A 31-year-old man comes to the physician because of a 1-week history of flank pain and blood in his urine. Three weeks ago, he was treated for a urinary tract infection. He has a 6-month history of hypertension treated with enalapril. His father died at the age of 43 years of a subarachnoid hemorrhage from a ruptured cerebral aneurysm. He is 180 cm (5 ft 11 in) tall and weighs 105 kg (231 lb); BMI is 32 kg/m2. Temperature is 36.7°C (98°F), pulse is 80/min, and blood pressure is 132/85 mm Hg. Physical examination shows no abnormalities. CT scan of the abdomen with contrast is shown below. Which of the following is the most likely diagnosis?

Question

A 31-year-old man comes to the physician because of a 1-week history of flank pain and blood in his urine. Three weeks ago, he was treated for a urinary tract infection. He has a 6-month history of hypertension treated with enalapril. His father died at the age of 43 years of a subarachnoid hemorrhage from a ruptured cerebral aneurysm. He is 180 cm (5 ft 11 in) tall and weighs 105 kg (231 lb); BMI is 32 kg/m2. Temperature is 36.7°C (98°F), pulse is 80/min, and blood pressure is 132/85 mm Hg. Physical examination shows no abnormalities. CT scan of the abdomen with contrast is shown below.  Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

Eductional Objective: Autosomal dominant (adult) polycystic kidney disease is caused by mutations in the polycystin genes (PKD1, PKD2), which result in cystic enlargement of the kidneys and progressive renal dysfunction.  Clinical features include hypertension, abdominal/flank pain, and gross hematuria; extrarenal manifestations include liver cysts and intracranial aneurysms

A 31-Year-Old Man Comes to the Physician Because of a 1-Week