Current Concepts and Controversies in Imaging of Renal Cystic Diseases

Levine, Eli; Hartman, David S.; Meilstrup, Jon W.; Slyke, Mark A. Van; Edgar, Kenneth; Barth, J C

doi:10.1016/s0094-0143(05)70400-6

Cited by 38 publications

(17 citation statements)

References 91 publications

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“…Radiologic features of pyocysts are unspecific and may be secondary to previous infections and hemorrhages, as well as chronic parenchyma injury. Cyst content of pus or blood may be indistinguishable (3), and contrast enhancement lining cyst walls can be caused by residual functional parenchyma (15,16). Furthermore, CT is most frequently performed in ADPKD patients without intravenous contrast medium because of CKD.…”

Section: Discussionmentioning

confidence: 99%

Positron-Emission Computed Tomography in Cyst Infection Diagnosis in Patients with Autosomal Dominant Polycystic Kidney Disease

Jouret

Lhommel²,

Beguin³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground Cyst infection remains a challenging issue in patients with autosomal dominant polycystic kidney disease (ADPKD). In most patients, conventional imaging techniques are inconclusive. Isolated observations suggest that 18 fluorodeoxyglucose ( 18 FDG) positron-emission computed tomography (PET/CT) might help detect cyst infection in ADPKD patients.Design, setting, participants, & measurements Comparative assessment of administrative databases from January 2005 to December 2009 identified 27 PET/CT scans performed in 24 ADPKD patients for suspicion of abdominal infection. Cyst infection was definite if confirmed by cyst fluid analysis. Cyst infection was probable if all four of the following criteria were met: temperature of Ͼ38°C for Ͼ3 days, loin or liver tenderness, C-reactive protein plasma level of Ͼ5 mg/dl, and no CT evidence for intracystic bleeding. Episodes with only two or three criteria were grouped as "fever of unknown origin".Results Thirteen infectious events in 11 patients met all criteria for kidney (n ϭ 3) or liver (n ϭ 10) cyst infection. CT was contributive in only one patient, whereas PET/CT proved cyst infection in 11 patients (84.6%). In addition, 14 episodes of "fever of unknown origin" in 13 patients were recorded. PET/CT identified the source of infection in nine patients (64.3%), including 2 renal cyst infections. Conversely, PET/CT showed no abnormal 18 FDG uptake in 5 patients, including 2 intracystic bleeding. The median delay between the onset of symptoms and PET/CT procedure was 9 days.Conclusions This retrospective series underscores the usefulness of PET/CT to confirm and locate cyst infection and identify alternative sources of abdominal infection in ADPKD patients.

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Section: Discussionmentioning

confidence: 99%

Positron-Emission Computed Tomography in Cyst Infection Diagnosis in Patients with Autosomal Dominant Polycystic Kidney Disease

Jouret

Lhommel²,

Beguin³

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…contrast material in dilated collecting tubules (7). CT scanning is also good at revealing papillary calcifications or hyperdense papillae (11,12).…”

Section: öZmentioning

confidence: 99%

A Case of Medullary Sponge Kidney Diagnosed at an Older Age

Eken¹,

Özkök²,

Arslan³

et al. 2015

Turk Neph Dial Transpl

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Medullary sponge kidney (MSK) is known as a congenital disesase with dilatation of collecting tubules. MSK is usually asymptomatic but various clinical manifestations may occur including nephrocalcinosis, renal tubular acidosis, impaired urine concentrating ability, urinary tract stones and infections. Although MSK is a congenital disorder, it is usually diagnosed in second or third decade. A 53-year-old woman presented with recurrent dysuria and bilateral costovertebral pain radiating to the groin region. Pyuria and hematuria were found. On ultrasonography, hyperechogenic densities of multiple calculi in the calyces of both kidneys, and minimal pelvicaliectasis were detected. Computed tomography revealed multiple punctate calcifications aligned concentrically in the medulla of both kidneys. On clinical and radiological grounds, the diagnosis of MSK was established. The patient's complaints were resolved with antibiotherapy for urinary tract infection. Thiazide or potassium citrate was not prescribed since hypercalciuria or hypocitraturia was not present. In conclusion, MSK should be considered in the differential diagnosis of nephrocalcinosis, nephrolithiasis and recurrent urinary tract infections in older patients, even in the fifth decade. ÖzMedüller sünger böbrek (MSB), renal papilladaki toplayıcı kanalların dilatasyonuyla karakterize konjenital bir hastalıktır. MSB genellikle asemptomatiktir fakat nefrokalsinozis, renal tübüler asidoz, idrarı konsantre etme kapasitesinde bozulma, böbrek taşları ve enfeksiyonları içeren çeşitli klinik durumlarla ortaya çıkabilir. MSB konjenital bir hastalık olmasına rağmen, genellikle 2. veya 3. dekada kadar tanı konulamaz. Bu olgu bildiriminde, 53 yaşında MSB tanısı konan bir kadın olguyu tartışmayı amaçladık. Hastamız, tekrarlayan idrarda yanma ve kasık bölgesine yayılan çift taraflı yan ağrısı şikayetiyle başvurdu. Tetkiklerinde piyüri ve hematüri saptandı. Ultrasonografide her iki böbrek kalikslerinde birden fazla taşla uyumlu hiperekojen dansiteler ile birlikte minimal pelvikaliektazi tespit edildi. Bilgisayarlı tomografide, her iki böbrek medüllasında çok sayıda noktasal kalsifikasyonlar saptandı. Hastaya klinik ve radyolojik kriterlerle MSB tanısı kondu. Uygun antibiyotik tedavisiyle idrar yolu enfeksiyonu tedavi edildi ve hastanın şikayetleri geriledi. Hiperkalsiüri veya hipositratüri saptanmadığı için tiazid veya potasyum sitrat tedavileri başlanmadı. Sonuç olarak, hastalar ileri yaşta olsa bile, MSB, nefrokalsinozis, nefrolitiazis ve tekrarlayan idrar yolu enfeksiyonu ayırıcı tanısında düşünülmelidir.

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“…Typical ADPKD kidneys have multiple bilateral renal cysts with associated renal enlargement ( Figure 1A) (1). The number and distribution of renal cysts, kidney size, and presence of associated features, including liver cysts (5), differentiate ADPKD from other hereditary cystic disorders (6).…”

Section: Diagnosing and Screening For Adpkdmentioning

confidence: 99%

Renal Relevant Radiology

Rahbari-Oskoui¹,

Mittal²,

Mittal³

et al. 2014

Clinical Journal of the American Society of Nephrology

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SummaryAutosomal-dominant polycystic kidney disease is a systemic disorder and the most common hereditary renal disease, which is characterized by cyst growth, progressive renal enlargement, and development of renal failure. The cystic nature of autosomal dominant polycystic kidney disease and its renal and extrarenal complications (kidney stones, cyst hemorrhage, intracerebral aneurysm, liver cysts, cardiac valve abnormalities, etc.) give radiologic imaging studies a central role in the management of these patients. This article reviews the indications, comparative use, and limitation of various imaging modalities (ultrasonography, magnetic resonance imaging, computerized tomography scan, Positron emission tomography scan, and renal scintigraphy) for the diagnosis and management of complications in autosomal dominant polycystic kidney disease. Finally, this work provides evidence for the value of total kidney volume to predict disease progression in autosomal dominant polycystic kidney disease.

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Current Concepts and Controversies in Imaging of Renal Cystic Diseases

Cited by 38 publications

References 91 publications

Positron-Emission Computed Tomography in Cyst Infection Diagnosis in Patients with Autosomal Dominant Polycystic Kidney Disease

Positron-Emission Computed Tomography in Cyst Infection Diagnosis in Patients with Autosomal Dominant Polycystic Kidney Disease

A Case of Medullary Sponge Kidney Diagnosed at an Older Age

Renal Relevant Radiology

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