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Acquired Cystic Disease Mimicking Polycystic Kidney Disease in a Long Term CAPD Patient

Acquired cystic disease was initially described in hemodialysis patients, and was originally thought to be unique to this modality. However, this complication has since been reported in patients with renal failure who have never undergone dialysis and in patients who have received only peritoneal dialysis (2,3). Acquired cystic disease of the kidney has been reported in approximately 200 CAPD patients ( 4 ). The etiology is unknown. although it is postulated that a retained uremic toxin acts as a growth or proliferative factor and stimulates cystic transformation in the kidney (5). The prevalence of ACDK in peritoneal dialysis patients ranges from 3% to 100% with a mean prevalence of 41% (4). The variability is likely the result of the method used to diagnose this condition, i.e., ultrasound versus CT scan versus past martem examination. Similar to patients with autosomal dominant polycystic kidney disease (ADPCKD), the cysts in ACDK carry the potential for malignant transformation, infection, and hemorrhage. The prevalence of renal neoplasm depends on the method of detection. A recent review noted a prevalence of 1.3% for renal malignancy in a population with ACDK. which was twice as great as the risk in dialysis patients without cystic transformation (6,7). Only rarely are these neoplasms metastatic (7,8). While there have been reports of hemorrhage into the cysts of peritoneal dialysis patients with ACDK, these occur less often than in hemodialysis patients because of the absence of regular anticoagulation (9, 10). In summary, we present a young man in whom ACDK developed over 11 years of peritoneal dialysis. During this time, the kidneys transformed from bilaterally small, echogenic structures into massively enlarged cystic kidneys that looked identical to polycystic kidney disease. This case emphasizes that long-term peritoneal dialysis patients are susceptible to cystic transformation and, furthermore, the acquired cysts can be very large and multiple and mimic adult polycystic kidney disease.