Managing cyst infections in ADPKD: an old problem looking for new answers.

The clinical determination of an infected kidney cyst may be difficult in a patient with ADPKD. The typical presentation of fever and abdominal pain carries a broad differential that includes pyelonephritis, infected kidney stones, perinephric or perihepatic abscess, cyst hemorrhage, or even intra-abdominal pathology unrelated to ADPKD. Conventional imaging with ultrasound, computed tomography, or magnetic resonance imaging scan may not be definitive in isolating the location of infection or even in differentiating cyst infection from cyst hemorrhage or pyelonephritis (3). A urine culture is often negative because kidney cysts become separated from their parent nephron, and one must rely more on blood cultures or cyst fluid aspiration when they can be obtained.