A 42yo woman with a PMH of severe headache treated in the ED presents with signs and symptoms of renal failure. She has been seen by her GP for HTN and abdominal pain with OP inv pending. Which inv is most likely to lead to a dx?
a. US KUB
b. CT brain
c. IVU
d. Renal artery Doppler
e. Renal biopsy
answer: A
ADPKD
Signs and Symptoms
• often asymptomatic; discovered incidentally on imaging or by screening those with FHx
• acute abdominal flank pain/dull lumbar back pain
• hematuria (microscopic frequently initial sign, gross)
• nocturia (urinary concentrating defect)
• rarely extra-renal presentation (e.g. ruptured berry aneurysm, diverticulitis)
• HTN (increased renin due to focal compression of intrarenal arteries by cysts) (60-75%)
• ± palpable kidneys
Common Complications
• urinary tract and cyst infections, HTN, CRF, nephrolithiasis (5-15%), flank and chronic back
pain
Clinical Course
• polycystic changes are always bilateral and can present at any age
• clinical manifestations rare before age 20-25
• kidneys are normal at birth but may enlarge to 10x normal size
• renal failure in up to 50% by age 60)
A
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