Polycystic Kidney Disease

General Inspection
  • Hypertensive
  • Plethoric facies secondary to overproduction of EPO by polycystic kidneys
  • May have signs of anaemia if CKD
  • Presence of neurological deficits secondary to aneurysm
    • old stroke
    • third nerve palsy secondary to berry aneruysm
  • Signs of AV fistula or lines for renal replacement therapy
  • Check volume status
  • Check for encephalopathy with asterixis
  • terry's nails
Abdomen
  • fullnes to flanks
  • Liver may be enlarged - hepatic cysts occur in 70% of patients
  • Nephrectomy scars - may be unilateral or bilateral, often necessary in context of trauma and haemorrhage
  • Scars of renal transplant
  • spleen may be enlarged with splenic cysts (5% of patients)
  • Presence of bilateral renal masses
Other
  • Examine for MVP/ AR

Differential diagnosis
  1. Autosomal dominant polycystic kidney disease - mostly chromosome 16, sometimes chromosome 4
  2. Autosomal recessive polycystic kidney disease - presenting in infancy, producing severe liver and renal disease
  3. Von Hippel Lindau syndrome, A/D chromosome 3, haemangioblastomas in cerebellem, retina, spine + cysts in kidney, liver, spleen, risk of renal cell carcinoma and phaemochromocytoma
  4. Tuberous sclerosis
  5. trisomies 13/ 18, 21
  6. Bilateral renal cysts (benign)
  7. Bilateral hydronephrosis
  8. Amyloidosis
  9. Bilateral Renal Cell Carcinoma

Renal Replacement Therapy and Transplantation

Establish mode of renal replacement therapy
  • ​AV fistula - mature vs immature - check via palpable thrill and auscultated bruit
  • tunneled vascath - usually used whilst an AV fistula matures
  • presence of peritoneal dialysis - look for evidence of peritoneal dialysis catheter, signs of infection, presence of peritonitis
  • renal transplant - scars in right iliac fossa, palpate mass (should be smooth), percuss mass, auscultate for bruit, determine tenderness (may signify infection, rejection etc)
  • Previous scars suggestive of past attempts at AV fistula access
Is the renal replacement therapy adequate
  • Comment on fluid status (JVP)
  • auscultate for pericardial rub
  • look for evidence of metabolic uraemic encephalopathy (check orientation, check asterixis)
  • excoriation marks
  • tachypnoea
Complications of CKD
  • parathyroidectomy scars
  • anaemia
Complications of immunosupressive therapy
  • Prednisolone side effects
  • stigmata of infection
  • Presence of SCC/ BCC
  • evidence of use of cyclosporin - gum hypertrophy, hirsutism, coarse tremor, hypertension, DM
Evidence of aetiology
  • ​Diabetes - glucose finger-prick testing, lipohypertrophy from s/c insulin, diabetic retinopathy, neuropathy
  • hypertension - hypertensive changes such as silver wiring, AV nicking
  • Polycystic kidney disease
  • vasculitis - livido reticularis, mononeuritis multiplex, stigmata of rheumatological disease