Cyst infections in patients with autosomal dominant polycystic kidney disease

Abstract

Background and objectives: Cyst infection is a complex diagnostic and therapeutic issue in patients with autosomal dominant polycystic kidney disease (ADPKD); however, published data regarding the diagnosis and the management of cyst infections in patients with ADPKD are sparse.

Design, setting, participants, & measurements: A retrospective study was conducted in a referral center for patients with ADPKD in Paris, France. We identified using a computerized database all patients who had ADPKD and were admitted in the nephrology department of Hôpital Necker between January 1998 and August 2008 with likely or definite renal and/or hepatic cyst infection. Medical files of all included patients were reviewed.

Results: Among 389 identified patients with ADPKD, 33 (8.4%) had 41 episodes of cyst infection, including eight definite and 33 likely cases. The incidence of cyst infections in patients with ADPKD was 0.01 episode per patient per year. Microbiological documentation was available for 31 episodes (75%), Escherichia coli accounting for 74% of all retrieved bacterial strains. Positron emission tomography scan proved superior to ultrasound, Computed tomography scan, and magnetic resonance imaging for the detection of infected cysts. Clinical efficacy of initial antibiotic treatment was noted in 71% of episodes. Antibiotic treatment modification was more frequently required for patients who were receiving initial monotherapy compared with those who were receiving bitherapy. Large (diameter >5 cm) infected cysts frequently required drainage.

Conclusions: Positron emission tomography scan will probably make the diagnosis of cyst infections easier and more accurate. Antibiotic association, including a fluoroquinolone, and the drainage of large infected cysts remain the main treatment for cyst infections.

Figure 1.

A 53-yr-old man with autosomal dominant polycystic kidney disease (ADPKD) and chronic kidney disease (GFR 30 ml/min per 1.73 m²) presented with fever, abdominal pain (upper left quadrant), and increased serum C-reactive protein level. A left kidney cyst infection was suspected. (A through C) A nonenhanced computed tomography (CT) scan (A) and magnetic resonance imaging (T2-weighted sequence; B) disclosed several renal cysts with variable fluid density in the absence of overt signs of cyst infection; however, a positron emission tomography (PET) scan (C) showed an area of increased FDG uptake (arrow) highly suggestive of ongoing infection in a left kidney cyst. (D) A 62-yr-old woman who had ADPKD and was undergoing hemodialysis (patient 6) was admitted for fever and abdominal pain (upper right quadrant). Blood cultures grew positive for Escherichia coli. Abdominal CT scan was inconclusive. A PET scan disclosed an ongoing infection in a liver cyst (arrow). (E) A control PET scan performed 1 mo after antibiotherapy (ciprofloxacin) showed the resolution of cyst infection (dashed arrow). Positive signal on the last frame occurs in the heart.