Renal Enlargement and PCKD Flashcards
What are the clinical features to assess in suspected renal condition? (outside of the abdomen, 4)
- Hypertension
- AV fistulae (with thrill and bruit)
- Tunelled dialysis line
- Signs of immunosupression e.g. moon face or gum hypertrophy
What are the clinical features to assess for in the abdomen in a suspected renal condition? (8)
- Palpable kidney: ballotable, can get above it and moves with respiration
- Polycystic kidneys: enlarged and lumpy
- Iliac fossa scar
- Transplanted kidney
- Hepatomegaly (PCKD)
- Catheter
- Peritoneal dialysis/scars
- External genitalia for varicocele
What are the causes of unilateral renal enlargement? (4)
- PCKD
- Renal cancer
- Simple cysts
- Hydronephrosis
- Enlargement of single functioning kidney
What are the causes of bilateral renal enlargement? (5)
- PCKD
- Renal cancer - 5% are bilteral
- Bilateral hydronephrosis
- Tuberous sclerosis
- Amyloidosis
What investigations should be done for a patient with renal enlargement? (8)
- Urine dip
- MC&S
- Urine cytology
- USS abdomen
- Biopsy
- Urogram
- CT scan (for cancer particularly)
- PCKD genetics - family, 10% are new mutations
What is the genetic basis of ADPKD?
Autosomal dominant mutation of 80% ADPKD1 on chromosome 16 or 20% ADPKD2 on chromosome 4
1/1000
What is the pathophysiology of ADPKD?
Progressive replacement of normal kidney tissue with cysts leading to renal enlargement and failure (5% of all end stage renal failure in the UK)
End stage renal failure by 40-60 (earlier in ADPKD 1)
How do patients with ADPKD present? (6)
- HTN
- Recurrent UTI
- Abdominal pain (due to haemorrhage or infection in cysts)
- Haematuria (+/- proteinuria on urine dip)
- Anaemia/polycythemia
- Signs/symptoms of renal failure
What are the features of ADPKD in other organs? (3)
- Hepatic cysts and hepatosplenomegaly
- Intracranial berru aneurysms - 5% look for CNIII palsy
- Mitral valve prolapse
What are the treatments for ADPKD? (7)
- Mangae hypertension with ACE-i
- Manage cholesterol
- High fluid, low salt diet
- Vasopressin receptor antagonists - Vaptans
Later in the disease: - Dailysis
- Transplant
- Nephroctomy (bleeding/infection pressure) should be avoided
What are the indications for nephrectomy in ADPCKD? (3)
- To make room for transplant
- If it progesses to cancer
- bleeding/infection pressure
How should the finding of enlarged kidney(s) be presented to the examiner?
This patient has an enlarged kidney, I was able to ballott it, get above it and I could/could not feel cysts
Renal failure: This patient does/does not have signs of renal failure
Fluid status: This patient appears euvolaemic
There is/is not evidence of current or previous renal replacement therapy
