Acquired cystic kidney disease

Abstract

A 34-year-old black sales manager was referred for evaluation of azotemia of undetermined duration. He claimed to be in good health except for borderline hypertension since age 25. He had no history of urinary tract signs or symptoms. A tumor of unspecified type had been removed from the left anterior chest wall 8 years previously; there had been no recurrence. A younger sister was a hemodialysis patient in another city; the cause of her renal failure was unknown to the patient. The family history included no deafness, hematuria, proteinuria, or renal cysts. The supine blood pressure was 160/100 mm Hg in both arms. The fundi were normal. His hearing acuity was judged to be intact. The left pectoralis major muscle had been removed surgically. Cardiovascular examination was normal. The abdomen was soft and nontender, and no masses were detected by palpation. Genital and rectal examinations were normal. The urine was negative for protein by dipstick examination. The urine sediment revealed 5 to 10 erythrocytes/high-power field and contained no casts or lipid bodies. The hemoglobin level was 13.4 g/dl and the hematocrit was 37.6%. The white blood cell and platelet counts were normal. Serum electrolyte levels were within normal limits. The serum creatinine concentration was 3.4 mg/dl; serum urea nitrogen, 45 mg/dl; serum calcium, 9,0 mg/dl; phosphate, 3.3 mg/dl; serum urate, 11.6 mg/dl; and alkaline phosphatase, 95 lU/liter. Total urinary protein excretion was 48 mg/24 hours. The creatinine clearance was 35 mI/mm. A renal scan with mTcDPTA showed prompt and symmetric flow to both kidneys; the excretion of '311-Hippuran was symmetric and slightly delayed; a furosemide washout test disclosed no evidence of obstruction. Ultrasound examination revealed kidneys of normal size