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POLYCYSTIC KIDNEYS

What are Polycystic Kidneys ?

The two kidneys are situated in the back of the abdomen. They remove waste products and excess water from blood to make urine. The urine then passes down the ureter on each side into the bladder. Polycystic kidneys occur as an inherited condition in which cysts form in both kidneys. As time goes on, more and more cysts form. They become larger and larger. As this happens, the function of the kidneys gets worse. The first symptoms are usually pain in the loins or abdomen, due to bleeding into the cysts. Blood may be seen in the urine. Sometimes the large kidneys are found by accident, when a person has an operation for another reason. In other patients the polycystic kidneys may be found when tests are being done to find the cause of raised blood pressure or kidney failure. Chronic kidney failure does eventually occur in many patients. Then the patient will need treatment with an artificial kidney (haemodialysis) OR peritoneal dialysis.

How do Polycystic Kidneys occur ?

The condition is usually inherited from one parent and runs in families. If someone has polycystic kidneys, there is a 50% chance of children getting it. Similarly, 50% of brothers and sisters are likely to have it too. If a child does not inherit the gene for polycystic kidneys and is therefore normal, then his or her children will not get the condition. Rarely, polycystic kidneys may occur in someone with no family history of this problem. A mutation (new gene) is likely to have appeared in that person. Although all people who inherit the gene will get polycystic kidneys, the age at which kidney failure develops varies from 35 years upwards. Some patients never develop it. It is not known what makes some patients more likely to get kidney failure than others.

Treatment Involved for Polycystic Kidneys

The diagnosis is confirmed by an ultrasound test of the kidneys. The equipment for this is like a radar system, using sound waves. The image produced shows the size of the kidneys and the individual cysts. These may not start forming until the age of 20 years. Polycystic kidneys cannot be ruled out before then. Once the diagnosis has been made, you will usually be seen once or twice each year for a blood pressure check and a blood test. Often, blood pressure rises many years before the kidneys start to lose their function. It is important that any high blood pressure which results from this condition is brought down to normal. This may help to delay the start of kidney failure. Once kidney failure occurs, it will require careful management. Bleeding into, or infection of, cysts can occur at any time. This shows up as pain in the side or blood in the urine. Fevers develop if there is infection in any of the cysts. If bleeding occurs, it is sensible to rest and not do any active exercise. If bleeding is severe, blood transfusion will be necessary. Rarely, the bleeding does not stop and the kidney concerned will have to be removed. Infection of the cysts can be quite difficult to treat. If given by mouth, antibiotics do not pass readily into the cysts themselves. They are therefore best given by injection into a vein. This means that a stay in hospital is required. Patients with polycystic kidneys often have cysts in the liver as well. These usually cause no problems, and do not affect the function of the liver. They can get infected, but less commonly than with kidney cysts. Infection of liver cysts usually requires antibiotic treatment for a few weeks.

During Treatment for Polycystic Kidneys

Blood pressure and kidney function are the two most important things for you to watch. Report any blood in the urine, pain in the side or fever to the doctor immediately. Regular blood pressure checks are essential, whether you are taking tablets for this or not. Symptoms of kidney failure include nausea, fatigue and loss of appetite. When this happens, the tell your doctor. He may need to plan for artificial kidney treatment. Later, transplantation of a kidney may well be required.

If Polycystic Kidneys are Left Untreated

If raised blood pressure is not picked up or properly treated, kidney failure may get worse more quickly. There is also a bigger risk of getting a stroke or a heart attack. If the start of kidney failure is not picked up early enough, illness may develop so quickly that urgent dialysis is needed. This increases the various risks from the procedure and creates unnecessary stress.

Effects on Family of Polycystic Kidneys

Since this is an inherited condition, any brothers or sisters may be at risk and should be given the benefit of screening. Any of your offspring are also at risk. Screening is best done after the age of 20 years, since cysts may not appear until then. The best screening test is a kidney ultrasound. The diagnosis can now be made in early pregnancy when abortion might be considered. However, it must be remembered that kidney failure does not occur until late in life. Furthermore, the quality of life on dialysis or with a transplant can be very good. The decision whether to have children or not is therefore a personal one. You will need to carefully discuss this with your doctor. For a woman with polycystic kidneys, there is no increased risk in having a baby, provided that kidney function and blood pressure are quite normal.