Snapshot A 26-year-old man presents to his primary care physician with abdominal and lower back pain. He reports to also seeing blood in his urine. Medical history is non-contributory. Family history is significant for his father requiring hemodialysis at a young age. Vitals signs are significant for a blood pressure of 162/112 mmHg. A renal ultrasound is performed and shown. (Adult polycystic kidney disease) Adult Polycystic Kidney Disease (ADPCKD) Clinical definition an inherited disorder that results in expansion of multiple renal cysts which ultimately leads to end-stage renal disease Epidemiology incidence the most common inherited cause of kidney disease demographics ≥ 30 years of age risk factors family history Pathogenesis PKD1 or PKD2 mutations results in abnormal cell signaling that results in cystogenesis expansion of cysts results in progressive loss of nephrons Genetics inheritance pattern autosomal dominant mutations PKD1 (on chromosome 16) or PKD2 (on chromosome 4) PKD1 encodes polycystin-1 PKD2 encodes polycystin-2 Associated conditions cyst development in other organs such as liver (most common extra-renal cyst type) pancreas seminal vesicle note, that kidneys appear normal at birth vascular abnormalities such as intracranial aneurysm coronary artery aneurysm cardiovascular abnormalities mitral valve prolapse left ventricular hypertrophy diverticulosis Prognosis with age the number and size of the cyst increases Presentation symptoms abdominal or flank pain low back pain hematuria urinary tract infection Juvenile Polycystic Kidney Disease (ARPCKD) Clinical definition a congenital fibrocystic disorder that results in renal and hepatic manifestations Epidemiology incidence 1 in 20,000 live births Pathogenesis PKHD1 gene mutation leads to abnormal production of fibrocystin and polyductin which results in defects of the renal tubular structures dilatation and elongation of collecting ducts bile duct structures cystic dilatation of intra- and extra-hepatic bile ducts Genetics inheritance pattern autosomal recessive mutation PKHD1 gene on chromosome 6 Associated conditions Potter sequence Presentation symptoms/physical exam bilateral abdominal mass in infants and children hepatomegaly in infants and children hypertension Medullary Cystic Disease Clinical definition an autosomal dominant inherited disorder that results in tubulointerstitial fibrosis of the kidney medullary cystic disease is characterized by autosomal dominant inheritance pattern progressive and slow impairment in renal function that ultimately results in end-stage renal disease no or minimal proteinuria with a bland urine sediment medullary cysts on renal ultrasound in most cases medullary cysts are not present can see shrunken kidneys on ultrasound
QUESTIONS 1 of 5 1 2 3 4 5 Previous Next Lab Values Blood Hematologic Cerebrospinal Sweat, Urine, and BMI Blood, Plasma, Serum Reference Range ALT 8-20 U/L Amylase, serum 25-125 U/L AST 8-20 U/L Bilirubin, serum (adult) Total // Direct 0.1-1.0 mg/dL // 0.0-0.3 mg/dL Calcium, serum (Ca2+) 8.4-10.2 mg/dL Cholesterol, serum Rec: < 200 mg/dL Cortisol, serum 0800 h: 5-23 μg/dL //1600 h: 3-15 μg/dL 2000 h: ≤ 50% of 0800 h Creatine kinase, serum Male: 25-90 U/LFemale: 10-70 U/L Creatinine, serum 0.6-1.2 mg/dL Electrolytes, serum Sodium (Na+) 136-145 mEq/L Chloride (Cl-) 95-105 mEq/L Potassium (K+) 3.5-5.0 mEq/L Bicarbonate (HCO3-) 22-28 mEq/L Magnesium (Mg2+) 1.5-2.0 mEq/L Estriol, total, serum (in pregnancy) 24-28 wks // 32-36 wks 30-170 ng/mL // 60-280 ng/mL 28-32 wk // 36-40 wks 40-220 ng/mL // 80-350 ng/mL Ferritin, serum Male: 15-200 ng/mLFemale: 12-150 ng/mL Follicle-stimulating hormone, serum/plasma Male: 4-25 mIU/mL Female: premenopause: 4-30 mIU/mL midcycle peak: 10-90 mIU/mL postmenopause: 40-250 pH 7.35-7.45 PCO2 33-45 mmHg PO2 75-105 mmHg Glucose, serum Fasting: 70-110 mg/dL2-h postprandial:<120 mg/dL Growth hormone - arginine stimulation Fasting: <5 ng/mLProvocative stimuli: > 7ng/mL Immunoglobulins, serum IgA 76-390 mg/dL IgE 0-380 IU/mL IgG 650-1500 mg/dL IgM 40-345 mg/dL Iron 50-170 μg/dL Lactate dehydrogenase, serum 45-90 U/L Luteinizing hormone, serum/plasma Male: 6-23 mIU/mL Female: follicular phase: 5-30 mIU/mL midcycle: 75-150 mIU/mL postmenopause 30-200 mIU/mL Osmolality, serum 275-295 mOsmol/kd H2O Parathyroid hormone, serume, N-terminal 230-630 pg/mL Phosphatase (alkaline), serum (p-NPP at 30° C) 20-70 U/L Phosphorus (inorganic), serum 3.0-4.5 mg/dL Prolactin, serum (hPRL) < 20 ng/mL Proteins, serum Total (recumbent) 6.0-7.8 g/dL Albumin 3.5-5.5 g/dL Globulin 2.3-3.5 g/dL Thyroid-stimulating hormone, serum or plasma .5-5.0 μU/mL Thyroidal iodine (123I) uptake 8%-30% of administered dose/24h Thyroxine (T4), serum 5-12 μg/dL Triglycerides, serum 35-160 mg/dL Triiodothyronine (T3), serum (RIA) 115-190 ng/dL Triiodothyronine (T3) resin uptake 25%-35% Urea nitrogen, serum 7-18 mg/dL Uric acid, serum 3.0-8.2 mg/dL Hematologic Reference Range Bleeding time 2-7 minutes Erythrocyte count Male: 4.3-5.9 million/mm3Female: 3.5-5.5 million mm3 Erythrocyte sedimentation rate (Westergren) Male: 0-15 mm/hFemale: 0-20 mm/h Hematocrit Male: 41%-53%Female: 36%-46% Hemoglobin A1c ≤ 6 % Hemoglobin, blood Male: 13.5-17.5 g/dLFemale: 12.0-16.0 g/dL Hemoglobin, plasma 1-4 mg/dL Leukocyte count and differential Leukocyte count 4,500-11,000/mm3 Segmented neutrophils 54%-62% Bands 3%-5% Eosinophils 1%-3% Basophils 0%-0.75% Lymphocytes 25%-33% Monocytes 3%-7% Mean corpuscular hemoglobin 25.4-34.6 pg/cell Mean corpuscular hemoglobin concentration 31%-36% Hb/cell Mean corpuscular volume 80-100 μm3 Partial thromboplastin time (activated) 25-40 seconds Platelet count 150,000-400,000/mm3 Prothrombin time 11-15 seconds Reticulocyte count 0.5%-1.5% of red cells Thrombin time < 2 seconds deviation from control Volume Plasma Male: 25-43 mL/kgFemale: 28-45 mL/kg Red cell Male: 20-36 mL/kgFemale: 19-31 mL/kg Cerebrospinal Fluid Reference Range Cell count 0-5/mm3 Chloride 118-132 mEq/L Gamma globulin 3%-12% total proteins Glucose 40-70 mg/dL Pressure 70-180 mm H2O Proteins, total < 40 mg/dL Sweat Reference Range Chloride 0-35 mmol/L Urine Calcium 100-300 mg/24 h Chloride Varies with intake Creatinine clearance Male: 97-137 mL/minFemale: 88-128 mL/min Estriol, total (in pregnancy) 30 wks 6-18 mg/24 h 35 wks 9-28 mg/24 h 40 wks 13-42 mg/24 h 17-Hydroxycorticosteroids Male: 3.0-10.0 mg/24 hFemale: 2.0-8.0 mg/24 h 17-Ketosteroids, total Male: 8-20 mg/24 hFemale: 6-15 mg/24 h Osmolality 50-1400 mOsmol/kg H2O Oxalate 8-40 μg/mL Potassium Varies with diet Proteins, total < 150 mg/24 h Sodium Varies with diet Uric acid Varies with diet Body Mass Index (BMI) Adult: 19-25 kg/m2 Calculator ( ) xy AC 7 8 9 ÷ 4 5 6 × 1 2 3 - 0 . = + Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.RL.72) A 35-year-old male with a history of hypertension presents with hematuria and abdominal discomfort. Ultrasound and CT scan reveal large, bilateral cysts in all regions of the kidney. The patient’s disease is most commonly associated with: Review Topic QID: 101026 1 Aortic stenosis 0% (0/12) 2 Berger’s disease 0% (0/12) 3 Diabetes mellitus 0% (0/12) 4 Berry aneurysm 100% (12/12) 5 Henoch-Schonlein purpura 0% (0/12) M1 Select Answer to see Preferred Response PREFERRED RESPONSE 4 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.RL.26) A female infant is born with a mutation in PKD1 on chromosome 16. An abdominal ultrasound performed shortly after birth would most likely reveal which of the following? Review Topic QID: 100980 1 Bilateral kidney enlargement 0% (0/5) 2 Microscopic cysts 40% (2/5) 3 Horseshoe kidney 0% (0/5) 4 Adrenal atrophy 0% (0/5) 5 Normal kidneys 60% (3/5) M1 Select Answer to see Preferred Response PREFERRED RESPONSE 5