NBME 13 PKD question

[britesky89]

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Hey guys, Im really having trouble understanding the following question from NBME 13:

"52 yo M, with a family hx of renal failure, comes with abdominal pain over last 6 mo. In the past he's been treated for renal calculus and HTN. Physical exam shows bilateral palpable masses in upper abdomen. Urine analysis shows created erythrocytes & mild proteinuria. CT scan identifies patient's problem. Diagnosis?"

A. Adrenal adenoma
B. Glomeruli nephritis
C. Henoch shonlein purpura
D. Polycystic kidney disease (Right)
E. Renal cell carcinoma (WRONG)

I'm having trouble understanding why the answer isn't renal cell carcinoma. Renal cell carcinoma can also be inherited (I.e positive family hx) and can be due to VHL, in which case it's bilateral.

If someone knows why Polycystic kidney disease is a better option please enlighten me!

Thanks!

 

[Suture15]

Bilateral masses in upper abdomen means cysts in liver, not sure about the left side though. But upper abdomen is not kidney.

 

[Slade009]

ADPKD (Autosomal Dominant) is the most common cause of hereditary Renal Failure in an adult. Patients are often asymptomatic till their 40's or 50's. Often causes HTN and extrarenal manifestations include Liver Cysts with visceral abdominal pain. Mild proteinuria due to the partial damage (not complete damage) of the kidneys since End-Stage Renal Disease manifests (in 50% of patients) by age 70.

As for why not RCC, Renal Cell Carcinoma has a classic triad of Hematuria, Flank Pain and Palpable abdominal mass in less than 10% of cases. Non-specific symptoms are more common such as fever, anorexia, malaise and weight loss. Pulmonary metastasis is most common in RCC and may show signs and symptoms there as well.

Based on both in terms of more common and this patients presentation, PKD fits better in this vignette.

 

[britesky89]

Thank you! That really helped .

 

[Slade009]

Thank you! That really helped .

You're welcome.