Acquired cystic kidney disease in children undergoing continuous ambulatory peritoneal dialysis

Our cross-sectional study aims to elucidate the prevalence of acquired cyst ic kidney disease (ACKD), time of occurrence of ACKD, relationship between the prevalence of ACKD and duration of dialysis, progression of cysts, and ACKD-related complications in 54 children undergoing continuous ambulatory peritoneal dialysis (CAPD). ACKD was defined as four or more cysts detected in each kidney by ultrasonography, computed tomography (CT), or magnetic r esonance imaging. The presence of less than four cysts was diagnosed as sol itary cysts (SCs). Noncystic primary disease was present as glomerulonephri tis in 23 patients (42.6%); hypoplastic kidney, 7 patients (13.0%); reflux nephropathy, 6 patients (11.1%); and other, 18 patients (33.3%). ACKD was e vident in 16 patients (29.6%) during the 57.9 +/- 39.8 months after the sta rt of CARD. Nine patients (16.7%) had SCs. SCs and ACKD were detected initi ally in patients with 1 and 3 years of CARD, respectively. The mean duratio n of CAPD for patients with ACKD (96.1 +/- 36.6 months) differed from that of patients with SCs (49.8 +/- 29.9 months) and no cysts (38.3 +/- 25.8 mon ths). The groups were classified according to time after the start of CARD: 0 to 4 years (0 = 33), 5 to 9 years (n = 16), and longer than 10 years (0 = 5). The prevalence of ACKD among these three groups was 9.1%, 50%, and 80 %, respectively, and this prevalence increased significantly with increasin g duration of CARD. Of 15 patients examined two to four times by ultrasonog raphy or CT, the number and size of cysts increased in 7 patients with ACKD and 2 patients with SC. Two patients with many and large cysts experienced gross hematuria, and one of those patients had intracystic and retroperito neal bleeding caused by cyst rupture. No solid mass lesion was found by ima ging diagnostic modalities in the 54 patients. In conclusion, the prevalenc e of ACKD in children undergoing CARD is just as high as that in adults. Th e prevalence of ACKD and number and size of cysts increased with increasing duration of CAPD. (C) 1999 by the National Kidney Foundation, Inc.