Clinical significance of incidentally discovered renal cysts in pediatric patients

  • Ariel Botwin
  • Teerasak Phewplung
  • Kaiming Wu
  • Ruth Lim
  • Avram Z. Traum
  • Michael S. GeeEmail author
Kidneys, Ureters, Bladder, Retroperitoneum



To determine the clinical significance of incidentally discovered renal cysts in pediatric patients and identify imaging predictors of autosomal dominant polycystic kidney disease (ADPKD).


A retrospective search of radiology reports from 2000 to 2016 was performed to identify patients < 18 years old with an imaging exam identifying at least one renal cyst and a ≥ 1-year follow-up renal imaging exam for cyst evaluation and/or diagnosis of ADPKD. Cysts with clear solid mass components were excluded.


84 pediatric patients with renal cysts were identified (mean age, 9.5 years), including 76 patients with incidentally discovered cysts and 8 patients with cysts identified from screening for ADPKD family history. Among the incidentally discovered cyst group, 7.9% were found to have ADPKD compared with 100% of patients with cysts and ADPKD family history. Maximum cyst diameter was significantly increased in patients with ADPKD compared to patients without ADPKD (22.0 mm vs 12.7 mm; P < 0.001, Fisher’s Exact test). Multiple cysts or bilateral cysts were imaging features associated with a significantly higher (P < 0.01) incidence of ADPKD, both for the entire study population and the incidentally discovered cyst group. An increase in cyst size on the follow-up study was associated with higher incidence of ADPKD (P < 0.05). No malignancies were identified.


Incidentally discovered renal cysts in pediatric patients are associated with a small but non-zero risk of ADPKD. Among cyst characteristics, bilaterality, multiplicity, large size, and increased size on follow-up imaging were associated with a statistically significant elevation of ADPKD risk, and should prompt diagnostic evaluation.


Incidental Renal cyst Pediatric Imaging Autosomal dominant polycystic kidney disease Renal malignancy Ultrasound 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Marietti S, Woldrich J, Durbin J, Sparks S, Kaplan G, Chiang G (2013) Urologic findings on computed tomography of the abdomen and pelvis in a pediatric population. Journal of pediatric urology 9 (5):609-612. doi: CrossRefGoogle Scholar
  2. 2.
    Torres VE, Harris PC, Pirson Y (2007) Autosomal dominant polycystic kidney disease. Lancet (London, England) 369 (9569):1287-1301. doi: CrossRefGoogle Scholar
  3. 3.
    Dell KM (2011) The spectrum of polycystic kidney disease in children. Advances in chronic kidney disease 18 (5):339-347. doi:10.1053/j.ackd.2011.05.001CrossRefGoogle Scholar
  4. 4.
    Avni FE, Hall M (2010) Renal cystic diseases in children: new concepts. Pediatric radiology 40 (6):939-946. doi: CrossRefGoogle Scholar
  5. 5.
    Ravine D, Gibson RN, Walker RG, Sheffield LJ, Kincaid-Smith P, Danks DM (1994) Evaluation of ultrasonographic diagnostic criteria for autosomal dominant polycystic kidney disease 1. Lancet (London, England) 343 (8901):824-827CrossRefGoogle Scholar
  6. 6.
    Rossetti S, Harris PC (2007) Genotype-phenotype correlations in autosomal dominant and autosomal recessive polycystic kidney disease. Journal of the American Society of Nephrology : JASN 18 (5):1374-1380. doi: CrossRefGoogle Scholar
  7. 7.
    Fujimaru T, Mori T, Sekine A, Mandai S, Chiga M, Kikuchi H, Ando F, Mori Y, Nomura N, Iimori S, Naito S, Okado T, Rai T, Hoshino J, Ubara Y, Uchida S, Sohara E (2018) Kidney enlargement and multiple liver cyst formation implicate mutations in PKD1/2 in adult sporadic polycystic kidney disease. Clinical genetics 94 (1):125-131. doi: CrossRefGoogle Scholar
  8. 8.
    McHugh K, Stringer DA, Hebert D, Babiak CA (1991) Simple renal cysts in children: diagnosis and follow-up with US. Radiology 178 (2):383-385. doi: CrossRefGoogle Scholar
  9. 9.
    Wallis MC, Lorenzo AJ, Farhat WA, Bagli DJ, Khoury AE, Pippi Salle JL (2008) Risk assessment of incidentally detected complex renal cysts in children: potential role for a modification of the Bosniak classification. The Journal of urology 180 (1):317-321. doi: CrossRefGoogle Scholar
  10. 10.
    Tada S, Yamagishi J, Kobayashi H, Hata Y, Kobari T (1983) The incidence of simple renal cyst by computed tomography. Clinical radiology 34 (4):437-439CrossRefGoogle Scholar
  11. 11.
    Israel GM, Silverman SG (2011) The incidental renal mass. Radiologic clinics of North America 49 (2):369-383. doi: CrossRefGoogle Scholar
  12. 12.
    Silverman SG, Israel GM, Herts BR, Richie JP (2008) Management of the incidental renal mass. Radiology 249 (1):16-31. doi: CrossRefGoogle Scholar
  13. 13.
    Karmazyn B, Tawadros A, Delaney LR, Marine MB, Cain MP, Rink RC, Jennings SG, Kaefer M (2015) Ultrasound classification of solitary renal cysts in children. Journal of pediatric urology 11 (3):149.e141-146. doi: CrossRefGoogle Scholar
  14. 14.
    Bosniak MA (2012) The Bosniak renal cyst classification: 25 years later. Radiology 262 (3):781-785. doi: CrossRefGoogle Scholar
  15. 15.
    Koutlidis N, Joyeux L, Mejean N, Sapin E (2015) Management of simple renal cyst in children: French multicenter experience of 36 cases and review of the literature. Journal of pediatric urology 11 (3):113-117. doi: CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Ariel Botwin
    • 1
  • Teerasak Phewplung
    • 1
    • 2
  • Kaiming Wu
    • 1
  • Ruth Lim
    • 1
  • Avram Z. Traum
    • 3
  • Michael S. Gee
    • 1
    Email author
  1. 1.Department of RadiologyMassachusetts General Hospital and Harvard Medical SchoolBostonUSA
  2. 2.Department of Radiology, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Faculty of MedicineChulalongkorn UniversityBangkokThailand
  3. 3.Department of PediatricsBoston Children’s Hospital and Harvard Medical SchoolBostonUSA

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