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# | '''Autosomal dominant polycystic kidney disease''', abbreviated '''ADPKD''', is a common genetic cause of [[chronic renal failure]]. | ||
==General== | |||
===Etiology=== | |||
*Mutation in ''PKD1'' gene or ''PKD2'' gene. | |||
*Is classified in a large group of diseases - ''ciliopathies''. | |||
PKD1 related disease:<ref name=Ref_MacSween174-5>{{Ref MacSween|174-5}}</ref> | |||
*Encodes polycystin. | |||
*Death at ~53 years. | |||
*Assoc. with cerebral aneurysms. | |||
PKD2 related disease:<ref name=Ref_MacSween174-5>{{Ref MacSween|174-5}}</ref> | |||
*Death at ~69 years. | |||
*Associated with colonic diverticula, [[aortic aneurysm]], [[mitral valve prolapse]]. | |||
===Liver cysts and PKD=== | |||
====General==== | |||
Features: | |||
*Most common extra-renal manifestation of PKD; dependent on age, sex and renal function:<ref name=pmid9186898>{{cite journal |author=Perrone RD |title=Extrarenal manifestations of ADPKD |journal=Kidney Int. |volume=51 |issue=6 |pages=2022–36 |year=1997 |month=June |pmid=9186898 |doi= |url=http://www.nature.com/ki/journal/v51/n6/pdf/ki1997276a.pdf}}</ref> | |||
**Age dependence: | |||
***10-17% <40 years old have liver cysts. | |||
***70-75% >60 years old have liver cysts. | |||
**Renal function: | |||
***60-70% of patients with [[end-stage renal disease]] (ESRD) and near-ESRD. | |||
**Females more often affected. | |||
*Hepatic function usu. preserved. | |||
Complications:<ref name=Ref_MacSween174-5>{{Ref MacSween|174-5}}</ref> | |||
#Infected cyst. | |||
#[[Cholangiocarcinoma]]. | |||
====Microscopic==== | |||
Features: | |||
*''Von Meyenburg complexes'': | |||
**Cluster of dilated ducts with "altered" bile. | |||
**Surrounded by collagenous stroma. | |||
See: ''[[Medical liver disease]]''. | |||
==Gross== | |||
Features: | |||
*Thin walled cysts. | |||
**Number of cysts: | |||
***If you can count 'em it favours acquired renal cystic disease... if you can't it favours the genetic condition. | |||
==Microscopic== | |||
Features:<ref name=Ref_DARP426>{{Ref DARP|426}}</ref> | |||
*Cysts lined by simple flattened epithelium. | |||
*Normal renal tubules interspersed between cysts. | |||
*+/-Fibrosis (late-stage). | |||
DDx: | |||
*[[Acquired renal cystic disease]] - rarely.<ref name=pmid1819219>{{cite journal |author=Kessler M, Testevuide P, Aymard B, Huu TC |title=Acquired renal cystic disease mimicking adult polycystic kidney disease in a patient undergoing long-term hemodialysis |journal=Am. J. Nephrol. |volume=11 |issue=6 |pages=513–7 |year=1991 |pmid=1819219 |doi= |url=}}</ref> | |||
**Morphologically similar to acquired renal cystic disease.<ref name=rj_oct2010>RJ. 20 October 2010.</ref> | |||
**It is said that "... if you can count 'em it's simple cysts; if you can't it's polycystic (renal disease)."<ref name=rj_oct2010>RJ. 20 October 2010.</ref><ref>{{cite book |author= Barbaric, Zoran L. |title=[http://books.google.com/books?id=uABgezxjhYwC&pg=PA87&lpg=PA87&dq=cystic+renal+disease,+%22if+you+can+count+them%22&source=bl&ots=GYyIdR9YmS&sig=DBYzT8LO2MltLA-wwW-0QwnQ6Lk&hl=en&ei=0hF-Taz0IsG3twe5yfG6BQ&sa=X&oi=book_result&ct=result&resnum=1&ved=0CBoQ6AEwAA#v=onepage&q=cystic%20renal%20disease%2C%20%22if%20you%20can%20count%20them%22&f=false Principles of Genitourinary Radiology] |publisher=Thieme |location= |year=1994 |pages= 87 |edition=2nd |isbn=978-0865774933 |oclc= |doi= |accessdate=}}</ref> | |||
==Sign out== | |||
<pre> | |||
Left Kidney, Nephrectomy: | |||
- Polycystic kidney with changes of chronic renal failure (thyroidization), | |||
consistent with polycystic kidney disease. | |||
- NEGATIVE for malignancy. | |||
</pre> | |||
==See also== | |||
*[[Cystic kidney diseases]]. | |||
==References== | |||
{{Reflist|1}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Genitourinary pathology]] |
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