Clinical Presentation and Outcomes of Autosomal Dominant Polycystic Kidney Disease in the Elderly

Abstract

The patient characteristics and outcomes associated with autosomal dominant polycystic kidney disease (ADPKD) have not been characterized in elderly population. The purpose of theis study was to delineate clinical presentation and outcome of ADPKD in elderly patients. We performed a retrospective study. Thirty four elderly patients were diagnosed with ADPKD between 1975 and 2005. The diagnosis of ADPKD was made using family history and ultrasound. There were 21 (61.7%) males and 13 (38.3%) females. The mean age at the time of diagnosis of ADPKD was 69.74 ± 3.36 years (range, 65-79 years). The earliest clinical features were renal failure in 67.6%, back pain in 38.2%, and hypertension in 17.6%. Most common form of presentation was hypertension in 70.6%. Kidneys were palpable in 26.5%, and liver was palpable in 32.4%. Left ventricular hypertrophy confirmed by transthoracic echocardiography was found in 5(1.5%) patients. Three (0.8%) patients had colonic diverticula and two (0.6%) had neurological manifestation. Twenty six 26 patients (76.5%) patients had end stage renal disease and 30 patients (88.23 %) patients had anemia. Median follow-up period for all patients was 17.9 months (range, 1-120 months). Two (0.6%) patients developed renal carcinoma while five patients (14.7%) died within six years following diagnosis Anemia was the strongest and an independent predictor of poor renal outcome. (p<0.03). The diagnosis of ADPKD in elderly patients was made late in most cases, with patients already at end stage renal disease. Anemia is risk factor of poor renal prognosis. Eearly diagnosis and efforts at prevention of the disease progression and complications are most essential.

Clinical presentation and outcome of autosomal dominant polycystic kidney disease in Nigeria

“…Helal et al reported uraemia among their subjects at presentation. 20 This may also account for the absence of polycythaemia (commonly associated with cystic production of erythropoietin) in our subjects. Hypertension was highly prevalent in this study.…”

“…18 The occurrence of liver cysts (attributed to oestrogen-induced cystic expansion and multiplication) was higher among females in this study as previously reported by other authors. 17,20,26 Cardiac valve anomalies: In our study, aortic regurgitation (AR) was the only cardiac anomaly detected by echocardiogram. The prevalence was higher than 8% and 19% reported earlier.…”

“…25 We found that 31.7% of our subjects had polycystic liver which is similar to 31.9% and 32.4% reported previously. 17,20 A lower incidence of 10.4% was reported by Alves et al in Brazil among elderly subjects. 18 The occurrence of liver cysts (attributed to oestrogen-induced cystic expansion and multiplication) was higher among females in this study as previously reported by other authors.…”

Study of some physiological parameters in patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD)

“…The elevated serum levels of uric acid or called hyperuricemia are common in patients with kidney disease or in those receiving maintenance dialysis therapies. Higher serum uric acid levels are associated with earlier onset of hypertension, larger kidney volume and increased hazard for ESRD in patients with ADPKD [17]. Figure (3) was showed normal levels of serum creatinine in the ADPKD patients without renal failure.…”