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Acquired cystic kidney disease in children undergoing long-term dialysis
H E Leichter1, R Dietrich, I B Salusky
1Division of Pediatric Nephrology and Pediatric Radiology, UCLA Hospital and Clinics.
Insights
Acquired cystic kidney disease (ACKD) can affect children and adolescents on dialysis. Early detection using MRI and ultrasound is crucial for identifying cysts and potential pre-cancerous changes.
Area of Science:
- Nephrology
- Radiology
- Pediatric Nephrology
Background:
- Acquired cystic kidney disease (ACKD) is a known complication in adults with end-stage renal disease on long-term dialysis.
- ACKD is associated with significant complications, including hematuria and renal malignancies.
- The incidence and presentation of ACKD in pediatric patients on dialysis are less understood.
Purpose of the Study:
- To evaluate the incidence of ACKD in pediatric patients undergoing long-term dialysis.
- To assess the utility of magnetic resonance imaging (MRI) and ultrasonography (US) in detecting ACKD in this population.
- To highlight the importance of early detection due to potential neoplastic changes.
Main Methods:
- Retrospective evaluation of 15 pediatric patients (ages 7.3-21.6 years) with non-cystic primary renal disease on dialysis.
- Patients underwent both MRI and US for cyst detection.
- Dialysis modalities (peritoneal dialysis only vs. hemodialysis and peritoneal dialysis) and duration (24-73 months) were recorded.
Main Results:
- ACKD was diagnosed in 10 out of 15 patients (67%) via MRI and US.
- Three patients (20%) had no cysts, while 5 (33%) had bilateral multiple cysts.
- Solitary cysts were found in 7 patients (47%), either unilaterally or bilaterally.
- One patient showed neoplastic tubular changes, a precursor to tumor formation.
Conclusions:
- ACKD is not exclusive to adult patients and can occur in pediatric patients on long-term dialysis.
- MRI and US are effective tools for early detection of ACKD in this age group.
- Early diagnosis is critical for monitoring and potentially preventing the progression to renal tumors.
Abstract:
Acquired cystic kidney disease (ACKD) occurs in adult patients undergoing long-term dialysis. Early detection is important because clinically significant hematuria and malignancies are associated with ACKD. We evaluated by magnetic resonance imaging (MRI) and ultrasonography (US) the incidence of ACKD in 15 patients aged 7.3-21.6 years (mean 15.9 years) with non-cystic primary renal disease. Nine patients had been treated with peritoneal dialysis only, and 6 with both hemodialysis and peritoneal dialysis for 24-73 months (mean 37 months). Three patients (20%) had no cysts. In 5 patients (33%) with bilateral multiple cysts, the diagnosis of ACKD was made by MRI and US. In another 5 patients, solitary cysts were localized to one kidney by MRI, and in 2 patients solitary cysts were seen in both kidneys. This study documents that ACKD is not limited to older patients with end-stage renal disease. Early detection of these cysts can be accomplished by MRI and is warranted since 1 patient developed neoplastic tubular changes which can precede tumor formation.