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ADPKD Cyst Haemorrhage — ESENeph MCQ

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HardPolycystic Kidney DiseaseADPKD Cyst HaemorrhageESENeph

A 52-year-old man with ADPKD (eGFR 45 mL/min/1.73m2) develops acute loin pain. CT shows haemorrhage into a large renal cyst (12 cm). He is haemodynamically stable. There is no evidence of infection. What is the initial management?

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Correct answer: D — Conservative management with bed rest, analgesia, and monitoring

Cyst haemorrhage is a common complication of ADPKD. In haemodynamically stable patients, conservative management is appropriate: bed rest, adequate analgesia (avoiding NSAIDs in CKD), hydration, and monitoring haemoglobin and vital signs. Most episodes resolve within 2-7 days. Intervention (embolisation or surgery) is only needed if there is ongoing haemodynamic instability, expanding haematoma, or infection. CT angiography may be needed if active bleeding is suspected.

Reference: ERA-EDTA 2016 – ADPKD; Chapman et al 2015 – ADPKD Management