Cystic kidney disease may be congenital or acquired. Congenital disorders may be inherited as autosomal dominant disorders or autosomal recessive disorders or have other causes (eg, sporadic mutations, chromosomal abnormalities, teratogens). Some are part of a malformation syndrome (see table Major Groups of Cystic Nephropathies).
Major Groups of Cystic Nephropathies
Disorder | Clinical Features |
|---|---|
Autosomal dominant | |
Flank and abdominal pain Large kidneys with multiple bilateral cysts Extrarenal cysts (liver, pancreas, intestine) Cerebral aneurysms ESKD during adulthood | |
Branchio-oto-renal syndrome (BOR syndrome or Melnick-Fraser syndrome) | Branchial fistulas and cysts Preauricular pits or tags Hearing loss Renal aplasia and cysts |
Familial renal hamartomas | Primary hyperparathyroidism Ossifying fibromas of the jaw New hamartoma which can manifest as cysts |
Autosomal dominant tubulointerstitial kidney disease (ADTKD) | Small to normal-sized kidneys Polydipsia and polyuria Absent-to-mild proteinuria Bland urinary sediment No severe hypertension during early stages Nocturia or enuresis in children ESKD during adulthood Gout for most variants Renal medullary cysts |
Benign tumors of the brain, kidneys, and skin Angiomyolipomas of the kidneys, which can appear like cysts | |
Hemangioblastoma proliferation in the retina, brain, spinal cord, and adrenal glands | |
Autosomal recessive | |
Alström syndrome | Renal cysts |
Autosomal recessive polycystic kidney disease | Large kidneys with multiple bilateral cysts ESKD during childhood |
Bardet-Biedl syndrome | Intellectual disability Retinopathy Obesity Polydactyly Renal cysts |
Ellis–van Creveld syndrome | Short-limb dwarfism Heart defects frequently Renal cysts |
Ivemark syndrome | Spleen agenesis Cyanotic heart disease Gut malrotation Renal cysts |
Jeune syndrome (asphyxiating thoracic dystrophy) | Dwarfism involving the chest, arms, and legs Microcystic renal disease |
Joubert syndrome | Intellectual disability Hypotonia Irregular breathing Eye movement abnormalities Renal cysts and liver disease in some individuals |
Meckel-Gruber syndrome | Occipital encephalocele Polydactyly Craniofacial dysplasia Renal cysts |
Small to normal-sized kidneys with cysts Polydipsia and polyuria Mild proteinuria with benign urinary sediment ESKD possibly during childhood | |
Zellweger syndrome (cerebrohepatorenal syndrome) | Brain and liver defects Developmental delay High serum iron and copper levels Hypotonia Kidney cysts |
Other congenital* | |
Cysts of nontubular origin (includes glomerular, subcapsular, and pyelocalyceal cysts) | Various clinical characteristics |
Tubular dilations and cysts of collecting ducts Associated renal tubular acidosis type 1 and renal calculi Does not typically progress to ESKD | |
Multicystic dysplastic kidney | Unilateral nonreniform mass of cysts and connective tissue, with typically absent functioning renal tissue |
Oral-facial-digital syndrome (can follow multiple inheritance patterns including X-linked, autosomal dominant, or autosomal recessive) | Partial clefts in lip, tongue, and alveolar ridges Hypoplasia of nasal cartilage Microcysts in kidneys |
Associated with urinary structural obstruction or metanephric malformation Degree of dysplasia asymmetric between kidneys and kidney cysts | |
Profound developmental delay Malformations of the head, face, hands, and feet Kidney cysts in some cases | |
Acquired | |
Multiple cysts Associated with long-term dialysis, usually after > 10 years High risk of renal cell carcinoma | |
Cysts associated with tumors | For example, with renal cell carcinoma or nephroblastoma |
Solitary simple cysts | Low risk of chronic kidney disease and hypertension Associated with aging |
* Caused by, eg, sporadic mutations, chromosomal abnormalities, teratogens, or unknown mechanisms. | |
ESKD = end-stage kidney disease. | |
