Renal cyst evolution in childhood: a contemporary observational study

Area of Science:

• Pediatric Nephrology
• Medical Imaging
• Urology

Background:

• Children with renal cysts undergo ultrasound (US) monitoring to detect potential malignant transformation or polycystic kidney disease (PKD).
• The clinical utility and necessity of ongoing surveillance for these cysts remain uncertain.
• Simple or minimally complex renal cysts are common findings in pediatric populations.

Purpose of the Study:

• To evaluate the natural history of simple or minimally complex renal cysts in children.
• To determine the proportion of these cysts that progress to autosomal dominant polycystic kidney disease (ADPKD), autosomal recessive polycystic kidney disease (ARPKD), or malignancy.
• To inform clinical guidelines regarding the surveillance of pediatric renal cysts.

Main Methods:

• Retrospective chart review of patients with renal cysts diagnosed between 2004 and 2014.
• Inclusion criteria: ≤3 simple or minimally complex cysts on initial US, without prior diagnosis of specific kidney conditions or malignancy.
• Logistic regression analysis to identify factors associated with ADPKD/ARPKD development.

Main Results:

• Eighty-seven eligible pediatric patients were included, with a median follow-up of 4.1 years.
• 12.6% were diagnosed with ADPKD and 1.2% with ARPKD, with diagnoses occurring early in the follow-up period.
• No patients developed malignancy, and most cysts did not require intervention.

Conclusions:

• Children with few simple or minimally complex renal cysts typically do not require extensive long-term monitoring.
• Progression to PKD or malignancy is rare, suggesting that current surveillance protocols may be excessive.
• Further research should focus on refining guidelines for optimal follow-up of pediatric renal cysts.