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LETTER TO EDITOR
Year : 2022  |  Volume : 7  |  Issue : 2  |  Page : 327-328

Diagnostic criteria and role of multimodality imaging in complicated autosomal dominant polycystic kidney disease


Department of Radiology, St. John's Hospital, Bengaluru, Karnataka, India

Date of Submission15-Apr-2021
Date of Acceptance30-Aug-2022
Date of Web Publication06-Dec-2022

Correspondence Address:
Ravikanth Reddy
Department of Radiology, St. John's Hospital, Bengaluru - 560 034, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bjhs.bjhs_54_22

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How to cite this article:
Reddy R. Diagnostic criteria and role of multimodality imaging in complicated autosomal dominant polycystic kidney disease. BLDE Univ J Health Sci 2022;7:327-8

How to cite this URL:
Reddy R. Diagnostic criteria and role of multimodality imaging in complicated autosomal dominant polycystic kidney disease. BLDE Univ J Health Sci [serial online] 2022 [cited 2023 Jan 28];7:327-8. Available from: https://www.bldeujournalhs.in/text.asp?2022/7/2/327/362837



Dear Editor,

A 42-year-old gentleman of Indian ethnicity presented with sudden-onset left-sided flank pain, for which he presented to the hospital. There was no history of fever or burning micturition or hematuria. There was no past history of hypertension or liver dysfunction. Renal function tests were deranged with creatinine level of 2.3 mg/dL and urea of 119 mg/dL. The patient was referred for ultrasound of the abdomen which revealed enlarged bilateral kidneys with the evidence of multiple cystic lesions of varying sizes replacing the renal parenchyma. Based on the ultrasound findings, the patient was diagnosed with bilateral autosomal dominant polycystic kidney disease (ADPKD) [Figure 1]. However, to rule out complications of ADPKD, the patient was referred for nonenhanced computed tomography (NECT) which revealed few hyperdense cysts on the left representing hemorrhage [Figure 2]. Furthermore, static-fluid magnetic resonance (MR) urography was performed which confirmed ADPKD [Figure 3].
Figure 1: Longitudinal ultrasound image of right kidney demonstrating multiple cystic lesions throughout the renal parenchyma causing renal enlargement, consistent with features of ADPKD. RT ADPKD: Right autosomal dominant polycystic kidney disease

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Figure 2: Axial nonenhanced computed tomography image demonstrating multiple renal cysts replacing renal parenchyma. Note the polymorphism of cysts with foci of calcifications and hyperdense attenuation representing hemorrhage (arrow) involving left kidney suggesting complicated autosomal dominant polycystic kidney disease

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Figure 3: Static-fluid magnetic resonance urography image demonstrating multiple renal cysts of autosomal dominant polycystic kidney disease

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ADPKD is a systemic hereditary condition characterized by renal cyst development and progressive renal enlargement, resulting in renal failure in advanced stages. Ultrasound is the first imaging modality of choice for the diagnosis of ADPKD.[1] Sonographic criteria for categorizing at-risk individuals with ADPKD include minimum four cysts in each kidney in individuals older than 60 years of age, minimum two cysts in each kidney in individuals between 40-59 years, and minimum three renal cysts which may be unilateral or bilateral in individuals between 15 and 39 years of age.[2] Key clinical features of ADPKD are fever and abdominal pain which may be related to complications such as hemorrhage and cyst infection which are better assessed on CT and MR imaging (MRI). A diagnosis of cyst infection is made based on the triad of findings which include pain, fever, and complex renal cyst on imaging studies. Potential renal complications of ADPKD include cyst infection, perinephric abscess, pyelonephritis, and hematuria. While NECT reveals dense cysts compliant with hemorrhage and infection, contrast-enhanced CT reveals wall thickening and enhancement. Furthermore, NECT has a role in guiding percutaneous drainage of infected cysts.[3] Nevertheless, diffusion-weighted MRI has emerged as the imaging modality of choice for the evaluation of infected and complex cysts of ADPKD. Extrarenal complications of ADPKD are varied ranging from intracranial aneurysms, abdominal hernias, and cardiac abnormalities such as valvulopathy and left ventricular hypertrophy.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rahbari-Oskoui F, Mittal A, Mittal P, Chapman A. Renal relevant radiology: Radiologic imaging in autosomal dominant polycystic kidney disease. Clin J Am Soc Nephrol 2014;9:406-15.  Back to cited text no. 1
    
2.
Gradzik M, Niemczyk M, Gołębiowski M, Pączek L. Diagnostic imaging of autosomal dominant polycystic kidney disease. Pol J Radiol 2016;81:441-53.  Back to cited text no. 2
    
3.
Sanon Aigbogun M, Stellhorn RA, Pao CS, Seliger SL. Radiographic imaging in autosomal dominant polycystic kidney disease: A claims analysis. Int J Nephrol Renovasc Dis 2021;14:133-42.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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