Events - Grand Rounds in Pediatric Nephrology – an ISN-IPNA Sister Centers initiative: All Cysts Are Not Equal

“Simple cysts” are extremely rare in children and any cyst in the kidney of a child should be appropriately evaluated. Major clinical entities include multicystic dysplastic kidney, juvenile nephronopthisis, glomerulocystic kidney and Polycystic kidney diseases.  

Clinical case: A 12-year-old, male, JE, was referred from peripheral hospital with recurrent fever and abdominal pain of 4 and 1 month(s) respectively.  Accompanying abdominal ultrasound report showed diffuse renal cysts which was confirmed on repeat scan. Some cysts contained debris suggestive of haemorrhage or infection. Autosomal Dominant Polycystic Kidney Disease (ADPKD) was suspected and both parents had KUB ultrasound scan done. Mother had bilateral multiple cysts. Genetic work up is not feasible in our center. Child had 100mls of serous aspirate drained from multiple locules Child’s BP remained normal (between 50th -90th). Fever persisted for 3 weeks and finally settled on Piperacin-Tozobactam. ADPKD, though rare in children, should be suspected if diffuse cysts without dysplasia can be demonstrated in either parent even in areas without facilities for genetic testing so that maximal anticipatory care could be instituted. Recalcitrant infected cyst(s) should be aggressively treated. 

Learning objectives: 

• How to approach kidney cyst in a child  

• When to suspect and diagnose Autosomal Dominant Polycystic Kidney Disease in children 

• Discuss anticipatory care, monitoring and complications of ADPKD in children