Evaluation of Renal Cyst Pattern on Clinical Sonography at Institute of Kidney Diseases, Peshawar

Background: Renal cysts are common sonographic findings, often incidental but occasionally associated with significant pathology. Differentiating simple from complex cysts is essential to guide monitoring and management. Objective: To evaluate the sonographic patterns, laterality, and associated pathologies of renal cysts in patients undergoing ultrasound examination at the Institute of Kidney Diseases, Peshawar. Methods: A descriptive cross-sectional study was conducted on 110 patients with renal cysts identified by ultrasonography between January and June 2024. Scans were performed using a Toshiba Aplio 500 ultrasound system (3–5 MHz curvilinear probe) in supine and decubitus positions. Cysts were classified using ultrasound-adapted Bosniak criteria and autosomal dominant polycystic kidney disease (ADPKD) was defined according to Pei et al. (2009) thresholds. Data were analyzed in SPSS v23 using chi-square tests and multivariable logistic regression, reporting adjusted odds ratios (ORs) with 95 % confidence intervals (CIs). Results: The mean participant age was 52.6 ± 14.9 years; 59.1 % were male. Solitary cysts were most frequent (48.2 %), followed by two cysts (21.8 %) and multiple cysts (30.0 %). Laterality was unilateral in 59.1 % and bilateral in 40.9 %. Simple cysts constituted 82.7 % and complex cysts 17.3 %. Renal stones were observed in 30.0 %, hydronephrosis in 7.3 %, and cyst wall calcification in 10.9 %. Participants aged > 45 years had higher odds of multiple or complex cysts (OR = 2.42, 95 % CI 1.05–5.55, p = 0.03). Complex cysts independently predicted nephrolithiasis (OR = 2.96, 95 % CI 1.04–8.40) and hydronephrosis (OR = 3.75, 95 % CI 1.01–13.89). Conclusion: Renal cysts are predominantly simple and unilateral, increasing in complexity with age. Ultrasound remains a reliable first-line tool for detection and risk stratification, with Bosniak-aligned reporting enabling identification of patients requiring advanced imaging or nephrology referral.