Presentation
Cystic disorders can present during infancy, childhood, or adulthood. [ncbi.nlm.nih.gov]
Entire Body System
- Congestive Heart Failure
[…] which is difficult to control and can result in congestive heart failure Autosomal dominant polycystic kidney disease ( ADPKD ) Chronic renal failure Flank or abdominal pain Recurrent urinary tract infections Nephrolithiasis Extrarenal manifestations [amboss.com]
Possible Complications ADTKD may lead to the following health problems: Anemia Bone weakening and fractures Cardiac tamponade Changes in glucose metabolism Congestive heart failure End-stage kidney disease Gastrointestinal bleeding, ulcers Hemorrhage [mountsinai.org]
Gastrointestinal
- Abdominal Pain
The patient reported nausea, vomiting, severe abdominal pain, and loose stools. [revistanefrologia.com]
A patient with end-stage renal disease on maintenance hemodialysis developed sudden severe abdominal pain and distension. [ncbi.nlm.nih.gov]
- Abdominal Mass
The condition is usually found during a prenatal ultrasound or when a doctor discovers an abdominal mass during a routine physical examination. The diagnosis of multicystic dysplastic kidney is usually made with an ultrasound examination. [nationwidechildrens.org]
The most common mode of presentation was abdominal pain followed by hypertension, urinary tract infection, chronic renal failure and palpable abdominal mass, in decreasing order. [ncbi.nlm.nih.gov]
masses; presents as flank mass or pyelonephritis In bilateral disease, neonates may also display oligohydramnios and pulmonary hypoplasia If blastema present, patient is at a slightly higher risk for Wilms tumor Segmental dysplasia is seen in children [pathologyoutlines.com]
[…] or inguinal hernias Cerebral berry aneurysm ( 5–20% ) References: [1] [4] [5] [2] [6] Diagnostics Positive family history Physical examination : palpable, bilateral upper abdominal masses that are not tender to touch Ultrasound Autosomal recessive polycystic [amboss.com]
Cardiovascular
- Heart Failure
[…] which is difficult to control and can result in congestive heart failure Autosomal dominant polycystic kidney disease ( ADPKD ) Chronic renal failure Flank or abdominal pain Recurrent urinary tract infections Nephrolithiasis Extrarenal manifestations [amboss.com]
Possible Complications ADTKD may lead to the following health problems: Anemia Bone weakening and fractures Cardiac tamponade Changes in glucose metabolism Congestive heart failure End-stage kidney disease Gastrointestinal bleeding, ulcers Hemorrhage [mountsinai.org]
American Society of Nephrology BEST PRACTICES IN NEPHROLOGY: RECOMMENDATIONS FROM THE CHOOSING WISELY CAMPAIGN Recommendation Sponsoring organization Avoid nonsteroidal anti-inflammatory drugs in individuals with hypertension or heart failure or chronic [aafp.org]
So under this condition, if there is no obvious edema, heart failure or high blood pressure, they should not restrict water intake blindly. 6. [kidney-cares.org]
[…] damage if left untreated. [2] According to the PKD Foundation website, "approximately 50% of PKD patients die from the heart and vascular complications of PKD, not renal failure." [2] Digestive/Gastrointestinal system The liver is the most common site [physio-pedia.com]
- Heart Murmur
If PKD affects the heart, the valves can become floppy, resulting in a heart murmur in some patients. What are the clues that someone has PKD? Most people do not develop symptoms until they are 30 to 40 years old. [kidney.org]
A physical exam/test can reveal enlarged liver, heart murmurs and elevated blood pressure [3] Natural history [ edit ] Most cases progress to bilateral disease in adulthood. [10] Treatment [ edit ] Chr 11 FISH-mapped BACs from CGAP There is no FDA-approved [en.wikipedia.org]
- Palpitations
Classic features of pheochromocytoma include paroxysmal hypertension, headache, sweating and palpitations. Hypertension, hypokalemia and hypernatremia characterize hyperaldosteronism. [aafp.org]
[…] include high blood pressure or hypertension, cerebral aneurysms, and mitral valve prolapse (MVP). [2] MVP is present in approximately 26% of people who have ADPKD compared to 2%-3% of the general population. [2] Symptoms associated with MVP are heart palpitations [physio-pedia.com]
Eyes
- Prolapse
ADPKD may associate some other extrarenal abnormalities, such as: cysts in the liver (polycystic liver disease), pancreas, spleen and lung, intracranial "berry" aneurysms and mitral valve prolapse. [pathologyatlas.ro]
[…] manifestations Multiple hepatic cysts (in up to 70% of cases) ; cysts may also occur in the pancreas, spleen, ovary, and testicles Cardiovascular Signs of arterial hypertension (e.g., morning headaches) Heart valve defects (particularly mitral valve prolapse [amboss.com]
[…] cases cysts in other organs specifically the liver (20% by 3rd decade; 75% by 6th decade) intracranial aneurysms (10% of cases) more common in patients with family history of intracranial aneurysms (22%) than those without this history (6%) mitral valve prolapse [en.wikibooks.org]
[…] seminal vesicles (40%), pancreas (9%), arachnoid membrane (8%), and spinal meningeal area (2%). 1 In addition to cyst formation in multiple organs, ADPKD can have extrarenal manifestations such as connective-tissue abnormalities (including mitral valve prolapse [mdedge.com]
As many as 1 in 4 adults with polycystic kidney disease develops mitral valve prolapse. When this happens, the valve no longer closes properly, which allows blood to leak backward. Colon problems. [mayoclinic.org]
Urogenital
- Hematuria
Hematuria is also managed conservatively with bedrest and intravenous hydration, and most episodes of hematuria are self-limiting and last 2 to 7 days. [mdedge.com]
[…] hemodialysis for less than 3 years only (14 months prior to receiving a functional renal transplant which lasted 8 years, followed by 18 additional months of dialysis), before the diagnosis of ACKD was made following an episode of flank pain with gross hematuria [ncbi.nlm.nih.gov]
- Uremia
[…] for end stage renal disease (unrelated to underlying renal pathology) Epidemiology Occurs in 10% - 20% of patients within the first three years of dialysis, 50% within the first five years and 90% after ten years Also occurs in patients with longterm uremia [pathologyoutlines.com]
Description of precancerous lesions and kidney tumors developing in a patient with chronic uremia treated by long-term hemodialysis. [ncbi.nlm.nih.gov]
[…] progressive symmetrical destruction of the kidneys involving both the tubules and glomeruli, characteristically resulting in anemia, polyuria, polydipsia, isosthenuria (decreased ability to concentrate the urine), progressive renal failure and death in uremia [medicinenet.com]
Later, anemia, metabolic acidosis and uremia reflect the progressive renal insufficiency. End-stage renal disease typically occurs in the third-fifth decade of life or even later. [orpha.net]
Workup
Standard workup includes Bosniak classification with contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI). However, these tests are costly and not without risks. [ncbi.nlm.nih.gov]
Therefore, ultrasound is the very first diagnostic tool and will guide further diagnostic workup with additional imaging studies or genetic testing. [link.springer.com]
The presentation and workup in patients with renal cysts varies with the underlying disease. Treatment is aimed at symptom control. In general, therapy is reserved for pain, hypertension, infection, renal salt wasting, and nephrolithiasis. [emedicine.medscape.com]
Serum
- Hyperuricemia
MCKD2 Also called Familial Juvenile Hyperuricemia Describes families with mutations in the uromodulin gene – a Tamm-Horsfall mucoprotein 46. [slideshare.net]
[…] end-stage renal disease at the mean age of 62 years, and MCKD2 (in 16p12, where the gene UMOD, encoding uromodulin or Tamm-Horsfall protein, has been identified as responsible of the disease) with earlier end-stage renal disease (around 32 years) often with hyperuricemia [orpha.net]
Ivanek R, Stranecky V, Sovova J, Claes K, Lerut E, Fryns JP, Hart PS, Hart TC, Adams JN, Pawtowski A, Clemessy M, Gasc JM, Gubler MC, Antignac C, Elleder M, Kapp K, Grimbert P, Bleyer AJ, Kmoch S: Dominant renin gene mutations associated with early-onset hyperuricemia [rarediseases.org]
Treatment
Embryonic kidney cyst formation of Sclt1-/- mice was effectively reduced by an anti-STAT3 treatment using pyrimethamine. [ncbi.nlm.nih.gov]
Treatment for cystic kidney disease There is no cure for any of the three cystic kidney diseases. Medical treatment aims to manage symptoms and reduce the risk of complications. [betterhealth.vic.gov.au]
Prognosis
Unilateral renal cystic disease with an ipsilateral non-functional kidney and an atretic pelvicalyceal system is a very rare condition that needs to be distinguished from multicystic dysplastic kidney in order to guide management and set prognosis. [ncbi.nlm.nih.gov]
Prognosis is highly unpredictable due to an inability to quantify residual functional parenchyma. Treatment is surgical correction of any associated GU abnormalities and, if renal insufficiency or renal failure is present, renal replacement therapy . [msdmanuals.com]
"Polycystic kidney disease: inheritance, pathophysiology, prognosis, and treatment". International Journal of Nephrology and Renovascular Disease. 3 : 69–83. ISSN 1178-7058. PMC 3108786. [en.wikipedia.org]
Etiology
There were no significant differences in the frequency of ACKD in the men and the women (P = .59) and in the etiology of end-stage renal disease (P = .64). [ncbi.nlm.nih.gov]
[ edit ] Two main types Autosomal Dominant PKD (adult PKD) Autosomal Recessive PKD (infantile PKD) ADPKD [ edit ] Etiology and Natural History gene PKD1 mutated in about 85% of cases gene PKD2 mutated in about 15% of cases symptoms usually develop beginning [en.wikibooks.org]
[…] renal calices → possibly caused by secondary hyperparathyroidism References: [3] [2] Pathology Differential diagnoses Multicystic dysplastic kidneys Definition : renal dysplasia with multiple cystic dilatation of nephrons during embryonic development Etiology [amboss.com]
Hains DS, Bates CM, Ingraham S, Schwaderer AL (2009) Management and etiology of the unilateral multicystic dysplastic kidney: a review. [link.springer.com]
Etiology Two genes have been linked to the disease: MCKD1 (1q21) is associated with end-stage renal disease at the mean age of 62 years, and MCKD2 (in 16p12, where the gene UMOD, encoding uromodulin or Tamm-Horsfall protein, has been identified as responsible [orpha.net]
Epidemiology
Epidemiology Incidence ADPKD : ∼ 1/1,000 ; one of the most common inherited kidney diseases in humans ARPKD : ∼ 1/20,000 References: [1] [2] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]
Definition / general Three or more cysts per kidney in patients on longstanding hemo- or peritoneal dialysis for end stage renal disease (unrelated to underlying renal pathology) Epidemiology Occurs in 10% - 20% of patients within the first three years [pathologyoutlines.com]
Bioinformatics and Genomics Programme, Centre for Genomic Regulation (CRG), Barcelona, Catalonia, Spain. 5 Universitat Pompeu Fabra, Barcelona, Catalonia, Spain. 6 Hospital del Mar Medical Research Institute (IMIM), Barcelona, Catalonia, Spain. 7 CIBER in Epidemiology [ncbi.nlm.nih.gov]
Summary Epidemiology Less than 60 families affected by ADMCKD have been described. Prevalence is estimated to be 1/100 000. Clinical description Clinical onset and course are insidious. [orpha.net]
Pathophysiology
Recently, several promising trials have further extended our understanding of the pathophysiology of CKD and may have the potential for rational personalized therapies in future years. [ncbi.nlm.nih.gov]
"Polycystic kidney disease: inheritance, pathophysiology, prognosis, and treatment". International Journal of Nephrology and Renovascular Disease. 3 : 69–83. ISSN 1178-7058. PMC 3108786. [en.wikipedia.org]
[…] dialysis Males > females during first ten years of dialysis Not restricted to adults; occurs in children and young adults on dialysis ( Pediatr Nephrol 1997;11:447 ) Frequency and severity not affected by online hemodiafiltration ( Ren Fail 2009;31:555 ) Pathophysiology [pathologyoutlines.com]
Definition Pathophysiology Classification (or lack thereof) Diseases 3. Cyst: fluid-filled sac that grows on the surface of, or within the kidney Generally arise from renal tubules 6. [slideshare.net]
Prevention
The National Institute of Diabetes and Digestive and Kidney Diseases recently asked the community to identify research objectives, which, if addressed, could improve understanding of basic kidney function and aid in prevention, treatment, and reversal [ncbi.nlm.nih.gov]
There is no known way to prevent either kidney cysts or polycystic kidney disease. [healthcommunities.com]
Frequent turning of the infant or bedridden child helps to prevent decubitus ulcers and lessens the danger of pneumonia, a constant threat to these children. [medical-dictionary.thefreedictionary.com]
Reassure that this could not have been prevented Recommended Follow-up for PKD [ edit ] renal ultrasounds to monitor cysts and function control of hypertension CT scan to detect aneurysm (ADPKD) monitor liver function Resources [ edit ] PKD foundation [en.wikibooks.org]
There is no way to prevent multicystic dysplastic kidney from occurring early in a baby's development, and there is no known way to prevent it from happening. [nationwidechildrens.org]