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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.

Ischiospinal dysostosis (ISD) is a recently described entity characterized by ischial hypoplasia and spinal segmental anomalies. Nephroblastomatosis that may manifest radiologically as 'polycystic kidney disease' has been regarded as a syndromic constituent of ISD. We report two children with ISD associated with 'renal cystic disease'. One child had multiple renal cysts resembling radiologically adult polycystic kidney disease, leading to renal dysfunction, whereas the other a solitary renal cyst with normal renal function. Renal malformations in ISD may be variable, ranging from diffuse nephroblastomatosis to a solitary renal cyst.

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.

I would like to begin with two examples of how human values might be added into the calculus of computer diagnosis and clinical management. The first issue concerns the implications for outcome when a particular diagnosis is made. Not all diagnoses are made in the same way. Some have significantly adverse implications if they are present and others do not. Take, for example, a case of a middle-aged man with an episode of hematuria following mild abdominal trauma. There are a number of possible diagnoses, each with an associated outcome. The first option is a condition with no adverse outcome for the patient, for example, the presence of a solitary renal cyst. The primary reason for making such a diagnosis is that the cause of bleeding is identified and other conditions do not have to be considered. The patient is not directly benefited but is protected from future concern and the cost and risk of further examination. A second possibility is a condition with a bad or even fatal outcome for which nothing can be done, for example, an advanced pancreatic carcinoma which has now invaded the kidney. A third intermediate possibility is that a condition is found that is serious and treatable, or even curable. An example of this would be an early resectable renal cell carcinoma. From the viewpoint of the patient, diagnosis number three is the most important one to make since it provides an opportunity to save the individual from a potentially fatal disease and restore health.

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.

孤立性腎嚢胞が腎実質を圧排して高血圧を来すことは,比較的まれとされている.今回われわれは,孤立性腎嚢胞により高レニン性高血圧を呈した, 43才の男性例を経験したので報告する.本例は,初診時190/110mmHgの高血圧があり,入院後の各種画像診断法により,右腎上極の孤立性腎嚢胞を認めた.また,末梢血の血漿レニン活性は3.9～4.4ng/ml/hと高く,左右の腎静脈血のレニン活性は,それぞれ3.4および8.7ng/ml/hで,患側と健側の比は2.6と有意差がみられたため,腎嚢胞の切除に踏み切つた.術後血圧は, 120～140/80～100mmHg前後に低下し,末梢血レニン活性も1.5～1.9ng/ml/hと正常化した.

Two cases of suppuration in solitary renal cyst are reported. The clinical history of acute pyelonephritis, avascular mass lesion of the kidney with ipsilateral pleural effusion (triad) seen in a female patient of child-bearing age is characteristic of this condition. Surgical management is satisfactory. Our Case 1 is the first reported case of solitary infected cyst that ruptured retroperitoneally, clinically mimicking a subphrenic abscess.

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.

There is a 20 per cent incidence of malignancy in renal masses with rim calcification in adults. A case of rim calcification in a solitary renal cyst in a child is presented and the diagnostic approach and surgical management are described. Solitary renal cysts are extremely rare in children, with no reported cases of rim calcification.

Two cases of extreme (contralateral) renal displacement produced by benign solitary renal cyst have recently been observed. Our search of the radiologic and urologic literature has failed to uncover previous detailed description of this occurrence. Although an apparently uncommon occurrence, such a possibility must now be considered in the differential diagnosis of masses producing extreme renal displacement.Furthermore, it is re-emphasized that the occurrence of severe renal displacement by a retroperitoneal mass is likely to be produced by a lesion of benign or low grade malignant character, rather than by a highly malignant lesion. It is, therefore, likely that such a lesion is amenable to surgical excision.

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.

Solitary renal cysts may cause renin hypersecretion with associated hypertension by compressing surrounding tissue and by distortion of renal vessels. Selective measurements of plasma renin activity in the renal veins can predict the antihypertensive effect of decompression. An illustrative case is presented and its significance is discussed.

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