iatroX Rounds #11
The clues
- 1
A 42-year-old man presents to his GP with a dull, persistent ache in both flanks and occasional episodes of visible haematuria.
- 2
He mentions he has been taking medication for high blood pressure for five years, but recent readings at home have remained persistently elevated.
- 3
His family history is significant for a father who required long-term dialysis and a sister who suffered a sudden subarachnoid haemorrhage.
- 4
Physical examination reveals that the patient is hypertensive and has large, firm, ballottable masses in both the left and right flanks.
- 5
Blood tests show a serum creatinine of 170 micromol/L and an eGFR of 42 mL/min/1.73m2, while urinalysis shows non-visible haematuria and mild proteinuria.
- 6
An abdominal ultrasound demonstrates that both kidneys are massively enlarged and contain numerous fluid-filled circular structures bilaterally, with similar findings noted in the liver.
Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disorder, characterized by the development of multiple fluid-filled pockets in the renal tissue that lead to organ enlargement and progressive failure.
- Bilateral loin pain and visible or non-visible haematuria
- Early-onset or resistant hypertension
- Large, palpable, ballottable kidneys on examination
- Positive family history of renal failure or cerebral aneurysms
for education and entertainment. not medical advice.