Fluid Turnover in Renal Cysts

Abstract

Cystic puncture was performed percutaneously in 18 patients with solitary renal cysts and in 22 with multiple, congenital renal cysts. With the aid of tritiated water it was possible to estimate the fluid turnover in the cysts and compare it with their volume, pressure and potassium and creatinine levels. Fluid turnover was rapid in all the renal cysts. Two to five hours after i. v. injection of tritium, the tritium concentration in cystic fluid averaged 88% of the concentration in plasma fluid in patients with polycystic kidneys and 73% in patients with solitary cysts. Fluid turnover was more rapid in small than in large cysts, but there was no such difference between cysts with high and low pressure. It is possible that the fluid turnover was slightly faster in cysts with high potassium and creatinine levels than in those with low levels. The results show that the fluid turnover in a renal cyst of 10 ml is considerable— probably more than 100 ml/24 hours. This indicates that fluid inflow to the cyst comes mainly from cells in the cyst wall and not from a single glomerule. Fluid probably leaves the cyst actively via cells in the cyst wall, since the fluid turnover does not increase with high cyst pressure. The fluid turnover is probably secondary to the active solute transportation, which is performed by the cyst cells. This means that these cells have a tubular cell‐like function and should respond to pharmacotherapy.

Strategies Targeting cAMP Signaling in the Treatment of Polycystic Kidney Disease

“…A study in 1977 using tritiated water shows a high turnover of cyst fluid in ADPKD (.100 ml in 24 hours for a 10-ml cyst) thought to be secondary to active solute transport and therefore, susceptible to pharmacotherapy. 82 Studies using polarized normal human kidney and ADPKD cells on permeable supports and microcysts in hydrated collagen confirm a model of fluid transport as previously shown in MDCK cells and other secretory epithelia. 83 Intact cysts excised from ADPKD kidneys secrete fluid when treated with forskolin, confirming that intact cyst epithelia secrete fluid by mechanisms regulated by cAMP.…”

The efficacy of retroperitoneal laparoscopic deroofing of simple renal cyst with perirenal fat tissue wadding technique

“…[ 7 , 22 , 23 ] However, the reported recurrence rate is still up to 19%, regardless the technique used. [ 12 ] Jacobsson et al [ 24 ] have shown that secretory activity of the remaining cyst wall after unroofing may play a causal role in cystic recurrence. If the resection of such a wall is incomplete, the residual secreting cyst wall can become adherent to surrounding tissues with the development of a new cyst.…”

Renal Cysts and Urinomas

“…33,34 The problem with simple aspiration is the high recurrence rate because the epithelium of cysts can rapidly produce more fluid and refill the cyst. 35 Recurrence of renal cysts after simple aspiration occurs in anywhere from 30 to 100% of cases in the series reported. [36][37][38][39] For this same reason, simple catheter drainage is rarely used.…”