Which of the following is the most likely diagnosis?
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A 52-year-old man with a family history of renal failure comes to the physician because of abdominal pain over the last 6 months. He has been treated in the past for renal calculi and hypertension. Physical examination shows bilateral palpable masses in the upper abdomen. Urinalysis shows crenated erythrocytes and mild proteinuria. A CT scan of the abdomen identifies the cause of the patient’s problem.
A. Adrenal adenoma
C. Henoch-Schonlein purpura
D. Polycystic kidney disease
E. Renal cell adenoma
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C. WasekPhilanthropist, Post Graduate, Corpus Christi
Philanthropist, Post Graduate, Corpus Christi
Answered on Jan 28, 2019
The 52-year old man seems to suffer from kidney problems and has for a while. His physician is aware that he has had renal calculi and hypertension but now is suffering from pain in his abdomen. It could be further complication from his other issues. The doctor may also know that this man has a family history of renal failure issues. The doctor may take blood samples or have the man do a urinalysis.
This will let the doctor know for sure what the problem is. He already knows that it has to do with his kidneys, but there are many different kinds of kidney problems and then there are many different ways to treat it. Based on the information, the man most likely has polycystic kidney disease.
Polycystic kidney disease- polycystic kidney diseasekey features common hereditary disease, affecting 500,000 individuals or 1 in 800 live births in united states end-stage renal disease develops in 50% of patients by age 60 seen in 10% of dialysis patients family history is positive in 75% variable penetrance at least two genes in disorder adpkd1 on the short arm of chromosome 16 (8590% of patients) adpkd2 on chromosome 4 (1015% of patients)clinical findings abdominal or flank pain microscopic or gross hematuria history of urinary tract infections and nephrolithiasis is common large kidneys that may be palpable on abdominal examination nephrolithiasis, primarily calcium oxalate stones, in up to 20% hypertension in 50% abdominal mass arterial aneurysms in the circle of willis in 1015% mitral valve prolapse in up to 25% aortic aneurysms aortic valve abnormalities hepatic cysts in 4050% pancreatic and splenic cysts also occurdiagnosis renal ultrasonogram: diagnostic depending on age and number of cysts urinalysis: may show hematuria and mild proteinuria ct scan: infected cyst has increased wall thickness cerebral arteriography screening: not recommended unless family history of aneurysms or patient undergoing elective surgery prone to cause hypertensiontreatment cyst rupture bed rest analgesics, not nonsteroidal anti-inflammatory drugs cyst pain: decompression cyst infection: antibiotics: fluoroquinolones, trimethoprim-sulfamethoxazole, or chloramphenicol intravenously for 2 weeks followed by long-term oral therapy hydration (23 l/day) treatment of hypertension and a low-protein diet may slow disease progression caffeine may worsen cyst formation; patients may want to limit total intakecontent adapted from current medical diagnosis & treatment 2012.