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Medullary Cystic Kidney Disease

MSK


Presentation

  • METHODS: The clinical, biochemical, sonographic and histopathological findings in 186 members of six large Cypriot families with ADMCKD-1 are presented.[ncbi.nlm.nih.gov]
Failure to Thrive
  • Nephronophthisis-medullary cystic disease In children, this disorder can lead to a failure to thrive, growth retardation, bone deformities, or muscle spasms caused by low calcium. Juveniles may have poor bone formation and neurologic abnormalities.[my.clevelandclinic.org]
  • Common findings include a failure to thrive and weakness. Anorexia, nausea, pruritus, bone pain, and neurologic symptoms herald ESRD. Because of salt wasting, hypertension is rare, except in the infantile form of nephronophthisis.[emedicine.medscape.com]
  • Unilateral or bilateral nephrectomy is performed in cases of respiratory compromise in neonates or when failure to thrive is present. Dialysis and transplantation are treatments of choice in end stage renal disease.[lecturio.com]
Pachyonychia
  • Novel and recurrent mutations in the genes encoding keratins K6a, K16 and K17 in 13 cases of pachyonychia congenital. J Invest Dermatol 2001 ; 117 : 1391 –6. Bross P, Corydon TJ, Andresen BS, Jorgensen MM, Bolund L, Gregersen N.[doi.org]
Blonde Hair
  • Rayfield EJ, McDonald FD: Red and blonde hair in renal medullary cystic disease. Arch Intern Med 130:72–75, 1972. PubMed Google Scholar 69.[link.springer.com]
Osteoporosis
  • , Osteopetrosis late-onset form type 1, Osteoporosis-pseudoglioma syndrome, Osteosclerosis, Van Buchem disease NOTCH2 Alagille syndrome, Hajdu-Cheney syndrome PKD1 Polycystic kidney disease PKD2 Polycystic kidney disease PKHD1 Polycystic kidney disease[genda.com.ar]
  • […] syndrome, Hyperostosis, endosteal, Osteosclerosis, Exudative vitreoretinopathy, Osteopetrosis late-onset form type 1, LRP5 primary osteoporosis AD/AR/Digenic 57 196 MAPKBP1 Nephronophthisis 20 AR 6 7 NEK8 Nephronophthisis AR 16 18 NOTCH2 * Alagille syndrome[blueprintgenetics.com]
Cerebellar Ataxia
  • Cerebellar ataxia (Joubert's syndrome). Liver fibrosis. Differential diagnosis Polycystic kidney disease Chronic pyelonephritis Urinary tract obstruction Investigations Hyponatraemia may occur if sodium intake is reduced for any reason.[patient.info]
  • Keywords Retinitis Pigmentosa Cerebellar Ataxia Retinal Degeneration Cystic Disease Renal Medulla These keywords were added by machine and not by the authors.[link.springer.com]
  • Mainzer F, Saldino RM, Ozonoff MB, Minagi H: Familial nephropathy associated with retinitis pigmentosa, cerebellar ataxia and skeletal abnormalities. Am J Med 49 : 556 -562, 1970 20.[jasn.asnjournals.org]
Polyuria
  • Nephronophthisis and autosomal dominant tubulointerstitial kidney disease cause inability to concentrate urine (with polydipsia and polyuria), sodium wasting, anemia, and ESRD.[merckmanuals.com]
  • The first sign of MCKD is polyuria; later, the clinical findings relate to renal insufficiency. Originally, NPH and MCKD were considered separate entities.[ncbi.nlm.nih.gov]
  • Symptoms typically appear at an average age of 28 years and may include polyuria (excessive production or passage of urine) and low urinary osmolality (decreased concentration) in the first morning urine.[diseaseinfosearch.org]
  • Presentation This results from gradual tubular injury. [ 1 ] Clinical features Polyuria - decreased concentrating ability with loss of sodium. Polydipsia. Growth retardation. Secondary enuresis. Renal impairment.[patient.info]
Kidney Failure
  • CONCLUSION: MUC1 mutation results in progressive chronic kidney failure with a bland urinary sediment.[ncbi.nlm.nih.gov]
  • Dialysis or kidney transplantation may be needed to address kidney failure.[merckmanuals.com]
  • Although dialysis is a life-sustaining treatment, people with kidney failure may also be able to undergo a kidney transplant. MCKD leads to end-stage renal disease — in other words kidney failure will occur eventually.[healthline.com]
  • As the disease progresses, kidney failure develops. Treatment may involve taking medicines and diet changes, limiting foods containing phosphorus and potassium. You may need dialysis and a kidney transplant.[mountsinai.org]
  • Everyone with MCKD will eventually need treatment for kidney failure. Treatment options include: dialysis kidney transplantation supportive care. Where to get help Your doctor Kidney Health Australia Information Service.[betterhealth.vic.gov.au]

Workup

  • Kashani, Biomarkers for Early Detection of Acute Kidney Injury, The Journal of Applied Laboratory Medicine: An AACC Publication, September 2017, jalm.2017.023325; DOI: 10.1373/jalm.2017.023325 (May 1, 2017) Arora, P Chronic Kidney Disease Workup.[labtestsonline.it]
Uric Acid Increased
  • (The fractional excretion of uric acid increases in patients as renal function declines. 27 ) Thirty-two of 36 subjects carrying the UMOD mutation met the strict clinical criteria required to be diagnosed as affected.[doi.org]
Lymphocytic Infiltrate
  • In case 3, tubules were ensheathed by dense acellular hyaline material. 3 In family 4, biopsy samples showed focal tubular atrophy with interstitial fibrosis and lymphocytic infiltration.[doi.org]

Treatment

  • Therefore, it may represent a treatment of choice in MCKD1 patients with ESRD.[ncbi.nlm.nih.gov]
  • Treatment for MCKD MCKD is a slow, progressive disease. There is no cure. Treatment aims to manage the symptoms and decrease the risk of complications.[betterhealth.vic.gov.au]
  • Lifelong treatment may control the symptoms of chronic kidney disease.[mountsinai.org]
  • Treatment for MCKD may include correction of water and electrolyte imbalances, and dialysis followed by renal transplantation for end-stage renal failure.[diseaseinfosearch.org]

Prognosis

  • Sep 11, 2005 316 1 241 33 Status Medical Student #1 Both have "cysts" in the medulla but Medullary Cystic has a poor prognosis, and medullary sponge kidney is benign with just a predisposion to kidney stones (and less often, hematuria and UTI's).[forums.studentdoctor.net]
  • Treat associated renal failure - usually haemodialysis followed by renal transplantation (the illness does not recur in the transplanted kidney). [ 1, 2 ] Prognosis Most children will develop renal failure by mean age of 13 years.[patient.info]
  • Outlook (Prognosis) The age at which people with ADTKD reach end-stage kidney disease varies, depending on the form of the disease. It can be as young as in the teens or in older adulthood.[mountsinai.org]
  • Prognosis for ARPKD Prognosis varies considerably. Patients who are born with oligohydramnios most often die due to pulmonary complications.[lecturio.com]

Etiology

  • Etiology and Pathophysiology of MCK MCK presents in two types, and both are inherited in an autosomal dominant fashion.[lecturio.com]
  • […] 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]
  • We also propose that hypokalemia induced tissue proliferation may, at least in some cases, be the etiological factor for the often described association of renal tubular acidosis and cystic disease of the kidney.[bmcnephrol.biomedcentral.com]

Epidemiology

  • Definition / general Sporadic cystic disease characterized by bilateral cystic dilations of medullary collecting ducts; normal cortex Epidemiology 1 per 5000 births; no gender preference; not familial Associated with hemihypertrophy of body (25% of cases[pathologyoutlines.com]
  • […] recessive and patients develop end-stage renal failure (ESRF) by adolescence. [ 1, 2 ] The protein products, named nephrocystins, which become abnormal in this disorder, have primarily a function in cilial structures (making it a ' ciliopathy '). [ 3 ] Epidemiology[patient.info]
  • Multicystic Dysplastic Kidney (MCDK) Epidemiology of MCDK MCDK is one of the most frequent congenital kidney disorders.[lecturio.com]
  • 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]
Sex distribution
Age distribution

Pathophysiology

  • Etiology and Pathophysiology of MCK MCK presents in two types, and both are inherited in an autosomal dominant fashion.[lecturio.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]
  • Conclusion The association of cystic renal disease with hypokalemia, and the possible pathophysiological basis of the development of renal cysts in patients with severe hypokalemia, are discussed.[bmcnephrol.biomedcentral.com]
  • Improved understanding of pathophysiologic mechanisms has led to development and testing of novel drugs for some of these diseases.[appliedradiology.com]

Prevention

  • Prevention Medullary cystic kidney disease is an inherited disorder. It may not be preventable. References Bleyer AJ, Kidd K, Živná M, Kmoch S. Autosomal dominant tubulointerstitial kidney disease. Adv Chronic Kidney Dis. 2017;24(2):86-93.[mountsinai.org]
  • Prevention of primary manifestations: Treatment of hyperuricemia with allopurinol can prevent development of gout.[ncbi.nlm.nih.gov]
  • These mutations alter the structure of the protein, preventing its release from kidney cells. Abnormal buildup of uromodulin may trigger the self-destruction (apoptosis) of cells in the kidneys, causing kidney disease.[ghr.nlm.nih.gov]
  • It may not be preventable. ADTKD; Medullary cystic kidney disease; Renin associated kidney disease; Familial juvenile hyperuricemic nephropathy; Uromodulin associated kidney disease Bleyer AJ, Kidd K, Živná M, Kmoch S.[nlm.nih.gov]
  • 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]

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