Sandbox: DDx Kidney mass

• 30 yo patients
• Abdominal, flank, or back pain
• Hematuria, hypertenstion, intracranial hemorrhage
• ESRD at age 60

• Progressive decrease in GFR
• Elevated creatinine and BUN

• Multiple bilateral renal cysts on U/S
• Anechoic with well-defined imperceptible walls

• Palpable, bilateral flank masses
• Nodular hepatomegaly

• Fluid filled saccular expansions of glomerular capsule and renal tubule
• Located in the cortex and medulla
• Lined by cuboidal epithelium
• Disconnection of the glomerular capsule
• Polyps and papillary projections
• Areas of tubular atrophy, interstitial fibrosis, and global sclerosis are present between cyst

• PKD1 gene at chromosome 16
• PKD2 gene at chromosome 4

Nonmalignant causes

acquired cystic kidney disease  cystic renal dysplasia glomerulocystic kidney medullary sponge kidney mesothelial cysts nephronophthisis simple cysts