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Clinical features of cyst infection and hemorrhage in ADPKD: new diagnostic criteria

Clinical and Experimental Nephrology volume 16, pages 892–902 (2012)Cite this article

Abstract

Background and objectives

Cyst infection and cyst hemorrhage are frequent and serious complications of autosomal dominant polycystic kidney disease (ADPKD), often being difficult to diagnose and treat. The first objective of this study is to clarify the clinical features of ADPKD patients with cyst hemorrhage or infection. The second objective is to establish diagnostic criteria for ADPKD patients with cyst infection or cyst hemorrhage.

Patients and methods

Patients with definite cyst infection or hemorrhage were enrolled from among the ADPKD patients referred to us between January 2004 and October 2011. We investigated their symptoms, laboratory data, and the computed tomography (CT)/magnetic resonance imaging (MRI) features of infected cysts (before and after onset), normal cysts, and cysts with hemorrhage.

Results

There were 24 patients with cyst infection (36 infected cysts) and 12 patients with acute cyst hemorrhage (13 bleeding cysts). White blood cell (WBC) count >10,000/μl, serum C-reactive protein (CRP) >15.0 mg/dl, and body temperature >38 °C strongly suggested cyst infection. All of the cysts with hemorrhage contained a high-density mass-like area or showed overall high density on CT, and all patients with cyst hemorrhage had abdominal pain or gross hematuria. On the other hand, infected cysts showed an increase of intensity on MRI [diffusion-weighted imaging (DWI)], while a fluid–fluid level, wall thickening, and gas were also evidence of infection. Abdominal pain and/or sequential changes on MRI after onset of symptoms were useful for localizing infected cysts.

Conclusion

Acute cyst hemorrhage and infection can be identified from symptoms, laboratory data, and CT/MRI findings.

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Acknowledgments

This study was funded by the Okinaka Memorial Institute for Medical Research.

Conflict of interest

None declared.

Author information

Affiliations

  1. Department of Nephrology, Toranomon Hospital Kajigaya, 1-3-1 Kajigaya, Takatsu-ku, Kawasaki, Kanagawa, 213-0015, Japan

    Tatsuya Suwabe, Yoshifumi Ubara, Keiichi Sumida, Noriko Hayami, Rikako Hiramatsu, Masayuki Yamanouchi, Eiko Hasegawa, Junichi Hoshino, Naoki Sawa & Kenmei Takaichi

  2. Department of Hepatology, Toranomon Hospital, Tokyo, Japan

    Satoshi Saitoh

  3. Department of Diagnostic Radiology, Toranomon Hospital, Tokyo, Japan

    Itsuko Okuda

  4. Okinaka Memorial Institute for Medical Research, Tokyo, Japan

    Yoshifumi Ubara & Kenmei Takaichi

Authors
  1. Tatsuya Suwabe
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  2. Yoshifumi Ubara
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  3. Keiichi Sumida
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  4. Noriko Hayami
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  5. Rikako Hiramatsu
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  6. Masayuki Yamanouchi
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  7. Eiko Hasegawa
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  8. Junichi Hoshino
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  9. Naoki Sawa
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  10. Satoshi Saitoh
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  11. Itsuko Okuda
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  12. Kenmei Takaichi
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Corresponding author

Correspondence to Tatsuya Suwabe.

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Suwabe, T., Ubara, Y., Sumida, K. et al. Clinical features of cyst infection and hemorrhage in ADPKD: new diagnostic criteria. Clin Exp Nephrol 16, 892–902 (2012). https://doi.org/10.1007/s10157-012-0650-2

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  • DOI: https://doi.org/10.1007/s10157-012-0650-2

Keywords

  • Autosomal dominant polycystic kidney disease (ADPKD)
  • Cyst infection
  • Cyst hemorrhage
  • Clinical features
  • Diagnostic criteria