Question: A 37-year-old female presents to her family physician with recurring abdominal and flank pain. She mentions her mother suffered from kidney problems but doesn’t know many details. Examination reveals a blood pressure of 170 / 110 mmHg and proteinuria is present on dipstick. Laboratory tests show an elevated hematocrit, microalbuminuria, and microscopic hematuria. A CT scan later reveals the findings seen here. Which of the following conditions is most commonly associated with this patient’s likely diagnosis?
A. Cerebral aneurysm
B. Abdominal aortic aneurysm
C. Renal cell carcinoma
D. Ovarian cyst
Details: The answer is a cerebral aneurysm. This patient’s presentation and imaging findings are indicative of autosomal dominant polycystic kidney disease (ADPKD)—a multisystemic genetic disorder characterized by the formation and enlargement of cysts in the kidney and other organs. Approximately 20% of older adults with the condition are at risk for a cerebral aneurysm, one of the major extrarenal manifestations of polycystic kidney disease and the most serious complication. Those at greatest risk have a family history of intracranial aneurysm or subarachnoid hemorrhage, and therefore screening may be recommended in these patients.
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