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Kidney Cysts

What are kidney cysts?

Kidney cysts (renal cysts) are usually small, round sacs that have a thin wall and contain a watery fluid. As you get older, cysts can form on the surface of your kidneys or in structures inside your kidneys called nephrons.

Kidneys are the filtration system for your body. The nephrons are made up of a filter and a tube. As blood flows through your kidneys, the nephrons remove extra water and waste products, which leave your body as urine (pee).

Kidney cysts can range in size, although most tend to be less than 2 inches wide. They can also grow over time or stay about the same size. Some people may have several cysts, while others have just one. You can have one or more cysts in one or both kidneys.

Kidney cysts typically don’t affect how well your kidneys work, and they’re usually not a cause for concern. In rare cases, a very large cyst can cause pain. Your healthcare provider may just want to monitor it and make note of it in your health history. In some cases, a kidney cyst is suspicious, and your provider may recommend additional tests or remove it.

Types of kidney cysts

There are generally two types of kidney cysts: simple and complex. Most kidney cysts are simple cysts. Healthcare providers use the Bosniak system to classify kidney cysts into five levels (named after the physician who developed the system).

Simple kidney cysts

Simple kidney cysts are almost always noncancerous (benign) and harmless. They typically don’t cause symptoms unless they become very large. You may not even know you have one. Simple cysts are fluid-filled and round, with thin walls. These are category I on the classification scale and don’t require any follow-up or treatment.

Complex kidney cysts

Complex kidney cysts have a chance of being or becoming cancerous. Your healthcare provider will monitor, treat or remove a complex cyst. They look different from a simple cyst. Complex kidney cysts may be solid (not filled with fluid), irregularly shaped or have a thick outer wall. Complex cysts are far less common than simple cysts.

Your provider will classify a complex cyst as II, II-F, III or IV. A level II cyst doesn’t require follow-up care, but a level II-F does (the F stands for follow-up). The risk of cancer for a II-F cyst is approximately 5%. A category III complex cyst has about a 50% to 80% chance of being cancerous, so your healthcare provider will remove it. A category IV cyst has about a 90% chance of being cancerous, so this type also requires removal.

Symptoms

Simple kidney cysts usually don’t cause any symptoms. In fact, most people who have them don’t know they have them. The cysts become a problem if they rupture (break open) and start to bleed, become infected, or grow so large that they push against other tissues and organs within your abdomen.

When simple kidney cysts do cause symptoms, they might include:

Pain or aches in your side between your ribs and hips, or in your stomach or back.

Fever.

Frequent urination (having to pee often).

Blood in your pee or dark pee.

Depending on where the cyst is located, it can affect how your kidney works. It can also lead to a type of high blood pressure if the cyst prevents the kidney from filtering extra fluid from your blood.

When to see a doctor

Make an appointment with your health care provider if you have symptoms of a kidney cyst.

Causes

Kidney cysts occur when the tube of a nephron begins to swell and fill with fluid. Researchers don’t know what causes this, but they do know that simple cysts aren’t inherited (they don’t happen because of conditions you get from your biological parents). They believe an injury or microscopic blockages in the tubules may lead to the development of simple kidney cysts.

Risk factors

Healthcare providers aren’t entirely sure what makes people more likely to get kidney cysts, but they know you’re more likely to have them if you’re older than 50.

Age older than 50 years

Male gender

A disease that affects how your kidneys work

High blood pressure

Smoking cigarettes

Family history of a kidney cyst

Some medical conditions can cause kidney cysts.

These include:

Polycystic kidney disease.

Chronic kidney disease (CKD).

Von Hippel-Lindau disease.

Tuberous sclerosis complex (TSC).

Complications

Kidney cysts may sometimes lead to complications, including:

An infected cyst. A kidney cyst may become infected, causing fever and pain.

A burst cyst. A kidney cyst that bursts causes severe pain in the back or side. Sometimes a burst cyst may cause blood in the urine.

Blocked urine flow. A kidney cyst that blocks the typical flow of urine may lead to kidney swelling.

Bleeding Cyst: Bleeding occurs inside the cyst, which can break the cyst open and cause bleeding around your kidney.

Diagnosis

Healthcare providers often find a simple kidney cyst by accident while performing imaging tests for another condition. If they notice a cyst, they may recommend other tests to see if the cyst is simple or complex.

Tests and procedures used to diagnose simple kidney cysts include:

Ultrasound: A kidney ultrasound is a non-invasive and painless way to take pictures of your kidneys. During the ultrasound, sound waves that can’t be heard by human ears bounce off the organs and surrounding tissues and structures, producing images of the size and shape of your kidneys. This allows your healthcare provider to identify the presence of cysts. Kidney ultrasounds differ from X-rays in that they don’t involve radiation, so they’re safe for pregnant women, children, or people who might not tolerate dyes used in other imaging methods.

Magnetic resonance imaging (MRI): The way in which MRIs gather information to create images of the body is through radio waves and magnets. Like CT scans, some MRIs may require you to be injected with a contrast dye before the test. MRI is often used to further define complex benign cysts from malignant cysts. It can also be ordered prior to surgery to define anatomy.

Kidney function tests. Testing a sample of your blood may reveal whether a kidney cyst is affecting how well your kidney works.

Computed tomography (CT): CT scans create 3-D images using a combination of X-ray and computerized technology. In some cases, it may be necessary to inject a contrast dye to perform the test. Complex cysts on a CT Scan can be classified by the Bosniak Scale; higher Bosniak numbers make the cysts more likely to become malignant.

Imaging Tool	Pros	Cons	Role
Ultrasound	Safe, cost-effective, widely available	Limited detail	Initial diagnosis, follow-up in cm size chart for kidney cyst
CT Scan	High detail, accurate measurement	Radiation exposure, cost	Precise assessment in renal cyst measurement guide
MRI	No radiation, detailed images	Expensive, longer procedure	Detailed analysis in cm size chart for kidney cyst

Your healthcare provider may determine a kidney cyst needs monitoring. If this is the case, they’ll likely repeat imaging tests every six months to two years. If the cyst causes symptoms between follow-up appointments, you should call your healthcare provider.

Kidney Cyst Medical Monitoring Chart

Cyst Size (cm)	Monitoring Frequency	Potential Interventions
< 1.0	Annual Check-Up	None
1.0 – 2.9	Every 6-12 Months	Watchful Waiting
3.0 – 5.0	Every 3-6 Months	Possible Biopsy
> 5.0	Immediate Action	Surgical Consideration

Kidney Cyst Size Chart

Cyst Size (cm)	Category	Implications
0 – 2 cm	Small	Usually harmless, but needs watching
2 – 4 cm	Medium	Could be risky, so watch closely
4+ cm	Large	More likely to cause symptoms or be cancerous, might need treatment

Comparative Guide: Kidney Cyst Dimensions

Cyst Size	Common Comparison
Small (under 2 cm)	Similar to a pea or a small cherry
Medium (2-5 cm)	Comparable to a grape or a walnut
Large (over 5 cm)	Resembling the size of a lime or an egg

Treatment

Treatment may not be needed

When simple kidney cysts aren’t causing symptoms, generally, no treatment is required. If the cyst is causing pain or impairing kidney function, the healthcare provider may need to perform a procedure to aspirate or drain the cyst. If the cyst is large, it may be necessary to surgically remove it.

If the cyst has lines/septations/or solid regions (making it a complex cyst), then additional management with further surveillance or removal may be indicated.

When there’s a diagnosis of PKD, treatment is aimed at maintaining the health of the kidney as best as possible. Medications for infections, like urinary tract infections, or high blood pressure, may reduce the rate at which kidney damage occurs.

Approximately 50% of people who have PKD develop chronic kidney disease, and subsequently, kidney failure. Usually, these people will need dialysis or a kidney transplant at some point in their lives.

Treatments for cysts that cause symptoms

If a simple kidney cyst is causing symptoms, your health care provider may recommend treatment. Options include:

Piercing and draining the cyst, then filling it with a solution. The solution causes scarring and helps prevent the cyst from filling with fluid again. Alcohol or a chemical compound may be used as the solution.

Rarely, to shrink the cyst, a long, thin needle may be inserted through your skin and through the wall of the kidney cyst. Then the fluid is drained from the cyst and filled with a solution to prevent it from reforming.

Surgery to remove the cyst. A large cyst that's causing symptoms may require surgery. To access the cyst, a surgeon makes several small incisions in your skin and inserts special tools and a small video camera.

While watching a video monitor in the operating room, the surgeon guides the tools to the kidney and uses them to drain the fluid from the cyst. Then the walls of the cyst are cut or burned away. Surgery is rarely performed for simple cysts. The procedure is more often used for complex cysts with changes that may be cancer.

Some procedures to treat a kidney cyst may require a brief hospital stay.

Prevention

Can simple kidney cysts be prevented?

You can’t prevent a simple kidney cyst. You can only reduce your risk by:

Drink liquids as directed. Liquids help your kidneys work correctly. They can also help prevent a urinary tract infection. Ask your healthcare provider how much liquid to have each day and which liquids are best for you. Ask if you need to limit or not drink alcohol. Alcohol may damage your kidneys.

Manage health conditions. Over time, conditions such as diabetes and high blood pressure that are not controlled may damage your kidneys.

Do not smoke. Smoking may narrow blood vessels in your kidneys and raise your blood pressure. Smoking can also damage your kidneys. Ask your healthcare provider for information if you currently smoke and need help quitting. E-cigarettes or smokeless tobacco still contain nicotine. Talk to your healthcare provider before you use these products.

Talk to your healthcare provider about ways you can best care for your kidneys.

Does a simple kidney cyst need to be watched over time?

It’s very important that a healthcare provider evaluate the type and location of a kidney cyst. There are often characteristics — such as cyst wall thickness, fluid density and irregular cyst wall shape — that may indicate the cyst is more likely to be, or could become, cancerous.

Generally, a small, simple cyst doesn’t need monitoring. But, your healthcare provider is the best person to determine if and how often you should return for a follow-up.

Prognosis

What is the outlook for someone with kidney cysts?

Since simple kidney cysts are almost always harmless, the outlook is excellent. Treating a cyst due to infection, rupture or blockage is very effective and most people make a full recovery.

If you have a complex kidney cyst, your healthcare provider will either remove it or watch it closely for changes. Removing a complex cyst before it becomes cancerous is usually very effective with few complications.

Living With Kidney Cysts

When should I call my healthcare provider about kidney cysts?

You should call your healthcare provider if you experience any of the symptoms of a kidney cyst, such as:

Pain in your side, stomach or low back.

Blood in your pee.

Fever.

Changes in urination habits like peeing more or less often.

Preparing for your appointment

A simple kidney cyst found during an imaging test for another disease or condition may concern you. Talk with your health care provider about what having a simple kidney cyst means for your health. Gathering information may put your mind at ease and help you feel more in control of your situation.

What you can do

Before meeting with your health care provider, prepare a list of questions to ask, such as:

How big is the kidney cyst?

Is the kidney cyst new or has it been visible on other scans?

Is the kidney cyst likely to grow?

Can the kidney cyst hurt my kidney?

I have these unexplained symptoms. Could they be caused by a kidney cyst?

Does the kidney cyst need to be removed?

What are my treatment options?

What are the potential risks of each treatment option?

What symptoms may indicate the kidney cyst is growing?

Should I see a specialist?

Are there any restrictions that I need to follow?

Do you have any printed material that I can take with me? What websites do you recommend?

Will I need a follow-up visit?

Don't hesitate to ask other questions as they occur to you during your appointment.
What to expect from your doctor

Your health care provider is likely to ask you a number of questions, such as:

Do you have any symptoms?

If so, how long have you experienced symptoms?

Have your symptoms gotten worse over time?

Do you have any blood in your urine?

Have you had pain in your back or sides?

Have you had a fever or chills?

Do you have any other medical conditions?

What medications, vitamins or supplements do you take?

Be ready to answer questions so that you have time to talk about what's most important to you.

One Final Note..

Hearing you have a cyst on your kidney may sound alarming. But rest assured, kidney cysts are common and usually not a cause for concern. Your healthcare provider may recommend more tests to get a better look at the cyst to determine if treatment is necessary. Talk to your provider about what type of cyst you have and what it means for your health. Don’t be afraid to ask questions. In most cases, your provider will monitor the cyst over time and ask you to watch for signs of a problem like pain, fever or blood in your pee.

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