Rationale & Objective

Simple kidney cysts are common and usually considered of limited clinical relevance. They are associated with older age and lower glomerular filtration rate (GFR), but little is known of their association with progressive chronic kidney disease (CKD) which was the focus of this study.

Study Design

Observational cohort study.

Setting & Participants

Patients with pre-surgical CT or MRI imaging who underwent a radical nephrectomy for a tumor. We reviewed the retained kidney images to characterize parenchymal cysts at least 5 mm in diameter according to size and location.

Exposures

Parenchymal cysts at least 5 mm in diameter in the retained kidney. Cyst characteristics were correlated with microstructural findings on kidney histology.

Outcomes

Progressive CKD defined by dialysis, kidney transplantation, a sustained >40% decline in eGFR, or an eGFR <10 ml/min/1.73m² that was at least 5 ml/min/1.73m² below the post-nephrectomy baseline for at least 3 months.

Analytical Approach

Cox models assessed the risk of progressive CKD. Models adjusted for baseline age, sex, body mass index, hypertension, diabetes, eGFR, proteinuria, and tumor volume. Non-parametric Spearman’s correlations were used to examine the association of the number and size of the cysts with clinical characteristics, kidney function, and kidney volumes.

Results

There were 1195 patients with 50 progressive CKD events over a median 4.4 years of follow-up. On baseline imaging, 37% had at least one cyst, 34% had at least one cortical cyst, and 8.3% had at least one medullary cyst. A higher number of cysts was associated with progressive CKD and was modestly correlated with larger nephrons and more nephrosclerosis on kidney histology. The number and size of medullary cysts was more strongly associated with progressive CKD than the number and size of cortical cysts.

Limitations

Patients who undergo a radical nephrectomy may differ from the general population. A radical nephrectomy may accelerate the risk of progressive CKD. Genetic testing was not performed.

Conclusion

Cysts in the kidney, particularly the medulla, should be further examined as a potentially useful imaging biomarker of progressive CKD beyond the current clinical evaluation of kidney function and common CKD risk factors.

中文翻译：

---

肾囊肿与根治性肾切除术后进行性 CKD 的关系

理由和目标

单纯性肾囊肿很常见，通常被认为临床相关性有限。它们与年龄较大和肾小球滤过率 (GFR) 较低有关，但人们对它们与进行性慢性肾病 (CKD) 的关系知之甚少，而慢性肾病是本研究的重点。

学习规划

观察性队列研究。

背景及参与者

因肿瘤接受根治性肾切除术的术前 CT 或 MRI 成像的患者。我们回顾了保留的肾脏图像，根据大小和位置来表征直径至少 5 毫米的实质囊肿。

曝光

保留肾脏中的实质囊肿直径至少为 5 毫米。囊肿特征与肾脏组织学的微观结构发现相关。

结果

进行性 CKD 定义为透析、肾移植、eGFR 持续下降> 40%，或 eGFR <10 ml/min/1.73m ²至少比肾切除术后基线低 5 ml/min/1.73m ²至少 5 ml/min/1.73m 2至少3个月。

分析法

Cox 模型评估了进行性 CKD 的风险。模型根据基线年龄、性别、体重指数、高血压、糖尿病、eGFR、蛋白尿和肿瘤体积进行调整。非参数 Spearman 相关性用于检查囊肿的数量和大小与临床特征、肾功能和肾体积的关联。

结果

在中位 4.4 年的随访中，有 1195 名患者出现了 50 次进展性 CKD 事件。基线影像学结果显示，37% 的患者至少有 1 个囊肿，34% 的患者至少有 1 个皮质囊肿，8.3% 的患者至少有 1 个髓质囊肿。较多的囊肿与进行性 CKD 相关，并且与较大的肾单位和肾脏组织学上更多的肾硬化有一定的相关性。与皮质囊肿的数量和大小相比，髓质囊肿的数量和大小与进展性 CKD 的相关性更强。

局限性

接受根治性肾切除术的患者可能与一般人群不同。根治性肾切除术可能会增加进行性 CKD 的风险。未进行基因检测。

结论

除了目前肾功能和常见 CKD 危险因素的临床评估之外，还应进一步检查肾脏囊肿，特别是髓质囊肿，作为进行性 CKD 的潜在有用的影像学生物标志物。