Adult polycystic kidney disease

　　Evidence has indicated that the occurrence of cysts is due to the structural defects in the collecting ducts, renal tubules, and their connecting parts during the developmental process. An excretory duct with a blind end connected to a functional glomerulus becomes a cyst. When these cysts grow larger, they compress the adjacent renal parenchyma, causing local ischemia and damaging its function, blocking the normal renal tubules, and ultimately leading to progressive renal dysfunction.

　　1、肾盂肾炎：是多囊肾的常见并发症，其原因尚不明了。可以不出现症状，尿中脓细胞很少甚至没有。涂片染色或定量培养可作出诊断。枸橼酸镓-67扫描摄影术可确定感染的部位包括脓肿的位置。

　　2What complications can adult polycystic kidney disease lead to?

　　1. Pyelonephritis:It is a common complication of polycystic kidney disease, and the cause is not yet clear. It may not show any symptoms, and there may be few or no pus cells in the urine. Smear staining or quantitative culture can be used for diagnosis. Citrate gallium-67 scanning photography can determine the location of infection including the location of abscesses.

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　　How should adult polycystic kidney disease be prevented?

　　5The need for laboratory tests for adult polycystic kidney disease

　　1. Laboratory examination: What kind of examination should be done for adult polycystic kidney disease?2. X-ray examination: Anemia can not only be caused by chronic hemorrhage, but more often it is due to the inhibition of hematopoietic function caused by uremia. Urinalysis can show proteinuria and gross or microscopic hematuria, pus and bacteriuria are also common. The function of urine concentration gradually decreases, and the renal clearance test can show various degrees of kidney function damage. About 1/3 of polycystic kidney disease patients are discovered with uremia.

　　3. CT scan: In the abdominal flat film, the bilateral renal shadows are usually enlarged, even up to 5 times the normal size. When the kidney length exceeds 16cm, this disease should be suspected. Tomography during excretory venography is helpful to establish the diagnosis. Tomography can show transparent multiple cysts. In the tomography and retrograde urinary tract imaging, the kidneys are often enlarged while the calyces have very strange shapes (such as spider-like deformities): the calyces are widened, flattened, expanded, and often bent around the adjacent cysts. This change is often milder on one side of the kidney or even does not occur, thus it is easy to misdiagnose as a tumor or other kidney disease. When the cysts are complicated by infection, perinephritis can make the renal shadow and even the lumbar plexus shadow blurred. Angiography can show the small curved blood vessels around the cysts and the 'negative' shadow formed by the cysts themselves (without blood distribution).In the non-invasive diagnostic techniques used in the past to diagnose polycystic kidney disease, CT is the most ideal, with thin cyst walls filled with cyst fluid and kidneys that are relatively larger than normal, making this imaging method extremely precise in diagnosis (95%).

　　4. Renal Radionuclide Examination:γ-Scintigraphy will show many avascular 'cold spots' in the enlarged renal shadow.

　　5. Ultrasound Examination:Ultrasound imaging is superior to excretory urography and renal radionuclide imaging for the diagnosis of polycystic kidney disease.

　　6. Instrumental Examination:Cystoscopy can detect cystitis, at which time the urine contains abnormal substances, and sometimes blood from the ureteral orifice can be seen. Ureteral catheterization and retrograde urinary tract imaging are rarely used.

　　What kind of food is good for adult polycystic kidney disease patients to eat:

　　1. Fruits and vegetables high in vitamins.

　　2. Fruits and vegetables rich in iron, such as carrots.

　　3. Vegetables containing calcium-precipitating substances, such as black fungus.

　　4. Diuretic foods.

　　5. Alkaline foods are also beneficial, and can play a role in auxiliary treatment.

　　Conservative and supportive therapy can be adopted unless there are uncommon complications.

　　1. General Measures:Patients need a low-protein diet (protein intake of 0.5-0.75/kg/d), and they must drink at least 3000ml of fluid every day. Physical labor should be performed within their limits, and剧烈的运动 should be prohibited. When patients are in the decompensated stage of kidney insufficiency, they should be treated for uremia. At this time, hypertension should be controlled, and remark dialysis can be performed.

　　2. Surgery:There is no evidence to show that removing the cyst or reducing the pressure on the cyst can improve kidney function. If a large cyst is found to compress the upper ureter, causing obstruction and further damage to kidney function, it can be removed or the internal cyst fluid can be aspirated. When the degree of kidney insufficiency is life-threatening, dialysis treatment or kidney transplantation should be considered.

　　3. Treatment of Complications:Pyelonephritis should be treated strictly to prevent further damage to kidney function. Incision and drainage should be performed when cyst infection occurs. When the bleeding on one side of the kidney is severe and extremely dangerous, nephrectomy or renal artery embolization can be performed, or segmental artery embolization can be done. Associated diseases (such as tumors, obstructive stones) all require surgical treatment.