Bilateral intrarenal pain

Introduction Bilateral intrarenal pain is one of the clinical manifestations of adult polycystic kidney disease. Adult polycystic kidney disease is an autosomal dominant hereditary disease, almost all of which is bilateral (95% of the total number of cases). Although it has been reported in the literature that infants have adult polycystic kidney disease, the disease occurs in infants different from adults. Infant polycystic kidney disease is an autosomal recessive hereditary disease, which prevents short survival. Adult polycystic kidney disease usually does not show symptoms before the age of 40, and multiple cysts of the same shape can be seen in the liver, spleen and pancreas. The polycystic kidney volume is larger than the normal kidney, and its surface is covered with cysts of different sizes.

Cause

Evidence suggests that the occurrence of cysts is due to the structure of the junction between the collection tube and the renal tubules and between them, which is defective during development. A blind end drain tube is connected to a functional glomerulus and becomes a cyst. As these cysts enlarge, they oppress the adjacent renal parenchyma, causing ischemia, destroying their function and occluding normal renal tubules, eventually leading to progressive damage to renal function.

an examination

Related inspection

Renal angiography retroperitoneal angiography

(1) hydronephrosis (caused by congenital disorders or acquired ureteral obstruction): bilateral flank abdominal mass and renal function impairment may occur. However, pyelography and ultrasonography will show that these manifestations are significantly different from polycystic kidney disease.

(2) bilateral renal tumors: this disease is rare, but it is very imaginable with polycystic kidney in urography. When the kidney of one side of the polycystic kidney is small or the urography is not showing distortion, it is difficult to distinguish it from one side of the kidney tumor. But the tumor is often confined to a certain part of the kidney, while the cyst of the polycystic kidney is filled with the entire kidney. Unilateral renal tumors may have normal renal function, while polycystic kidneys often have impaired total renal function. CT or renal angiography can be used to identify both diseases. Scintillation scanning or ultrasonography also helps in differential diagnosis.

(3) Von Hippel-Lindau disease (cerebellar hemangioma cyst, retinal angiomatosis and pancreatic tumor or cyst): multiple cysts or adenocarcinomas of the kidney can progress progressively. Urinary angiography or renal tomography can show polycystic kidney disease, which can be diagnosed according to other characteristic manifestations. CT, angiography, ultrasound imaging or scintigraphy can determine the diagnosis.

(4) Nodular sclerosis (paroxysmal convulsions, mental retardation and sebaceous adenoma): Sebaceous adenomas often involve the skin, brain, retina, bones, liver, heart and kidneys. Kidney lesions are usually multiple bilateral, and angiolipoma can be seen under the microscope. Urinary tract urography during uremia is easy to suggest cystic kidney. Other characteristic manifestations and CT and ultrasound images can be identified.

(5) simple renal cyst: usually single-sided single, normal renal function. Urography can be shown as a single lesion, while polycystic kidney disease is bilateral and multiple lesions.

Differential diagnosis

It needs to be distinguished from the following symptoms:

Diffuse renal disease: Diffuse renal disease is a manifestation of kidney damage caused by various kidney diseases. It is usually caused by infectious diseases such as urinary tract infection.

Dull pain in the kidney area: dull pain in the kidney area is another common symptom of kidney cancer. Most of them are dull pain, which is limited to the waist. The pain is often caused by the swelling of the tumor and the kidney capsule is inflated. The blood clot can also cause low back pain through the ureter. The tumor is heavier and persistent when it invades the surrounding organs and the psoas.

Renal tenderness: The angle between the lateral edge of the erector spinae and the 12th rib is called the kidney area. Nephritis or kidney stones can cause tenderness in this area.

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