Assessment of Solitary Simple Renal Cyst Progression in Asymptomatic Pediatric Patients
Andrew Win, Medical Student1, pamela Ellsworth, MD2, Monica Epelman, MD2, T.Ernesto Figueroa, MD3, Robert Mathias, MD2.
1Univeristy of Central Florida College of Medicine, Orlando, FL, USA, 2Nemours Children's Hospital, Orlando, FL, USA, 3Nemours/Alfred I. duPont Hospital for Children, Wilimington, DE, USA.
BACKGROUND: Renal cyst prevalence is lower in children than adults, however, more cysts are being identified due to the increasing use of pediatric ultrasound. The natural history of renal cysts in children is not well-defined. Serial imaging is commonly performed, however, it is unclear if such follow-up imaging is necessary for simple renal cysts in asymptomatic pediatric patients.
METHODS: A retrospective review was performed of 2445 charts of pediatric patients from 3 Nemours healthcare sites were obtained using the search parameter "cyst" and "kidney". Inclusion criteria included: initial visit before January 1, 2012, solitary asymptomatic simple renal cyst, no pre-existing renal anomalies, and at least 3 ultrasound studies after the initial visit. Data collection included: years since initial visit, cyst size, shape, presence/absence of septation(s) and/or calcification, additional cysts and occurrence of symptoms. Change in cyst size was calculated as a percent change in cyst maximum diameter from initial maximum diameter. Linear regression was use to determine correlation of cyst size change with time in years since diagnosis.
RESULTS: Forty two children (27 male, 15 female) met the study criteria. The mean duration of follow up was 3.67 +/- 1.21 years and the majority of patients underwent yearly renal ultrasounds. The average renal cyst size was 17.6 + 13.9mm at initial diagnosis,. The mean percentage change in renal cyst size from initial visit to latest follow-up visit was 13.68% +/- 29.96% (1.5mm+ 4.5mm) . A statistically significant positive correlation between percentage change in renal cyst size and time (p<0.05), was noted. Of the 42 cyst patients, 2 patients (4.8%) developed a change in cyst appearance , 1 with new septation and 1 with new calcification in the cyst occurred .Two patients (4.8%) developed a new cyst during follow-up. No patient develop cyst-related symptoms over this time period.
CONCLUSIONS: Our data suggests that over a mean follow-up duration of 3.67 years, asymptomatic solitary simple renal cysts in pediatric patients do increase in size, although the change the size is not clinically significant. No statistically significant change in cyst complexity was noted nor did patients become symptomatic. We acknowledge that the study is limited by the small number of patients, however, these initial results support larger studies to determine the role of follow up renal ultrasound evaluation in asymptomatic simple renal cysts.$$graphic
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