:
      • If you can count 'em it favours acquired renal cystic disease... if you can't it favours the genetic condition.

Microscopic

Features:[4]

  • Cysts lined by simple flattened epithelium.
  • Normal renal tubules interspersed between cysts.
  • +/-Fibrosis (late-stage).

DDx:

  • Acquired renal cystic disease - rarely.[5]
    • Morphologically similar to acquired renal cystic disease.[6]
    • It is said that "... if you can count 'em it's simple cysts; if you can't it's polycystic (renal disease)."[6][7]

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Left Kidney, Nephrectomy: 
- Polycystic kidney with changes of chronic renal failure (thyroidization), 
  consistent with polypcystic kidney disease. 
- NEGATIVE for malignancy. 

Acquired renal cystic disease

General

  • Thought to arise due to uremia,[8] not specific to the type of renal dialysis, i.e. hemodialysis vs. peritoneal dialysis.
  • Presence of cysts dependent on duration of dialysis:[8]
    • < 3 years ~44%.
    • >4 years ~80%.
    • >10 years ~90%.
  • Associated with papillary renal cell carcinoma.[9]

Microscopic

Features:[5]

  • Cysts - location: cortex and medulla.
    • Lined by simple flattened epithelium.

DDx:

Autosomal recessive polycystic kidney disease

  • Abbreviated ARPKD.

Localized cystic disease of the kidney

  • AKA segmental cystic disease of the kidney.
  • AKA unilateral cystic disease of the kidney.
  • AKA benign multilocular cyst of the kidney.

See also

References

  1. Epstein, Jonathan I.; Netto, George J. (2014). Differential Diagnoses in Surgical Pathology: Genitourinary System (1st ed.). Wolters Kluwer. pp. 197. ISBN 978-1451189582.
  2. 2.0 2.1 2.2 Burt, Alastair D.;Portmann, Bernard C.;Ferrell, Linda D. (2006). MacSween's Pathology of the Liver (5th ed.). Churchill Livingstone. pp. 174-5. ISBN 978-0-443-10012-3.
  3. Perrone RD (June 1997). "Extrarenal manifestations of ADPKD". Kidney Int. 51 (6): 2022–36. PMID 9186898. http://www.nature.com/ki/journal/v51/n6/pdf/ki1997276a.pdf.
  4. Fogo, Agnes B.; Kashgarian, Michael (2005). Diagnostic Atlas of Renal Pathology: A Companion to Brenner and Rector's The Kidney 7E (1st ed.). Saunders. pp. 426. ISBN 978-1416028710.
  5. 5.0 5.1 5.2 Kessler M, Testevuide P, Aymard B, Huu TC (1991). "Acquired renal cystic disease mimicking adult polycystic kidney disease in a patient undergoing long-term hemodialysis". Am. J. Nephrol. 11 (6): 513–7. PMID 1819219.
  6. 6.0 6.1 RJ. 20 October 2010.
  7. Barbaric, Zoran L. (1994). Principles of Genitourinary Radiology (2nd ed.). Thieme. pp. 87. ISBN 978-0865774933.
  8. 8.0 8.1 Fick GM, Gabow PA (October 1994). "Hereditary and acquired cystic disease of the kidney". Kidney Int. 46 (4): 951–64. PMID 7861721. http://www.nature.com/ki/journal/v46/n4/pdf/ki1994354a.pdf.
  9. Fogo, Agnes B.; Kashgarian, Michael (2005). Diagnostic Atlas of Renal Pathology: A Companion to Brenner and Rector's The Kidney 7E (1st ed.). Saunders. pp. 438. ISBN 978-1416028710.