Unilateral renal cystic disease--report of one case and review of literature

Diagnostic and therapeutic challenges of an ambiguous cystic kidney disease in a resource limited setting: a case report

Background

Unilateral renal cystic disease is a rare condition that shares morphological similarities with multicystic dysplastic kidney, the former often distinguished from the latter on some clinical and histopathological grounds. However serious diagnostic and therapeutic dilemmas set in when there is a considerable overlap in the distinguishing features between these entities.

Case presentation

A 19-year-old African female presented with a chronic severe debilitating right lower quadrant abdominal pain refractory to analgesics. Biochemical investigations and imaging studies revealed a non-functional polycystic right kidney and no identifiable pelvicalyceal system or ureter but with preserved renal function. The marked overlap in clinical presentation between unilateral renal cystic disease and multicystic dysplastic kidney in this patient necessitated further investigation to pose an appropriate diagnosis. A right nephrectomy was performed and histopathological analysis of the resected kidney done, the results of which were more consistent with unilateral renal cystic disease. The post-operative course was favorable.

Conclusion

Unilateral renal cystic disease with an ipsilateral non-functional kidney and an atretic pelvicalyceal system is a very rare condition that needs to be distinguished from multicystic dysplastic kidney in order to guide management and set prognosis. A suspicion of either of these diseases therefore warrants a thorough clinical evaluation and the appropriate combination of biochemical and imaging investigations.

Localized cystic disease of the kidney: case report and review of the literature

Localized cystic disease of the kidney (LCDK) is a benign and non-progressive renal anomaly that may initially be confused with autosomal dominant polycystic kidney disease (as in the index case) or cystic neoplasms. It is best diagnosed with contrast-enhanced CT scan demonstrating the characteristic features of an unencapsulated mass of smooth-walled cysts with enhancing renal parenchyma between them. It is most often an incidental finding, but may present with flank pain or haematuria. Hypertension and renal impairment are uncommonly associated with LCDK. A complete physical examination and comprehensive family history are important to exclude other acquired or inherited causes of cystic kidney disease and to avoid unnecessary diagnostic procedures or nephrectomy. We describe a case manifesting many of the typical features of the condition and review previously published cases to describe the natural history and presentation of this rare entity.

Secondary polycythaemia associated with unilateral renal cystic disease

Unilateral renal cystic disease (URCD) is a rare condition, with pathological features indistinguishable from autosomal dominant polycystic kidney disease (ADPKD). In contrast to this condition, however, URCD is not inherited, is not associated with progressive deterioration in renal function, and is unilateral. We present a case of URCD associated with polycythaemia, which showed resolution following nephrectomy. Secondary polycythaemia has not previously been reported in cases of URCD, but may be hypothesised to be a result of excess erythropoietin production.

Case Report. A case of unilateral renal cystic disease

Unilateral renal cystic disease (URCD) is a distinct entity that is one of the renal cystic diseases. The clinical importance of URCD is to make a differential diagnosis from autosomal dominant polycystic kidney disease (ADPKD), multicystic dysplastic kidney, multilocular cystic renal neoplasm, and simple cysts. To confirm the diagnosis and to rule out asynchronous ADPKD requires long-term follow up, especially in younger patients.