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A 45-year-old man presents to the Emergency Department complaining of loin pain and passing blood inhis urine. This is not the first time he has had similar symptoms but they are generally not as severe. Thepain is concentrated around the left loin region and is described as 'dull' and 6/10 in terms of severity. Heis generally fit and well but is currently awaiting ambulatory blood pressure monitoring by his GP as he hada borderline blood pressure at a recent medical.

He has recently been on holiday in Greece. He works as a car mechanic and drinks around 30 units ofalcohol per week.

Blood tests in the Emergency Department show the following:

Hb 13.9 g/dl Na 141 mmol/l

Platelets 286 * 10 /l K 4.8 mmol/l

WBC 6.9 * 10 /l Urea 6.9 mmol/l

Creatinine 109 µmol/l

CRP 14 mg/l

A presumed diagnosis of renal colic is made and a CT requested:

Question 14 of 31

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What is the most likely underlying diagnosis?

Metastatic renal cell cancer

Pseudomyxoma peritonei

Autosomal dominant polycystic kidney disease

Hydatid disease

Medullary cystic disease

The presence of both renal and hepatic cysts on the CT make the diagnosis relatively straight forward.Note also the raised creatinine and borderline blood pressure, both clues to underlying autosomal


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dominant polycystic kidney disease.

ADPKD: features

Featureshypertensionrecurrent UTIsabdominal painrenal stoneshaematuriachronic kidney disease

Extra-renal manifestationsliver cysts (70%)berry aneurysms (8%)cardiovascular system: mitral valve prolapse, mitral/tricuspid incompetence, aortic root dilation,aortic dissectioncysts in other organs: pancreas, spleen; very rarely: thyroid, oesophagus, ovary

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Extensive cysts are seen in an enlarged kidney


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CT of the abdomen demonstrates both kidneys to be markedly enlargedby innumerable cysts ranging in size from a few millimeters to multiplecentimeters with cysts also present in the liver








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CT showing multiple cysts of varying sizes in the liver, and bilateralkidneys with little remaining normal renal parenchyma.

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