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Solitary serous renal cysts are common but their suppuration is rare. Cystic infection is usually a complication of autosomal-dominant polycystic kidney disease (ADPKD). Indeed, they account for approximately 10% of causes for hospitalization in patients with adult polycystic kidney disease.1 Herein, we report an extremely rare case of an emphysematous infection of a solitary renal cyst. To the best of our knowledge, this is the eighth case of a gas-forming infection of a renal cyst being reported in the literature.2,3

A 43-year-old woman with a solitary renal cyst developed polycythaemia. 21 well documented cases of this type have been previously published. In the majority of them a causal connection could be assumed between the renal cyst and polycythaemia: in 13 of the 15 cases (as in the reported one), the polycythaemia disappeared after surgical removal of the cyst. Measurement of serum erythropoietin can help in the differential diagnosis, but exclusion of polycythaemia vera may be difficult in the individual case.

Solitary renal cysts are a common and usually asymptomatic occurrence in older patients. They may be associated with hypertension or abdominal disturbances, as they can be responsible for compression of surrounding tissues and distortion of renal vessels. This report presents an interesting case of a hypertensive patient with a solitary renal cyst of a marked size. Owing to the high risk of performing a surgical procedure in such a patient, a distinct therapeutic solution was opted for. Successful management of this case was achieved by a combination of percutaneous fluid aspiration and injection of alcohol and Vibramycin inside the cystic cavity. Percutaneous fluid evacuation combined with the administration of a sclerosing agent is suggested as a safe and effective alternative for cyst decompression and blood pressure normalisation.

We report the case of a middle-aged female with a solitary renal cyst suppurated by Actinomyces israeli . The patient was treated successfully by emergency nephrectomy. Based on a detailed negative history of inciting events and predisposing factors for actinomycosis, negative imaging modalities for extra-renal organ implication and no involvement of the surrounding renal parenchyma, the case is considered as primary renal actinomycosis affecting a solitary cyst of the kidney. This is the first such case reported in the international literature.

1. 1. The etiology of solitary renal cyst is not known. It is controversial whether such cysts are congenital or acquired. 2. 2. Solitary renal cyst, although uncommon, is not rare in occurrence. 3. 3. The condition occurs with equal frequency on the right or left side. 4. 4. Occurrence is relatively equal in either sex. 5. 5. The most frequent site of origination is the lower pole of the kidney. Next in frequency is the upper pole and lastly the body of the kidney. 6. 6. The condition may be observed at any time of life, but is not commonly seen in the first two decades, but is most common between the ages of thirty and fifty years. 7. 7. The most logical treatment is that of resection of the cyst. However, nephrectomy may be advisable because of extensive destruction of the kidney, or because of uncontrollable hemorrhage following resection of the cyst.

1. 1. Solitary cyst of the kidney with free stones is discussed. 2. 2. Present concepts as to the etiology are mentioned. 3. 3. Symptoms and signs simulating disease of the gallbladder and cholelithiasis are emphasized. 4. 4. The accepted form of treatment is outlined.

A case of a left simple renal cyst associated with hypertension is presented. Preoperative renin was elevated on the left renal vein. Hypertension disappeared after evacuation of the cyst. The possibility of renovascular hypertension in association with the cyst is considered.

Solitary renal cysts associated with hypertension and documented hyperreninemia are relatively uncommon. A 13 year old boy with these findings is described (pressure 160/120 mm Hg). Contrast studies of the urinary tract and arteriography with selective renal vein sampling demonstrated a solitary cyst in the right kidney. The ratio of plasma renin activity in the right renal vein to left renal vein (RRV:LRV) was 2.35:1. After drainage of the cyst, there was a marked reduction in both systolic and diastolic pressures (126/84 mm Hg). Hypertension has not recurred during 14 months' follow up.

In this report, a dog is described that was referred to the Small Animal Department, Faculty of Veterinary Medicine (Ghent University) for further work-up and treatment of a solitary renal cyst. The cyst was treated successfully with ultrasound-guided drainage and percutaneous sclerotherapy. The dog was followed-up during twenty-four months post procedure with renal sonography. The complaints of intermittent lethargy disappeared after the first treatment. The ultrasonographic appearance of the cyst evolved from a round, anechoic, sharply demarcated lesion to an ill-defined, hyperechoic lesion.

Summary A fatal case of rupture of a large infected renal cyst is presented. Antibiotic therapy is indicated after aspiration of a suppurative renal cyst, and recurrence, particularly if large, is an indication for prompt surgical intervention.

ALTHOUGH it is clear that the erythrocytosis often found in patients with renal cysts is caused by excess production of an erythropoietic factor, it is not known whether this factor is actually produced by such cysts or released from some other tissue under stimuli related to these lesions. This report describes a patient in whom erythrocytosis remitted following surgical drainage of a solitary simple renal cyst. The renal cyst fluid, as well as samples of plasma and urine obtained before and after renal cyst decompression, was assayed for erythropoietic activity. Tissue culture media, in which a portion of the renal cyst wall had been incubated, were also assayed. Our study suggests that renal cysts associated with erythrocytosis stimulate release of an erythropoietic factor from the kidney but do not directly produce such a factor. Report of a Case In November 1965, a 46-year-old white man an active-duty army sergeant major