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Abstract: SA-PO883

Genetically Identical Kidneys With Different Rates of Cyst Formation

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Ahuja, Roma Nitin, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
  • Garg, Harshit, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
  • Pruthi, Deepak K., The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
  • Rodriguez, Ronald, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
Introduction

Renal damage due to end stage renal disease (ESRD) and chronic hypertension may result in the development of acquired cystic kidney disease (ACKD). Additionally, renal transplantation may cause ACKD, however it occurs at a less frequent rate than ESRD patients on dialysis.

Case Description

A 54-year-old male underwent voluntary left nephrectomy 18 years ago. Over the 18 year follow up period, he developed minimal cyst progression and retained optimal renal function. His serum creatinine (Cr) was 1.3mg/dL with estimated glomerular filtration rate (eGFR) of 56 mL/min/1.73m2. Magnetic resonance imaging (MRI) of the abdomen revealed right solitary kidney with 3 cysts, the largest being 1.1x1.0 cm in the interpolar region. The total cyst volume was 4.2cc and the total kidney volume was 252cc.
His wife, a 52-year-old female with diabetes, hypertension, and ESRD underwent renal transplant 18 years ago with donor nephrectomy from her husband. Over the 18 years follow up period, the patient retained optimal renal function but had significant cyst progression. Her renal function was stable with a serum Cr of 1.2mg/dL and eGFR of 47 mL/min/1.73m2. MRI of the abdomen and pelvis revealed bilateral atrophic native kidneys with simple cyst of 1.5cm in left atrophic kidney. The right lower quadrant transplant kidney measured 12 cm in maximum dimension with numerous cysts of varying sizes with largest cyst measuring 7.7cm. The total kidney volume was 350cc and the total cyst volume was 185cc.

Discussion

Rarely has there been a situation in which the health of both the retained and transplanted kidney were able to be concurrently studied at regular intervals. This case provides a unique opportunity to study the impact of transplantation on the kidney as well as long-standing hypertension and immunomodulation on renal cyst development. A previous study demonstrated that environmental factors such as ischemic reperfusion injury causes acute kidney injury and promotes cystogenesis. In addition, immunomodulation has been reported to impact cyst development through activation of the mTOR pathway. Our findings support current literature and offer insight on the capacity environmental factors have on cyst development and progression in an otherwise healthy kidney.