Summer, 2015



Figure 1 is an image of the right kidney mid in a sagittal plane. Figure 2 is an image of the left kidney mid in a sagittal plane. Notice figures 1 & 2 show bilaterally enlarged kidneys covered with numerous cysts of various sizes. Which are characteristic of Polycystic Kidney Disease. Figure 3 is an image of the right kidney-mid in transverse. Figure 4 is an image of the medial left kidney in sagittal. Notice the color Doppler signals are splayed throughout the kidney sinus. Which could be a possible reason for development of hypertension.

The sonographic characteristics of this disease are poorly defined renal contour that is secondary to multiple peripheral cysts. These cysts cause distortion and a decrease in specular reflections from the renal capsule (Kawamura & Lunsford, 2012). While scanning a patient with this known disease, close attention should be given to the liver, pancreas, and spleen because this is a multi-systemic and progressive disorder (Torra, 2014). Cyst formations can occur in these organs as well as the ovaries and testes.

Patients with this disease can be asymptomatic throughout their life until age 40 when symptoms most commonly can present. Some symptoms clinically presented are abdominal and lumbar pain, hematuria, and hypertension (brought on by the obstruction sometimes placed on the renal arteries from neighboring enlarged cysts). Deaths in these patients occur around ten years after the onset of symptoms (most commonly in their 70s) with the majority being uremia, or urea present in the patient’s blood (59%) (Kawamura & Lunsford, 2012).

Treatments for the symptoms include blood pressure medicines, diuretics, and low-salt diet. Certain cysts that are painful, infected, bleeding, or obstructing may be drained. Ultimately the final stage for this disease is end-stage renal failure and a transplant may be necessary as long as the disease does not affect any other organs. (Healthline, 2015)

Some differential diagnoses for ADPKD are autosomal recessive polycystic kidney disease (which affects the neonatal/ childhood population), medullary cystic kidney disease (the renal cystic spaces are seen only in the deeper part of the kidney), acquired cystic kidney disease (family history would be used to differentiate these cases), and multiple simple renal cysts (which would most likely not involve other organs nor occur bilaterally).

References
Kawamura, D., & Lunsford, B. (2012). The Kidneys. In Diagnostic Medical Sonography: Abdomen and Superficial Structures (3rd ed., pp. 289). Baltimore: Lippincott, Williams and Wilkins. Lusaya, MD, D. (2013, February 14).
Retrieved April 21, 2015, from http://emedicine.medscape.com/article/244907-overview. Roser Torra, MD, PhD. (2014, Apr 28).
Retrieved April 21, 2015, from http://www.healthline.com/health/polycystic-kidney-disease. Healthline Networks, Inc (2005-2015).