Related Experiment Videos
Acquired cystic kidney disease before and after renal transplantation
U Querfeld1, F Schneble, W Wradzidlo
1Department of Pediatric Nephrology, University of Heidelberg, Germany.
Insights
Acquired cystic kidney disease (ACKD) is common in pediatric end-stage renal disease patients, even post-transplant. Ultrasonography is more effective than MRI for detecting ACKD in this population.
Area of Science:
- Pediatric Nephrology
- Medical Imaging
- Renal Disease Research
Background:
- Acquired cystic kidney disease (ACKD) is a known complication in adults with end-stage renal disease (ESRD).
- Limited data exists on ACKD prevalence and detection in pediatric ESRD patients, including those with renal transplants.
Purpose of the Study:
- To determine the prevalence of ACKD in pediatric patients with ESRD.
- To compare the efficacy of high-resolution ultrasonography and magnetic resonance imaging (MRI) in diagnosing ACKD in this cohort.
Main Methods:
- Study included 48 pediatric patients with ESRD (mean age 17 years).
- Imaging techniques used were high-resolution ultrasonography and/or MRI.
- Patients had ESRD for a mean of 5.7 years, with 83% having functioning renal transplants.
Main Results:
- Ultrasonography detected ACKD in 29% of patients, solitary cysts in 33%, and no cysts in 38%.
- MRI diagnosed ACKD in only 3 of 37 patients, while ultrasonography identified it in 11 of 31 patients studied by both methods.
- ACKD was associated with longer ESRD duration, but not impaired renal function. One patient developed renal cell carcinoma.
Conclusions:
- Pediatric ESRD patients, including those with successful renal transplants, should be regularly monitored for ACKD.
- Ultrasonography appears to be the preferred imaging modality for ACKD detection in this population.
- Early detection and monitoring are crucial, given the potential for malignancy.
Abstract:
To determine the prevalence of acquired cystic kidney disease (ACKD), as reported in adults receiving long-term hemodialysis treatment, we studied 48 pediatric patients (aged 17 +/- 5.1 years) with end-stage renal disease by high-resolution ultrasonography or magnetic resonance imaging or both. Forty patients (83%) had a functioning renal transplant, with a mean transplant survival time of 3.4 years (range, 0.3 to 14.8 years); four patients were treated by hemodialysis and four by peritoneal dialysis. The mean duration of end-stage renal disease was 5.7 +/- 3.8 years. Ultrasonography detected ACKD in 12 (29%) of 42 patients, solitary cysts in 14 patients (33%), and no cysts in 16 patients (38%). In contrast, ACKD was diagnosed in only 3 of 37 patients studied by magnetic resonance imaging. In 31 patients studied by both imaging techniques. ACKD was diagnosed in three patients by magnetic resonance imaging but in 11 by ultrasonography. In patients with ACKD, the duration of end-stage renal disease was significantly longer, but renal (transplant) function was not different from that in patients with solitary cysts or no cysts. One patient with a history of 12 1/2 years of hemodialysis had multiple renal tumors that were diagnosed as renal cell carcinomas after bilateral nephrectomy. These results indicate that young patients with end-stage renal disease should be monitored regularly for the presence of ACKD, preferably by ultrasonography, even after successful renal transplantation.