Polycystic renal disease

Abstract

Polycystic kidney disease (PKD) is a leading cause of end-stage renal disease (ESRD). Urinary tract infections (UTI) occur in 21–75% of patients with autosomal dominant polycystic kidney disease (ADPKD) and as high as 50% have been reported in patients with autosomal recessive polycystic kidney disease (ARPKD) during their lifetime. Frequently UTI is the first presentation of the disease. The urinary tract, renal parenchyma and cysts may be involved in the inflammatory process. Renal infection is a common occurrence in ADPKD and often leads to serious complications, including infected cysts, perinephric abscess, septicemia, and death. Important predisposing factors include age, female sex, and recent instrumentation of the urinary tract and diabetes mellitus. Gram-negative enteric organisms most commonly cause renal infections in PKD. Diagnosis of these infections may be difficult since some patients do not have bacteriuria. CT or MRI (or both) may be helpful in some patients with UTI and is often superior to sonography for detecting cysts in organs other than the kidney. In recent years, 18FDG-PET/CT has shown to be the most sensitive and accurate modality for diagnosis of infected cysts. Eradication of cyst infections with conventional antibiotic therapy can be difficult despite proven in vitro sensitivity of the causative organisms to the agents administered and in some cases, percutaneous drainage is indicated.