cysts are abnormal, fluid-filled sacs that arise from the kid-ney tissue. They
may be genetic in origin, acquired, or associated with a host of unrelated
conditions. Cysts of the kidney may be single or multiple (polycystic),
involving one or both kidneys. Polycystic disease of the adult is inherited as
an autosomal dom-inant trait and affects men and women equally.
dominant polycystic kidney disease is a common in-herited condition, occurring
in between 1 in 200 and 1 in 1,000 of the population. After diagnosis, patients
are usually treated by nephrologists because of the risk of progression to
ESRD. Almost two thirds (64%) of people with adult polycystic kidney disease
also develop hematuria. Most episodes are due to UTIs and rup-ture of renal
cysts that relate to the underlying anatomic abnor-malities. The symptoms are
usually short-lived and resolve with conservative measures such as rest and
antibiotic treatment. Renal stone disease is also common, occurring in 20% of
patients. Frank hematuria is also a presenting symptom of common, but
unrelated, disorders that may occur coincidentally. These patients must be
evaluated to rule out a genitourinary cancer because hematuria is also a
presenting symptom of urinary tract cancer. Simple noninvasive diagnostic
studies such as transabdominal ultrasound and urine cytology may demonstrate
additional pa-thology that needs treatment to reduce further morbidity (Dedi,
Bhandari, Turney et al., 2001).
renal disease is also associated with cystic diseases of other organs (liver,
pancreas, spleen) and aneurysms of the cere-bral arteries. It has long been
recognized that patients on long-term dialysis (both hemodialysis and
peritoneal dialysis) develop multiple cysts on their nonfunctioning kidneys.
Many of these cysts contain cancer cells.
acquired form of polycystic disease occurring as a result of ESRD associated
with dialysis is called acquired cystic kidney dis-ease. While most of the
cysts remain benign, serious complications can develop. Acquired cystic kidney
disease has been associated with cyst infection, cyst hemorrhage,
retroperitoneal hemorrhage, and spontaneous rupture of the kidney; therefore,
it is important for the nurse to be aware of this variation of cystic kidney
disease (Dedi, Bhandari, Turney et al., 2001; Headley & Wall, 1999).
kidney gradually enlarges, with signs and symptoms becom-ing apparent in the
fourth or fifth decade of life. The patient reports abdominal or lumbar pain.
Hematuria, hypertension, pal-pable renal masses, and recurrent UTIs are
additional manifesta-tions. Renal insufficiency and failure usually develop in
the end stages. Diagnosis of renal cysts is confirmed either by intravenous
urography or CT scan.
there is no specific treatment for polycystic renal disease, patient care
focuses on relief of pain, symptoms, and complica-tions. Hypertension and UTIs
are treated aggressively. Dialysis is initiated when signs and symptoms of
renal in-sufficiency and failure occur. Genetic counseling is part of
man-agement with polycystic kidney disease that is genetic in origin. The
patient is advised to avoid sports and occupations that pre-sent a risk for
trauma to the kidney. Simple cysts of the kidney usually occur unilaterally and
differ clinically and pathophysio-logically from polycystic kidney disease. In
such cases, the cyst may be drained percutaneously.