What to Do If You Have Multiple Kidney Cysts: A Practical, Evidence-Based Guide
Understanding Multiple Kidney Cysts
Multiple kidney cysts—fluid-filled sacs that develop in one or both kidneys—are far more common than many people realize. In fact, studies show that up to 50% of adults over age 50 have at least one simple renal cyst detected incidentally during imaging for unrelated conditions. While most are harmless and asymptomatic, the presence of multiple cysts warrants thoughtful evaluation—not panic. The key is distinguishing benign, age-related cysts from those that may signal underlying pathology or functional compromise.
When Observation Is the Best First Step
Most small, simple cysts require no treatment—just regular monitoring. According to guidelines from the American College of Radiology (ACR) and the European Association of Urology (EAU), simple cysts under 3 cm in diameter with smooth walls and no internal complexity are highly unlikely to affect kidney function or structure. These are often discovered during routine abdominal ultrasounds or CT scans performed for other reasons—like evaluating back pain or gastrointestinal symptoms. For older adults, especially those over 60, multiple small cysts are frequently part of normal aging and rarely progress. Annual or biennial ultrasound follow-up is typically sufficient to track stability and rule out concerning changes.Red Flags That Warrant Closer Evaluation
Not all cysts are created equal. Be proactive if you experience any of the following: persistent flank or abdominal pain, unexplained hypertension, hematuria (blood in urine), recurrent urinary tract infections, or a sudden decline in estimated glomerular filtration rate (eGFR). Imaging features such as thickened or irregular cyst walls, internal septations, calcifications, or contrast enhancement on CT/MRI should prompt referral to a nephrologist or urologist for further risk stratification using the Bosniak classification system.
When Intervention Becomes Necessary
Surgery or minimally invasive procedures are reserved for specific clinical scenarios—not just cyst size alone. Intervention is generally considered only when cysts cause measurable harm: for example, by compressing the renal pelvis and leading to hydronephrosis (kidney swelling due to urine backup), significantly distorting kidney anatomy, impairing filtration capacity, or triggering chronic pain that impacts quality of life. Younger patients with rapidly enlarging cysts (>1 cm growth per year) or those with confirmed autosomal dominant polycystic kidney disease (ADPKD) may benefit from early specialist involvement—including genetic counseling, blood pressure optimization, and emerging disease-modifying therapies like tolvaptan.Modern Treatment Options Beyond Traditional Surgery
Today's approach prioritizes precision and preservation. Options include ultrasound- or CT-guided cyst aspiration with sclerotherapy (injecting alcohol to prevent refilling), laparoscopic cyst decortication for large symptomatic cysts, and—increasingly—targeted medical management for inherited forms. Importantly, prophylactic removal of asymptomatic cysts is discouraged, as it carries surgical risks without proven long-term benefits. Instead, lifestyle support—such as maintaining healthy blood pressure, staying well-hydrated, limiting sodium intake, and avoiding NSAIDs—plays a vital role in protecting overall kidney health.
Takeaway: Knowledge Empowers Smart Decisions
Discovering multiple kidney cysts can be unsettling—but in the vast majority of cases, it's not a sign of serious illness. With accurate imaging interpretation, individualized risk assessment, and shared decision-making between patient and provider, most people live full, active lives without ever needing intervention. If you've recently received this diagnosis, schedule a consultation with a board-certified nephrologist or urologist to review your imaging reports, discuss your personal risk profile, and build a tailored monitoring or management plan.