A, Acquired cystic kidney disease (ACKD) detected by contrast-enhanced computed tomography (CT) in a 71-year-old man on hemodialysis for 4 years. A, Note the several intrarenal calcifications, which are not unusual in dialysis patients. ACKD is characterized by the development of many cysts in the setting of chronic uremia. It can occur at any age, including childhood, whatever the original nephropathy. The diagnosis is based on detection of at least three to five cysts in each kidney in a patient who has chronic renal failure but not hereditary cystic disease. The prevalence of ACKD averages 10% at onset of dialysis treatment and subsequently increases, to reach 60% and 90% at 5 and 10 years into hemodialysis and peritoneal dialysis, respectively [5]. In the early stage, kidneys are small or even shrunken and cysts are usually smaller than 0.5 cm. Cyst numbers and kidney volume increase with time, as seen on this patient's scan (B) repeated 8 years into dialysis. Advanced ACKD can mimic autosomal-dominant polycys-tic disease. ACKD sometimes regresses after successful transplantation; it can involve chronically rejected kidney grafts. Although ACKD is usually asymptomatic it may be complicated by bleeding—confined to the cysts or extending to either the collecting system (causing hematuria) or the perinephric spaces—and associated with renal cell carcinoma. (Courtesy of M. Jadoul.)

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