Beruflich Dokumente
Kultur Dokumente
Presentation
Sir, this patient has bilateral enlarged kidneys. There are bilateral masses in the flanks
which are bimanually palpable and ballotable with a nodular surface. Of note, I am
able to get above both masses. Percussion note was resonant over both kidneys and
they move inferiorly with respiration. They are not tender in nature and there was no
renal bruit.
There is no associated hepatomegaly and the liver span is 12 cm at the right mid-
clavicualar line. The spleen is not enlarged. There is no ascites detected clinically and
the bladder is not palpable or percussible.
The patient does not have a sallow appearance and not cachexic looking. There are no
pruritic scratch marks or bruising. There is also no leukonychia or Terry’s nails. There
is no conjunctival pallor to suggest anaemia and no features of polycythemia such as a
plethoric facies or conjunctival suffusion. Patient is not in fluid overload as there is
no pedal oedema, he is able to lie flat and is not oxygen dependent. There is no
Kussmaul’s breathing pattern and also no flapping tremor or uremic fetor.
In summary, this middle age gentleman has got bilateral enlarged kidneys with no
complications of chronic renal failure detected clinically. There is also no evidence
that the patient is undergoing renal replacement therapy. The most underlying etiology
is Adult Polycystic kidney disease.
Questions
What are the causes of bilateral enlarged kidneys?
APCK
Commoner
o Acromegaly (hepatosplenomegaly)
o Early diabetic nephropathy
o Bilateral hydronephrosis
Rare
o Tuberous sclerosis
o Amyloidosis
o Von-Hippel Lindau disease
Autosomal dominant
Multiple angiomata in the retina, CNS
Cysts in liver, kidneys pancreas
RCC, phaeochromocytoma
What are the conditions that can result in bilateral renal cysts?
o Polycystic kidneys
Dominant and recessive
Simple cyst
Von Hippel Lindau
Tuberous sclerosis
What are the types of signs in the nails that you can detect in patients with CRF?
Hypoalbuminaemia
o Leukonychia
o Muehrcke’s nails (paired white transverse line near the distal end of nails)
Renal failure
o Terry’s nails (distal brown arc 1mm or >)
o Mee’s line (single white line; also in arsenic poisoning)
o Beau’s line (non-pigmented indented band = catabolic state)