Infected Hepatic and Renal Cysts: Differential Impact on Outcome in Autosomal Dominant Polycystic Kidney Disease

Abstract

Background: Infected cysts are a frequent and serious complication of autosomal dominant polycystic kidney disease. Such infections are classified into those affecting hepatic cysts and those affecting renal cysts. The purpose of this study was to compare the clinical course of infected hepatic cysts with that of infected renal cysts in patients with autosomal dominant polycystic kidney disease. Methods: We analyzed 43 patients referred to us for additional treatment of severely infected cysts between January 2004 and December 2006. All patients who required further treatment in addition to antibiotic therapy were included. Results: Aspiration was performed in all 28 patients with infected hepatic cysts. As a result, 17 patients were cured, 4 remain under treatment, and 6 died. One patient was cured by partial hepatectomy. Among the 15 patients with renal cysts, aspiration was performed in 4 with identifiable infected cysts, while renal transcatheter arterial embolization after appropriate antibiotic therapy was performed in 11 without identifiable infected cysts. No patient developed recurrence. Conclusion: In patients with infected renal cysts, aspiration or renal transcatheter arterial embolization after appropriate antibiotic therapy was effective. Although aspiration was often effective in patients with infected hepatic cysts, a good outcome was less likely than in those with renal cysts.

Factors Influencing Cyst Infection in Autosomal Dominant Polycystic Kidney Disease

“…In the present study, hepatic cyst infection was more severe than renal cyst infection, which was consistent with our previous findings [9], since renal cyst infection was less likely to recur than hepatic cyst infection and had a lower fatality rate. One reason for this difference might be that nephrectomy is effective for refractory renal cyst infection, while hepatic cyst infection can recur after partial hepatectomy.…”

“…One reason for this difference might be that nephrectomy is effective for refractory renal cyst infection, while hepatic cyst infection can recur after partial hepatectomy. In addition, the incidence of renal cyst infection might be reduced by renal TAE [9].…”

“…We previously investigated 50 patients with antibioticresistant cyst infection who received treatment, such as cyst drainage [9]. In that series, hepatic cyst infection was more serious than renal cyst infection and some patients died of refractory hepatic cyst infection.…”

Suitability of Patients with Autosomal Dominant Polycystic Kidney Disease for Renal Transcatheter Arterial Embolization

“…Renal cyst infection can progress rapidly after renal TAE, and it should not be performed in patients with active cyst infection, although we previously reported that the incidence of renal cyst infection decreases if adequate RV reduction is achieved by renal TAE. 35 A proton pump inhibitor should be administered after renal TAE to prevent gastrointestinal bleeding, and food intake should be restricted for several days to prevent intestinal perforation. In this study, RV was calculated with the equation for an ellipsoid.…”

Bilateral multiple cystic kidney disease and renal cortical abscess in a Boerboel

“…Cysts can have internal echoes that can be related to haemorrhage or cellular debris, or might be artefactual due to a slice thickness artefact mimicking sediment in the cyst 14,30,35 . In humans complications such as infection and acute rupture of these cysts have been reported 3,9,13,15,16,20,[23][24][25]27,29,[39][40][41][42][43][44][45] . To the authors' knowledge, there are no previous case reports that documents renal cyst infection in dogs with multiple-, solitary cystic kidney disease or PKD.…”