The role of ischemia in acquired cystic kidney disease

Acquired cystic kidney disease (ACKD) is the result of cyst formation in failing noncystic kidneys. This condition occurs in patients with chronic renal failure and becomes more common with increasing time on renal replacement therapy. Its complications include hemorrhage and tumor formation, which have acquired greater significance as more patients are started on dialysis treatment. The causes of ACKD remain speculative thus far. Its occurrence in nondialyzed patients suggests that dialysis itself is not a necessary factor in its pathogenesis. Five cases of severe unilateral renovascular disease and associated cyst formation are reported. The authors conclude that ACKD may derive from primary renovascular occlusion or from the secondary arterial and arteriolar occlusions seen in the end-stage kidney.