Diagnostics and treatment of patients with renal polycystosis and cyst infections

Cyst infections in patients with renal polycystosis is a complex problem for urologists, nephrologists and diagnosticians. On one hand, this is accounted by high risks of sepsis formation, especially in patients who receive programmed dialysis. On the other hand, the problem is caused by the heterogeneity of clinical and laboratory evidences and low informativity of conventional methods of X-ray diagnostics. The clinical picture is characterized by fever, low-back or hypochondrium pain and changes in macroscopic characteristics of urine. Blood analyses reveal leukocytosis, leukogram changes with left shift, thrombocytosis or thrombocytopenia, anemia and increase in pro-inflammatory markers: C-reactive protein, Ferritin and Interleukin-6. Leukocyturia and positive results of urine culture screening are not typical for all patients. Cyst puncture can be regarded as a reliable method of diagnostics but the procedure is not always technically possible. At the present time, ultrasound screening of kidneys and multispiral computed tomographic (in particular, phase contrast tomography) are not seen as optimal methods of diagnosis of cyst infections. Diffusion-weighted magnetic resonance imaging (DW-MRI) and positron emission tomography-computed tomography (PET-CT) demonstrate higher specificity and sensitivity. The choice of a strategy for treatment depends on patient’s somatic state, severity of renal disease, and also on the possibility of visualization, the number of cysts infected and the resistance of infectious agents. In this paper, we have attempted to generalize the accumulated international experience of treating this group of seriously-ill patients.