Can kidney cysts resolve on their own in patients with a history of kidney disease or other underlying medical conditions?

Can Kidney Cysts Resolve Spontaneously?

Simple kidney cysts rarely disappear on their own, but documented cases exist where hemorrhagic cysts or superficial simple cysts have spontaneously resolved or shrunk over time. However, this is uncommon and should not be expected as the typical course.

Simple Cysts in Adults

Simple cysts (Bosniak class I and II) are extremely common—affecting approximately 50% of individuals older than 50 years—and do not require routine surveillance or follow-up when asymptomatic 1, 2. These cysts are benign, stable lesions that typically persist indefinitely rather than resolve 1.

Rare Spontaneous Resolution

• Documented cases show that hemorrhagic renal cysts can disappear on follow-up imaging, and large superficial simple cysts may shrink over time 3
• The mechanisms for spontaneous resolution remain unclear but may include:
  • Bleeding into the cyst with subsequent resorption 3
  • Rupture of the cyst into the perirenal space 3
  • Rupture into the collecting system 3
• These occurrences are exceptional rather than typical, and only rarely associated with renal scarring 3

Polycystic Kidney Disease (ADPKD/ARPKD)

Cysts in hereditary polycystic kidney disease do not resolve and progressively increase in number and size over time 4, 5.

• PKD1 mutations cause more severe disease progression than PKD2 mutations 5
• The Mayo Imaging Classification uses height-adjusted total kidney volume to stratify patients into 5 groups (1A-1E) indicating accelerating decline in kidney function 4
• Cysts in ADPKD are derived from tubular epithelium and show diffuse bilateral involvement with progressive kidney enlargement 6

Important Caveat in Children

• A normal fetal or childhood ultrasound does not exclude ADPKD in at-risk children, as cysts develop gradually and may not be detectable early in milder phenotypes 5
• If kidney ultrasonography is normal in an at-risk child, rescreening should occur at intervals no shorter than 3 years 7

Acquired Cystic Disease (ACD)

Acquired cystic disease occurs exclusively in end-stage renal disease and does not resolve; cysts increase with duration of hemodialysis 5, 6.

• Duration of hemodialysis directly correlates with increased cyst occurrence 5
• Male gender is associated with higher risk of developing ACD 5
• These cysts can show proliferative changes and harbor cytogenetic alterations, with malignant potential 5

Clinical Management Implications

For simple cysts, routine surveillance has minimal impact on diagnosis and management in patients with kidney disease, hypertension, or diabetes 1. However:

• Ultrasound may be indicated when there is prior history of stones or obstruction, frequent urinary tract infections, or family history of ADPKD 1
• Complex cysts with septations, calcifications, internal echoes, or irregularities need further characterization due to malignancy risk 1
• Symptomatic large simple cysts may require treatment with percutaneous drainage and sclerotherapy or surgical decortication 8, 9

Key Pitfall to Avoid

Do not assume all simple-appearing cysts are truly non-proliferative—this is a critical error, as approximately 3% of children with ADPKD-causing mutations have very-early-onset or unusually rapid progressive disease 5. Multiple inherited disorders can mimic ADPKD with kidney and/or liver cysts, including collagen disorders, nephrolithiasis-associated conditions, and syndromic ciliopathies 5.