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Acquired cystic disease of the kidney is common in patients with chronic renal failure. The authors present prevalence and pathogenesis of the disease, which is not of a great clinical importance unless accompanied by its complications, especially malignant transformation. The incidence of renal cell carcinoma, which usually remains asymptomatic, is high. Ultrasound is screening method of choice for detecting acquired cystic disease of the kidney and possible malignant alterations of the kidneys.