Presentation
Right sided abdominal pain.
Patient Data
Grossly abnormal and enlarged kidneys and liver, with minimal renal parenchyma. Small volume free fluid within the rectovesical pouch and minor right-sided peri-nephric stranding. Both kidneys demonstrate heterogenous hyperdensities within some cysts, which may reflect prior hemorrhagic or calcific material.
Case Discussion
This case is nice a demonstration of pathology.
This is a gentleman who underwent an open right nephrectomy.
Indication: Bleeding right kidney, hemodynamically unstable and failed conservative management. Background of known polycystic kidney disease. High risk secondary to anti-coagulation given recent AVR and aortic root replacement (previously on warfarin - ceased, now on heparin infusion).
Intraoperative findings: Large right polycystic kidney with overlying hematoma surrounding the upper pole. Hemorrhagic cysts. Nil active bleed.
Histopathology report:
MACROSCOPIC
- nephrectomy measuring 260x130x160mm
- specimen weighs 1800g
- entire renal parenchyma is replaced by variable sized cysts (5-30mm) which contain clear fluid or clotted blood
- pelvis is severely dilated and contains clotted blood
MICROSCOPIC
- sections reveal renal parenchyma replaced by multiple variably sized cysts lined by cuboidal to flattened epithelium
- cysts involve both cortex and medulla
- cystic dilatation of tubules and glomeruli are noted
- no epithelial dysplasia or evidence of invasive malignancy
SUMMARY
- features consistent with adult polycystic kidney disease
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