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Multiple renal cysts — Clinical Guidelines

Overview

Multiple renal cysts are fluid-filled sacs within the kidney that can be benign or, in some cases, associated with malignancy risk, particularly in complex cysts like Bosniak III and IV categories. 4 6

Diagnosis

Imaging: Ultrasonography (US) is primary, with CT and MRI providing additional detail. 6 12

Grading: Bosniak classification system used for complex cysts to assess risk of malignancy. 4 6

Surveillance: Recommended for Bosniak III cysts to monitor for changes indicative of malignancy. 4

Management

Surgical: Bosniak IV cysts typically managed surgically due to high malignancy risk. 4

Active Surveillance: Bosniak III cysts often managed with active surveillance rather than immediate surgery, reflecting evolving evidence. 4

Monitoring: Regular imaging follow-up for complex cysts to detect any transformation or growth. 4 6

Special Populations

Pediatrics: Increased incidence noted with routine US use; management may consider hereditary cystic diseases. No specific follow-up universally recommended for simple cysts. 6

Elderly: Management strategies similar to general population but consider comorbidities affecting surgical risk. 4

Key Recommendations

Use Bosniak classification for complex renal cysts to guide management decisions (Evidence: Moderate 4).

Consider active surveillance for Bosniak III cysts to avoid unnecessary surgery, balancing risk and benefit (Evidence: Moderate 4).

Regular imaging follow-up is essential for complex cysts to monitor for malignant transformation (Evidence: Moderate 4 6).

Surgical intervention is recommended for Bosniak IV cysts due to high malignancy risk (Evidence: Moderate 4).

Pediatric cases require tailored approaches, potentially including genetic evaluation for hereditary conditions (Evidence: Expert opinion 6).

References

1 Whittle C, Silva-Hirschberg C, Loyola K, Fajre X, Andrews A. Ultrasonographic Spectrum of Cutaneous Cysts With Stratified Squamous Epithelium in Pediatric Dermatology: Pictorial Essay. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine 2023. link 2 Vanden Bulcke A, Jaekers J, Topal H, Vanbeckevoort D, Vandecaveye V, Roskams T et al.. Evaluating the accuracy of three international guidelines in identifying the risk of malignancy in pancreatic cysts: a retrospective analysis of a surgical treated population. Acta gastro-enterologica Belgica 2021. link 3 Lanke G, Lee JH. Similarities and differences in guidelines for the management of pancreatic cysts. World journal of gastroenterology 2020. link 4 Couture F, Finelli A, Tétu A, Bhindi B, Breau RH, Kapoor A et al.. Management of complex renal cysts in Canada: results of a survey study. BMC urology 2020. link 5 Hasan A, Visrodia K, Farrell JJ, Gonda TA. Overview and comparison of guidelines for management of pancreatic cystic neoplasms. World journal of gastroenterology 2019. link 6 Eroglu FK, Kargın Çakıcı E, Can G, Güngör T, Yazılıtaş F, Kurt-Sukur ED et al.. Retrospective analysis of simple and stage II renal cysts: Pediatric nephrology point of view. Pediatrics international : official journal of the Japan Pediatric Society 2018. link 7 Scheiman JM. Pancreatic Cysts - Part 1: Using the American Gastroenterological Association Guidelines for the Management of Pancreatic Cysts-A Practical Approach. Pancreas 2017. link 8 Lennon AM, Canto MI. Pancreatic Cysts - Part 2: Should We Be Less Cyst Centric?. Pancreas 2017. link 9 Rosati M, Bramante S, Conti F, Rizzi M, Frattari A, Spina T. Laparoscopic Salpingo-oophorectomy in Conscious Sedation. JSLS : Journal of the Society of Laparoendoscopic Surgeons 2015. link 10 Z'graggen K, Metzger A, Klaiber C. Symptomatic simple cysts of the liver: treatment by laparoscopic surgery. Surgical endoscopy 1991. link 11 Menczer J. Use of the Deaver retractor for exteriorization of ovarian cysts at laparotomy. American journal of obstetrics and gynecology 1985. link80085-5) 12 Derezic D, Cecuk L. Hydrostatic pressure within renal cysts. British journal of urology 1982. link 13 Kessel HC, Tynes WV. Spontaneous regression of renal cysts. Urology 1981. link90264-8) 14 Parel SM. Custom-made perforated cyst decompression stents. The Journal of prosthetic dentistry 1979. link90041-6) 15 Spiegel RM, King DL, Green WM. Ultrasonography of primary cysts of the liver. AJR. American journal of roentgenology 1978. link 16 Pollack HM, Goldberg BB. Percutaneous needle endoscopy of renal cysts. Radiology 1976. link

Multiple renal cysts