Station 1 - Kidneys

Question 1

What peripheral signs would indicate renal enlargement?

Answer 1

• BP (hypertension)
• AV fistula
• tunnelled dialysis line
• Immunosuppressant stigmata (cushingoid habitus from steroids, gum hypertrophy with ciclosporin)
• Peritoneal dialysis catheter/scars

Question 2

What abdominal signs would indicate renal enlargement?

Answer 2

• Palpable kidney:ballotable, can get above and moves with respiration
• Polycystic kidney: both may/should be palpable, grossly enlarged, cystic/nodular
• Iliac fossae scar with or without transplanted kidney
• Ask to dip urine for proteinuria and haematuria
• Ask to examine external genitalia (varicocele in males)

Question 3

If renal enlargement is found with splenomegaly, what should be considered?

Answer 3

Polycystic kidney disease

Question 4

If renal enlargement is found with indwelling catheter, what should be considered?

Answer 4

Obstructive nephropathy with hydronephrosis

Question 5

What are the causes of unilateral kidney enlargement?

Answer 5

• PKD (other kidney not palpable/contralateral nephrectomy)
• Renal cell carcinoma
• Simple cysts
• Hydronephrosis (due to ureteric obstruction)

Question 6

What are the causes of bilateral kidney enlargement?

Answer 6

• PKD
• Bilateral renal cell carcinoma (5%)
• Bilateral hydronephrosis
• Tuberous sclerosis (renal angiomyolipomata and cysts)
• amyloidosis

Question 7

What investigations are needed for renal enlargement?

Answer 7

• U+Es
• Urine cytology
• US abdo +/- biopsy
• IVU
• CT if carcinoma is suspected
• Genetic studies for ADPKD

Question 8

What is PKD? What is the prevalence?

Answer 8

• 1:1000

- Progressive replacement of normal kidney tissue by cysts leading to renal enlargement and failure

Question 9

Describe the genetics for ADPKD type 1 and type 2, which is most common?

Answer 9

Type 1:

• 85% cases
• chromosome 16
• presents with renal failure earlier

Type 2:

• 15% cases
• Chromosome 4

Question 10

How does ADPKD present?

Answer 10

• HTN
• Recurrent UTIs
• Abdo pain - bleeding into cyst/cyst infection
• Haematuria

Question 11

What is the prognosis of ADPKD?

Answer 11

End-stage renal failure by age 40-60

Question 12

What other organs are involved in ADPKD?

Answer 12

• Liver: hepatic cysts and hepatomegaly
• Brain: berry aneurysm
• Heart: mitral valve prolapse (needs echo)
• Bowel: colonic diverticulae

Question 13

what is the screening investigation for ADPKD and who is screened?

Answer 13

US abdo >20yrs:;
• 2 cysts, unilateral or bilateral, if aged < 30 years
• 2 cysts in both kidneys if aged 30-59 years
• 4 cysts in both kidneys if aged > 60 years

Question 14

What is the management of ADPKD?

Answer 14

• Painkillers
• Urinary tract infections: → ABX
• ↑BP control
• End-stage renal disease → Transplantation
• Dialysis
• nephrectomy for recurrent bleeds/infection/size