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ADPKD Cyst Haemorrhage Conservative Management — ESENeph MCQ

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EasyPolycystic Kidney DiseaseADPKD Cyst Haemorrhage Conservative ManagementESENeph

A 38-year-old woman presents with bilateral flank pain and macroscopic haematuria following a car accident. She has known ADPKD with bilateral enlarged kidneys (18 cm each). CT shows haemorrhage into a large right renal cyst with no active extravasation and no evidence of other abdominal injury. She is haemodynamically stable. What is the most appropriate initial management?

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

Traumatic cyst haemorrhage in ADPKD, when haemodynamically stable without active extravasation, is managed conservatively: bed rest, adequate analgesia (avoiding NSAIDs), IV fluids, serial haemoglobin monitoring, and observation. Most cyst haemorrhages are self-limiting. ADPKD kidneys are more vulnerable to traumatic injury due to their size. Contact sports avoidance is generally advised for patients with significantly enlarged kidneys. Angiography and embolisation are reserved for haemodynamically unstable patients or those with active extravasation. Emergency nephrectomy is a last resort. Cyst drainage risks introducing infection into a haemorrhagic cyst.

Reference: Chapman et al 2015 – ADPKD Complications Management; Torres et al 2007 – ADPKD NEJM