Diagnosis of cyst infection in patients with autosomal dominant polycystic kidney disease: attributes and limitations of the current modalities

Nephrol Dial Transplant. 2012 Oct;27(10):3746-51. doi: 10.1093/ndt/gfs352.


Cyst infection is a diagnostic challenge in patients with autosomal dominant polycystic kidney disease (ADPKD) because of the lack of specific manifestations and limitations of conventional imaging procedures. Still, recent clinical observations and series have highlighted common criteria for this condition. Cyst infection is diagnosed if confirmed by cyst fluid analysis showing bacteria and neutrophils, and as a probable diagnosis if all four of the following criteria are concomitantly met: temperature of >38°C for >3 days, loin or liver tenderness, C-reactive protein plasma level of >5 mg/dL and no evidence for intracystic bleeding on computed tomography (CT). In addition, the elevation of serum carbohydrate antigen 19-9 (CA19-9) has been proposed as a biomarker for hepatic cyst infection. Positron-emission tomography after intravenous injection of 18-fluorodeoxyglucose, combined with CT, proved superior to radiological imaging techniques for the identification and localization of kidney and liver pyocyst. This review summarizes the attributes and limitations of these recent clinical, biological and imaging advances in the diagnosis of cyst infection in patients with ADPKD.

Publication types

  • Review

MeSH terms

  • Bacterial Infections / diagnosis*
  • Bacterial Infections / etiology*
  • Biomarkers / blood
  • C-Reactive Protein / analysis
  • CA-19-9 Antigen / blood
  • Fluorodeoxyglucose F18
  • Humans
  • Kidney Diseases / diagnosis*
  • Kidney Diseases / etiology*
  • Liver Diseases / diagnosis
  • Liver Diseases / etiology
  • Magnetic Resonance Imaging
  • Multimodal Imaging
  • Polycystic Kidney, Autosomal Dominant / complications*
  • Positron-Emission Tomography
  • Tomography, X-Ray Computed


  • Biomarkers
  • CA-19-9 Antigen
  • Fluorodeoxyglucose F18
  • C-Reactive Protein