07-07-2008, 08:54 PM
A 50-year-old man has renal cystic disease. At age 19 years he was found to have hematuria and 1+ proteinuria on urinalysis. At age 29 years he was found to have hypertension and proteinuria. At age 34 years he had ultrasonography for gross hematuria, which showed normal to small-sized kidneys, two cysts in the right kidney, and one cyst in the left kidney, the largest of which was 2 cm.
He has no family history of premature deaths or renal disease. Physical examination is remarkable only for a blood pressure of 170/110 mm Hg and 1+ pedal edema. Laboratory studies show a serum creatinine of 3.0 mg/dL and 24-hour urinary protein excretion of 3.0 g. Urinalysis shows 3+ proteinuria and 5 to 10 erythrocytes per high-power field without casts. Repeat ultrasonography shows small-sized kidneys, two cysts in the right kidney, and one cyst in the left kidney, the largest of which is 2.5 cm.
Which of the following is the most likely diagnosis?
( A ) Autosomal dominant polycystic kidney disease
( B ) Medullary cystic disease
( C ) Acquired cystic disease
( D ) Tuberous sclerosis
( E ) Multiple simple cysts
He has no family history of premature deaths or renal disease. Physical examination is remarkable only for a blood pressure of 170/110 mm Hg and 1+ pedal edema. Laboratory studies show a serum creatinine of 3.0 mg/dL and 24-hour urinary protein excretion of 3.0 g. Urinalysis shows 3+ proteinuria and 5 to 10 erythrocytes per high-power field without casts. Repeat ultrasonography shows small-sized kidneys, two cysts in the right kidney, and one cyst in the left kidney, the largest of which is 2.5 cm.
Which of the following is the most likely diagnosis?
( A ) Autosomal dominant polycystic kidney disease
( B ) Medullary cystic disease
( C ) Acquired cystic disease
( D ) Tuberous sclerosis
( E ) Multiple simple cysts