A newborn undergoes an abdominal ultrasound that shows kidneys of normal size, structure, and location. The patient does not appear to be in distress and physical examination reveals no abnormalities. If this patient were to be diagnosed with renal disease later in life, it would most likely be which of the following?

Question

A newborn undergoes an abdominal ultrasound that shows kidneys of normal size, structure, and location.  The patient does not appear to be in distress and physical examination reveals no abnormalities.  If this patient were to be diagnosed with renal disease later in life, it would most likely be which of the following?

Quizplus · Accepted Answer

11ec160b_3a41_9395_9249_4b0e03efd4ea_MD0001_00 Autosomal dominant polycystic kidney disease (ADPKD), like many autosomal dominant diseases, manifests later in life. Microscopic cysts are present at birth but are too small to be detected by abdominal ultrasound. Over the years, the cysts enlarge, compression of the renal parenchyma occurs, and patients become symptomatic. (Choice A) Autosomal recessive polycystic kidney disease (ARPKD) presents at birth or during the first year of life with bilateral flank masses. Cysts are formed by dilated distal tubules and collecting ducts. Abdominal ultrasonography demonstrates enlarged kidneys at birth and also shows cysts if they are >1 cm in diameter. (Choice C) Multicystic kidney dysplasia is characterized by the presence of multiple cysts of varying size in the kidney and the absence of a normal pelvocaliceal system. The condition is associated with ureteral or ureteropelvic atresia, with the affected kidney essentially rendered nonfunctional. Abdominal ultrasound of the fetus or newborn is diagnostic. (Choice D) The abnormal fusion of kidneys at their poles (usually, the lower poles) is called horseshoe kidney. The isthmus of renal tissue is anterior to the great vessels and is easily detected on abdominal ultrasound. (Choice E) A number of fetal renal abnormalities (eg, bilateral renal agenesis, ARPKD) can cause a decrease in fetal urine production and oligohydramnios. The combination of abnormalities that ensues, called Potter syndrome, includes pulmonary hypoplasia, Potter facies (flattened nose, recessed chin, prominent epicanthal folds, and low-set ears), limb defects, and cardiovascular abnormalities. Renal defects that lead to Potter syndrome are usually profound and would be easily seen on ultrasound. Educational objective: Autosomal dominant polycystic kidney disease manifests in patients 40-50 years old with enlarged kidneys, hypertension, and renal failure. In newborns, the kidneys are of normal size, and the cysts are too small to be detected on abdominal ultrasonography. As the cysts enlarge, they compress the renal parenchyma and cause symptoms. __________ References: Polycystic kidney disease: inheritance, pathophysiology, prognosis, and treatment. (http://www.ncbi.nlm.nih.gov/pubmed/21694932)

A Newborn Undergoes an Abdominal Ultrasound That Shows Kidneys of Normal