Acquired cystic kidney disease
Renal failure on hemodialysis for one year, fever and jaundice.
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Both kidneys are small in size showing replacement of their parenchyma by innumerable simple looking cysts (acquired cystic kidney disease).
The liver shows established cirrhotic changes, manifested as nodular contours and parenchymal dysmorphism. No focal lesions in T2 or diffusion sequences. No intrahepatic biliary dilatation observed. Normal course and caliber of the CBD, with no signal defects identified. The gall bladder shows a small 1 cm stone at its neck, with mild luminal distension and luminal mud.
The spleen is missing (surgically removed). Mild free upper abdominal ascites is seen.
Acquired cystic kidney disease is incidentally noted with characteristic numerous small parenchymal cysts, most of them are less than 5 mm. The appearance can mimic autosomal dominant polycystic kidney disease which is also a cause of late onset of end stage renal disease. So, history of the new development of these cystic changes after dialysis is important to establish the diagnosis.
This case was referred to investigate jaundice (MRCP), the intra- and extra-biliary radicals are normal. In the presence of established cirrhotic liver change, cholestatic jaundice was suggested.