Polycystic Kidneys:

Please examine the Abdominal System of this 53 year old man who has been
referred by his GP with abdominal pain

Clinical Examination:

Classical Signs Additional Signs

- Palpable kidneys: can get above - Transplanted kidney in right/left

them, whereas you cannot get above
a liver/spleen.
- Resonant percussion note due to
overlying bowel
- AV fistula in the arms/subclavian
dialysis line
Common discussion topics:
Diagnosis & Differentials
Genetics and Investigations
Complications and Management
iliac fossa
- Evidence of berry aneurysm: third
nerve palsy, cranial surgery
- Signs of CKD – pallor (anaemia)
- Polycythaemia (due to increased
erythropoiesis)
- Evidence of hypertensive change
to fundi

Quick Revision:
Differential Diagnosis: Diabetic Nephropathy, Bilateral Hydronephrosis,
Amyloidosis. Also consider Hepatosplenomegaly (but mention can get above)

Investigations Management

Monitor renal function and blood Affected individuals should be started on an

pressure ACEi if have proteinuria
Treat UTIs Regular blood pressure check and renal
USS kidneys – diagnostic criteria: function check and control of hypertension
>=3 cysts in total in individuals aged with medications
15-39 years Control of other cardiovascular risk factors
Timely initiation of dialysis
>= 2 cysts in each kidney age 40-59
Offer genetic counselling
years,
4 or more cysts in each kidney aged
60+ years
USS liver for cysts
Investigate for intracranial aneurysms
in patients aged 18-40 with a FHx