Polycystic Kidney Disease

 

Welcome to PT 635 Pathophysiology of Complex Patient Problems This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors - Emily Hartman from Bellarmine University's Pathophysiology of Complex Patient Problems project.

Lead Editors - Your name will be added here if you are a lead editor on this page.  Read more.

Definition/Description

Polycystic Kidney Disease (PKD) is a genetic kidney disease which causes large benign cysts to form on the kidneys. The cysts are fluid filled cavities (seen in Figure 1) that can ultimately impede kidney function leading to degeneration of renal tissue and renal failure.   Cysts can range anywhere from microscopic in size to several centimeters in diameter.   A cyst begins as a protrusion of the nephron and can occur anywhere along its length.   Most cysts detach from the nephron, and eventually enlarge and fill with either clear fluid or fluid that contains blood or white blood cells.

There are two types of PKD; autosomal dominant and autosomal recessive. Autosomal dominant PKD, or ADPKD, is the most common form of PKD and typically manifests itself in middle aged adults while autosomal recessive PKD is less common and typically manifests itself in childhood. Autosomal recessive PKD is the more serious form and often leads to death in infancy or early childhood.   For a person to inherit ADPKD, it takes a mutated gene from only one parent, while it takes a mutated gene from both parents for a person to inherit ARPKD (see Figures 2 and 3).

Prevalence

ADPKD affects approximately 600,000 Americans; however, the number could actually be higher as many adults who have PKD do not yet exhibit symptoms.   Each child born to a parent with the gene for ADPKD has a 50% chance of inheriting the disease.   Approximately 10% of those in end stage renal failure have ADPKD.

Characteristics/Clinical Presentation

People with ADPKD may not know they have the disease because their symptoms have not yet manifested themselves. ADPKD signs and symptoms typically begin to show themselves between the ages of 30 and 40.

Symptoms/Signs for PKD include:
• high blood pressure
• back or side pain related to enlarged kidneys
• headache
• increase in the size of the abdomen due to enlarged kidneys ( see Figures 4 and 5)
• blood or protein in the urine
• frequent urination
• kidney stones
• kidney failure
• urinary tract or kidney infections

Symptoms that are also associated with PKD include:
• drowsiness
• joint pain
• nail abnormalities
• painful menstruation

Associated Co-morbidities

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Medications

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Diagnostic Tests/Lab Tests/Lab Values

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Etiology/Causes

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Systemic Involvement

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Medical Management (current best evidence)

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Physical Therapy Management (current best evidence)

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Alternative/Holistic Management (current best evidence)

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Differential Diagnosis

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Case Reports/ Case Studies

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Resources

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Recent Related Research (from Pubmed)

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References

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1. Goodman CC, Fuller KS, Boissonnault WG. Pathology: implications for the physical therapist. 2nd ed. Philadelphia, PA: Saunders; 1998.

2. PKD Foundation. The Science of PKD. http://www.pkdcure.org/tabid/1354/Default.aspx (accessed 5 March 2011).

3. National Center for Biotechnology Information, U.S. National Library of Medicine. Polycystic kidney disease. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001531 (accessed 5 March 2011).

4. National Kidney Foundation. Polycystic Kidney Disease. http://www.kidney.org/atoz/content/polycystic.cfm (accessed 5 March 2011).

5. Mayo Clinic. Polycystic kidney disease. http://www.mayoclinic.com/health/polycystic-kidney-disease/DS00245/DSECTION=symptoms (accessed 5 March 2011).

6. Mayo Clinic. Acetaminophen (Oral Route, Rectal Route). http://www.mayoclinic.com/health/drug-information/DR601885 (accessed 5 March 2011).

7. Pechter U, Ots M, Maaroos J, et al. Beneficial effects of water-based exercise in patients with chronic kidney disease. International Journal of Rehabilitation Research [serial online]. June 2003;26(2):153-156. Available from: CINAHL with Full Text, Ipswich, MA. Accessed March 5, 2011.

8. Heiwe S, Clyne N, Tollbäck A, Borg K. Effects of Regular Resistance Training on Muscle Histopathology and Morphometry in Elderly Patients With Chronic Kidney Disease. American Journal of Physical Medicine & Rehabilitation [serial online]. November 2005;84(11):865-874. Available from: Academic Search Premier, Ipswich, MA. Accessed March 5, 2011.

9. Torkington M, MacRae M, Isles C. Uptake of and adherence to exercise during hospital haemodialysis. Physiotherapy [serial online]. June 2006;92(2):83-87. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed March 5, 2011.

10. Wrong Diagnosis. Causes of Blood in urine. http://www.wrongdiagnosis.com/symptoms/blood_in_urine/causes.htm (accessed 5 March 2011).

11. Goodman CC, Snyder TE. Differential Diagnosis for physical therapists: screening for referral. 4th ed. St. Louis, MO: Saunders Elsevier; 2000.