Kidney Cysts

Overview

Kidneys are the organs of the human body which are essential for sustaining life. Kidneys are responsible for the purification of the blood by eliminating the waste products from the body in the form of urine. On a daily basis, the kidneys process about 200 quarts of blood and excrete 1-2 quarts of urine. Filtration capacity of the kidneys may be impacted by multiple etiological factors. These factors, combined with the structural and functional abnormalities of the kidneys give rise to a number of kidney diseases. A widespread form of kidney disease is “Kidney Cysts”. It is more common in elderly women than in men of the same age. Based on the facts produced by the National Institute of Diabetes and Digestive and Kidney Diseases, around 10% of the kidney cysts occur spontaneously.

Definition of kidney cyst

Kidney cysts are defined as abnormal fluid-filled outgrowths on the walls of the kidneys. They may appear singly or in clusters. Usually, kidney cyst conditions are symmetric in nature. This means that if one of the kidneys develop cysts, the other one is likely to develop cysts at some point in time. Simple kidney cysts of minor severity do not cause complications. About 25% of the people above the age of 40 develop simple kidney cysts. But complex cysts or polycystic conditions can lead to serious complications. Enlargement of the kidneys may occur in this condition, which in turn can adversely impact the filtration capacity of the kidneys.

What causes kidney cyst?

Kidney cyst is caused by a number of extrinsic and intrinsic factors. The common factors are listed below-

• Shortage of blood supply to the kidneys
• Blockage of the tubules that are responsible for the collection of urine
• An occurrence of diverticula or sacs on the tubules, that transform into simple cysts once they are detached from the surface of the tubules
• Reduced glomerular permeability with age
• Bacterial infections induced by Escherichia coli or Chlamydia
• Obstruction of the renal tract or tubules due to the excess deposition of calcium (Hypercalciuria), protein (Proteinuria) or uric acid wastes
• Congenital defects of the urinary tract structures
• Presence of scars or medullary sponge kidney
• Certain medications like corticosteroids, androgenic drugs, anti-depressants, anti-diuretic and tranquilizers that adversely affect the kidney health
• Deficiency of essential vitamins and micronutrients in the body
• Existing medical illnesses like Gout, Rheumatoid arthritis, Diabetes mellitus or Sickle cell disease
• Poor health and hygiene practices like using unclean toilets, improper wiping after a bowel movement, using unclean sanitary napkins etc, which helps the bacteria resent in those environments to migrate to the urinary tract
• Using Indwelling Urinary Catheter for a long time
• Alterations in the urine pH (increased acidity or alkalinity)
• Surgeries of the urinary tract in the past (risks of infections are high if a part of the renal tract is removed)
• Abnormal variation in the blood levels of a few hormones like estrogen and progesterone
• History of kidney diseases in the family
• Past occurrence of kidney infections or major kidney diseases
• Acute dehydration due to low fluid intake or increased drainage of fluid from the body (occurs mainly after Diarrhoea or vomiting)
• Obesity or overweight condition

Symptoms of kidney cysts

Kidney cysts are usually manifested through the following symptoms-

• Painful urination with a burning sensation in the genital region
• A feeling of a lump in the lower abdomen (may occur on one or both sides)
• Tenderness of the lower abdomen
• Feeling of fullness even after a short meal (due to pressure exerted by the enlarged kidneys on the stomach)
• Pain in the pelvic regions (due to pressure caused by bigger cysts)
• Digestive disorders
• Presence of blood in the urine (Hematuria)
• Increased tendency of urinary tract infections
• Elevated blood pressure
• Fever, general weakness, and fatigue

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Types of kidney cysts

Kidney cysts are broadly classified into two main categories-

• Simple cyst: They generally originate from the renal parenchyma. They may be present as solitary cysts or clusters. They can occur on one or both kidneys. Size of simple kidney cysts usually varies from 2-10 cm.
• Complex cyst: These are hyperdense cysts with thickened walls, nodular outgrowths, and increased calcifications. These types of kidney cysts are more likely to cause malignancy.

A few other varieties of kidney cysts have also been identified-

• Polycystic Kidney Disease (PKD): In this condition, hundreds of cysts are present in one or both kidneys. They may be of two types-
• Autosomal Dominant PKD: This occurs due to a familial history of kidney diseases, wherein a defective or mutated gene is passed onto the future generations.
• Autosomal Recessive PKD: This is also a hereditary kidney disease, but the chances of the future generation acquiring the disease are less (25%).
• Parapelvic cysts: They generally originate from the renal sinus. They may cause obstruction or constriction of the ureter or the renal pelvis.
• Acquired cysts: These types of cysts are formed due to chronic hemodialysis or presence of an Indwelling Catheter (IDC) for a long time. Both the conditions may cause kidney infections and lead to the formation of cysts.

Diagnosis

The following laboratory tests are recommended-

• Cystourethrogram
• Cystoscopy
• Intravenous Pyelogram
• X-ray (of lower abdomen)
• Ultrasound
• MRI
• CT scan

Treatment & Prevention

In cases where the kidney cyst does not interfere with the functioning of the kidney and is asymptomatic, no treatment is usually recommended. However, imaging test should be conducted on a regular basis so as to evaluate any changes in the size of the kidney. In case the cyst increases in size later, treatment might be required.

The treatment options for symptomatic kidney cysts are as follows:

• Puncture and drainage– This procedure is usually executed under local anesthesia. This procedure involves the insertion of a long needle through the skin into the cyst. The fluid in the cysts is then drained with the help of the needle. The empty cyst is then filled with an alcohol solution so as to prevent recurrence. This is also known as sclerotherapy.
• Surgical intervention– In cases where the cyst is large and symptomatic, a surgical removal of the cyst is planned. The surgery is planned through an endoscope. The endoscope has fine surgical tools and a small video camera attached to it. The endoscope is inserted through small incisions in the skin. The surgical tools are guided to the cyst with the help of a video monitor installed in the operating room. The fluid in the cyst is carefully drained and cyst walls are cut or burnt.

A brief hospital stay might be required depending on the type of treatment a patient undergoes.

The best preventive measure includes lowering your salt intake and regulating your blood pressure. People with hypertension need to adopt a completely healthy lifestyle that includes following a heart-healthy diet and monitoring your BP regularly.

References