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Symptoms of polycystic kidney disease
Last reviewed: 04.07.2025
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Polycystic kidney disease has various symptoms. They depend on the patient's age, the number and size of cysts, and the integrity of the organ parenchyma. The most common symptoms of polycystic kidney disease are pain in the lumbar and epigastric region, cardiovascular disorders, macrohematuria, palpable enlarged kidneys, thirst, polyuria, and other symptoms of renal failure.
Pain in the lumbar region appears relatively early in 40-70% of cases, and with age it is noted in 90% of patients. In the vast majority of patients it is of an inconstant, intermittent nature. The intensity of pain depends on the degree of disturbance of urodynamics and microcirculation in the kidney and on the severity of pyelonephritis.
Pain in the epigastric region occurs from the pressure of enlarged kidneys on the intra-abdominal organs and from the tension of the renal ligamentous apparatus. Dyspeptic disorders combined with pain are often mistaken for acute gastrointestinal diseases, which sometimes serves as a reason for unjustified urgent laparotomy. Cardiovascular disorders are manifested by pain in the heart, headache, dizziness. In 70-75% of patients with polycystic kidney disease, symptomatic arterial hypertension with high diastolic blood pressure (over 110 mm Hg) is observed, that is, in most patients, arterial hypertension is malignant.
The degree of hypertension depends on ischemia of the renal tissue as a result of compression of the renal parenchyma by cysts, which leads to its atrophy and increased intrarenal pressure. In addition, developing pyelonephritis with subsequent asymmetric replacement of the renal parenchyma with connective tissue aggravates renal dysfunction. In 70-75% of patients, retinopathy is determined during examination of the fundus.
Thirst and polyuria are observed as symptoms of chronic renal failure of various stages. In hot weather, patients with polycystic kidney disease drink up to 3-4 liters of liquid and excrete up to 2-2.5 liters per day. Thirst and polyuria characterize impaired concentration capacity of the kidneys.
Macrohematuria as a symptom of polycystic kidney disease is detected in 30-50% of patients, it is often short-term, total and, as a rule, is not accompanied by life-threatening anemia of the body. The source of bleeding is most often the fornices, in which congestive processes develop, leading to papillitis. In most patients, macrohematuria can be eliminated by anti-inflammatory therapy, hemostatic drugs, and rest. In rare cases, with significant hematuria, it is necessary to perform surgical intervention.
Kidneys with polycystic disease are enlarged in 70-80% of patients, who often palpate the enlarged kidneys themselves. Mobile polycystic kidneys are often encountered, which are easily palpated through the anterior abdominal wall, have a lumpy, sometimes painful, surface.
[ Complications of polycystic kidney disease
Complications of polycystic kidney disease are very diverse and numerous, often leading to death. A.V. Lyulko et al. (1978) identified the following groups of complications: urological, neurological, nephrogenic hypertension. Urological complications include pyelonephritis, urolithiasis, suppuration of cysts, hemorrhages in their cavities, and others. In addition, polycystic kidneys can be affected by neoplasms and tuberculosis.
The addition of pyelonephritis to polycystic kidney disease causes the addition of arterial hypertension, severe renal failure, significantly accelerating their occurrence. Neurological complications include intracerebral hemorrhages as a result of high hypertension. Convulsions occur with hypocalcemia. Intoxication caused by a violation of nitrogen metabolism affects the metabolism of nerve cells. Hypertension is a constant companion of polycystic kidney disease in the decompensation stage.
In the clinical course of polycystic disease, several periods are distinguished. I.M. Talman (1934), E. Bell (1950), M.D. Javad-Zade (1975) distinguish 5 stages, N.A. Lopatkin and A.V. Lyulko (1987) in their classification - 3 stages: compensated, or subclinical; subcompensated; decompensated, or uremic.
The compensated, or subclinical, stage is characterized by a slow, latent course, slight dull pain in the lumbar region; in most patients, blood pressure does not increase, and the functional capacity of the kidneys is slightly reduced.
The subcompensated stage is characterized by such symptoms of polycystic kidney disease as thirst, headaches, rapid fatigue of patients, dry mouth, nausea. Blood pressure increases, work capacity decreases. All these phenomena are associated with developing renal failure.
In the decompensated stage of the disease, the symptoms of polycystic kidney disease and subcompensation are more pronounced and severe. All patients are disabled. The functional state of the kidneys is sharply depressed, their filtration and concentration capacity is impaired; the concentration of urea and creatinine in the blood serum increases significantly. In most patients, hypertension takes a malignant form, and persistent anemia appears.