Polycystic Kidney Disease (with transplant)

 

Aim to answer:

• Identify transplant

• Aetiology of underlying cause for transplant

• Adequacy of graft function

• Complications from transplant/immunosuppression

 

Thank you for asking me to examine Harry who presented with abdominal fullness.

 

My salient findings were bilateral enlarged kidneys suggestive of polycystic kidney disease. This was associated with evidence of a renal transplantation.

 

I will now present my findings in full:

 

On general inspection, Harry appeared comfortable. He did / did not have a Cushingoid appearance.

 

On inspection of the abdomen, there was a ____ cm scar in the right iliac fossa / left iliac fossa, with a smooth, firm non-tender mass underneath and overlying dullness to percussion, suggestive of a previous renal transplant. There was / was no bruit suggestive of stenosis in the allograft.

 

On further inspection, there was / was not obvious distension with striae. There was/was no scar suggestive of a previous nephrectomy. There was / was not a scar from a previous Tenchkoff catheter.

 

On further palpation, there were bilateral palpable masses in the subcostal areas. There were palpable upper edges, they moved inferiorly on inspiration, and there was overlying resonance on percussion, and hence I believe these are consistent with bilateral enlarged polycystic kidneys. They were non-tender.

 

There was/was not associated hepatomegaly with an estimated liver span of ____ on percussion. It was non-tender and had a smooth / irregular /cystic edge. OR I could not appreciate hepatomegaly in the setting of the enlarged cystic kidneys.

 

On percussion, there was / was not shifting dullness, suggesting ascites.

 

Bowel sounds were normal / absent. There was / was not a renal bruit.

 

My further examination was targeted towards the adequacy of the renal transplant, any complications from the transplant and treatment, and any other contributing aetiologies to the initial renal disease.

• There was / was not evidence of previous dialysis dependence with a non-functioning fistula, Tenchkoff catheter, or central venous access. There was/was not an active thrill and bruit.

• In the hands, there were / were not Terry’s nails in the hands. There was / was not palmar crease pallor and small muscle wasting. There were/were not fingertip pin pricks from diabetic testing. There were/were not any vasculitic rashes.

• There were/were not scratch marks, suggestive of uraemia.

• The blood pressure was ____.

• On examination of the face, there was/was not conjunctival pallor. There were/were not any hearing aids (Alports).

• On cardiorespiratory examination, the JVP was _____ above the sternal notch with normal waveforms. There were/were not vesicular breath sounds and peripheral oedema. There was/was not a pericardial rub. There was/was not evidence of extra-renal valvular disease associated with PKD.

• There was/was not gout in the legs, or peripheral neuropathy.

 

In terms of complications of immunosuppression from the renal transplant:

• There was / was not signs of steroid complications, such as a Cushingoid appearance, bruising, skin atrophy, cataracts, or proximal myopathy. 

• There was no tremor, rash or gum hypertrophy from calcineurin inhibitors, or evidence of diabetes.

• There were/were not skin malignancies.

 

In summary, Harry presented with abdominal fullness. My findings are a functioning renal transplant secondary to polycystic kidney disease with nil current uraemic symptoms or fluid overload, or complications of immunosuppression.

 

I would proceed from here by:

• Confirming the diagnosis

• Assessing the adequacy of renal function

• Assessing for complications