Figure 920

Autosomal-dominant polycystic kidney disease (ADPKD): kidney involvement. Examples of various cystic involvements of kidneys in ADPKD. Degree of involvement depends on age at presentation and disease severity. A, With advanced disease as in this 54-year-old woman, renal parenchyma is almost completely replaced by innumerable cysts. Note also the cystic involvement of the liver. B, Marked asymmetry in the number and size of cysts between the two kidneys may be observed, as in this 36-year-old woman. In the early stage of the disease, making the diagnosis may be more difficult (see Fig. 9-28 for the minimal sonographic criteria to make a diagnosis of ADPKD in PKD1 families). C, D, Contrast-enhanced CT is more sensitive than ultrasonography in the detection of small cysts. The presence of liver cysts helps to establish the diagnosis, as in this 38-year-old man with PKD2 disease and mild kidney involvement.

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