Diagnosis of polycystic kidney disease

The need for further in-depth search for criteria for reliable diagnosis is dictated by the similarity of many known clinical and diagnostic signs of this disease with other kidney diseases. Despite the appearance of new high-quality medical equipment, the diagnosis of polycystic kidneys is complex and often proves to be too late, and because of diagnostic errors in polycystic kidneys, although rarely, perform unjustified surgical interventions.

Diagnosis of polycystic kidney is based on an anamnesis, which necessarily includes the study of the genealogical line, which often allows us to establish the hereditary nature of the diseases.

When examining patients, you should pay attention to dryness and some jaundice of the skin, scrapes due to itching. When palpating the abdominal cavity, the kidneys are felt in the form of large, dense, tuberous formations. Sometimes polycystic soils swell so much out of the sub-stems that the mot can be determined visually. In the study of urine show:

• hypoisostenuria (relative density of urine from 1.005 to 1.010), which indicates a lesion of the tubular apparatus of the kidneys;
• proteinuria (not higher than 1 g / l):
• leukocyturia, indicating the attachment of a urinary infection.

Blood test often reveals hypochromic anemia, with pyelonephritis - a moderate non-atrophilic leukocytosis with a shift of the leukocyte formula to the left. To assess the functional state of polycystic kidneys, the concentration of urea and creatinine in the blood serum is determined, urine analysis is performed according to Zimnitsky, the Reberg test.

A decisive role in the diagnosis of polycystic kidney is played by X-ray methods of investigation. On the survey radiographs, it is possible to detect vertical localization of both kidneys, more medial and lower location of their shadows, and insignificant mobility of the kidneys. Significantly more clearly these signs are revealed against a background of prescapal retro-pneumoperitoneum, but at the present time it practically has lost its diagnostic value, since ultrasound, CT and MRI allow to clearly define this anomaly.

Excretory urography allows to obtain valuable data in the initial stages of the disease. Since polycystosis is accompanied by a decrease in kidney function, it is advisable to carry out its infusion modification. ON. Lopatkin and A.V. Lyulko (1987) identified three radiographic signs:

• change in the shape of the kidneys (low location, increase in length and width, uneven contour);
• change in the pelvis and calyxes (deformation of the axes of large and small cups, their semicircle, spherical and kolbovidnoe change, narrowing and elongation of necks, elongation and displacement of the pelvis);
• changes in the vascular system of the kidneys (narrowing of large arterial trunks and a decrease in the number of small arteries, the presence of different-caliber avascular fields).

To this we should add that in the polycystic case the number of calyces has always been increased-hyperramy, compression, elongation, displacement and lowering of the pelvis. LMS is usually displaced in the medial direction, and the pelvis has an intracellular location.

In addition, to clarify the diagnosis of polycystic kidney apply radionuclide research methods, ultrasound scanning, CT. On the rheograms performed in patients with polycystosis, N.A. Lopatkin, Yu.Ya. And E.B. Mazo (1977) identified three options:

• bilateral slowing of secretion and evacuation;
• primary lesion of one kidney with a preserved function;
• the damage to the tubular apparatus is one and the absence of the function of the second polycystic kidney, which is observed with a severe form of polycystosis. When there is atrophy of the parenchyma of one of the kidneys due to compression by her cysts.

As a rule, these patients have a different degree of renal insufficiency. Renography serves as an orienting test, since it does not even indirectly answer the question of the number of functioning parenchyma. Dynamic scintigraphy replenishes the listed disadvantages of renography.

Ultrasound can diagnose polycystic kidney disease in a large number of echo-negative zones. In the early stage of polycystic kidney ultrasonography reveals their increase. If this developmental defect is progressing, cysts of various size and shape are usually found in the kidney parenchyma. Absolutely reliable diagnosis of polycystic kidney by CT. Sometimes renal angiography is necessary to clarify the diagnosis. In polycystic kidneys on angiograms (especially important parenchymal phase), saturation defects are determined, kidney vessels are narrowed, the number of small arteries is reduced. Determine the field without vessels, corresponding to the cysts.

[1], [2], [3], [4], [5]