What is your approach for patients with advanced CKD who have bilateral Bosniak 2F cysts?  

I would do a baseline CT or MR, then repeat in 6 months. Going forward, every 6-12 months, depending on imaging features, patient characteristics, and preferences.

Bosniak 2F cysts require follow-up on a regular basis with either US or preferably, CT. Some studies have found that up to 25% may become malignant (Smith et al., PMID 22106359).