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Pathology for Urologists

Adult Polycystic Kidney Disease


Image A
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Image B
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  • Patients present in 30-50's
  • Cysts only involve a portion of nephron, so renal function is maintained until 40's to 50's.
  • Relatively common, seen in 1 of 400-1,000 live births and responsible for 5-10% of CRF requiring dialysis.
  • Autosomal dominant; most common cystic renal disease and most common genetically transmitted disease (1:500 - 1:1000)
  • 25% has no family history.
  • Caused by mutations in genes at chr 16p13.3 (PKD1) that encodes for polycystin-1 and at chr 4q21 (PKD2) that encodes for polycystin-2.
  • PKD1 is more common (85%) and associated with more severe disease and earlier onset (30's).
  • Presents with hypertension, renal failure and abdominal pain.
  • Extrarenal involvement: Liver cysts (90%), cyst in pancreas (10%), seminal vesicles, pineal glands, and mitral valve prolase.
  • Gross: kidneys are massively enlarged and multicystic with essentially complete replacement of renal cortex (image A) & (image B). Hint: kidney larger and cyst more widespread than in acquired cystic disease (related to dialysis) because patients in the later have shrunken kidneys of CRF before acquiring cysts.

Image C
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Image D
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  • Histology:
    • Cystic dilatation of terminal ends of ampullary collecting ducts, proximal convoluted tubules, and Bowman's capsule (glomerular or tubular cysts) (image C).
    • Cysts can be up to several centimeters.
    • Cysts lined by a single layer of cuboidal or flattened cells.
  • Complications: Metanephric abscesses; hypertension; berry aneurysms of Circle of Willis; nephrolithiasis; and RCC (1-5% of cases).
  • CRF beginning at age 40-60 years
  • ~1/2 requires dialysis by age 50.

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