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  #1  
Old 04-22-2011
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Kidney IV pyelogram in a case of back pain

A 38-year-old man with chronic migraine, 6 months history of worsening of back pain, hematuria, anorexia and malaise. He was found to have hypertension. IVP is shown below. Which of the following is most likely associated with the patient’s clinical findings?



A. Adult polycystic kidney disease
B. Amyloidosis
C. Renal cell carcinoma
D. Drug
E. Homocystinuria
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  #2  
Old 04-22-2011
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no doubt about this. answer is A. and to add, if a ct scan is done, one can almost definitely observe a berry/saccular aneurysm of the anterior communicating artery of the circle of Willis.
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Old 04-22-2011
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I think C is the right answer........


@seetal ......can u xplain ur ans....bcoz in APKD kidneys are enlarged bilaterally ..........back pain and brain symptoms can be due to metastasis and anorexia and malaise due to loss of appetite which is due to release of TNF by the tumor.......hypertension due to the growth compressing the vessels causing ischemia and therefore release of renin........
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Old 04-22-2011
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i think it is A.....

there are also cystic cavities with air fluid levels in both the kidneys....but i am not able to explain anorexia which favors carcinoma....again the age of the patient is against the carcinoma.....
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Old 04-22-2011
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I think it is C,
as hematuria - buzz for kidney tumor,
A is excluded as is not bilateral.
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Old 04-23-2011
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All,

It looks like A and C are popular answers.

Please look at the imaging again paying more attention on the right side-renal pelvis!

No worries if you still don't get it! I got it wrong and so I like to share with you all. Answer on the way!

BTW-this is not from NBME!!!!!
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Old 04-23-2011
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Quote:
Originally Posted by 1TA2B View Post
All,

It looks like A and C are popular answers.

Please look at the imaging again paying more attention on the right side-renal pelvis!

No worries if you still don't get it! I got it wrong and so I like to share with you all. Answer on the way!

BTW-this is not from NBME!!!!!

i still think its A.. because both kidneys look lobulated to me. renal cell carcinoma is not bilateral and more calcified picture than bilateral...... y cant i see renal cell carcinoma as an option??
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Old 04-23-2011
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another guess - D;
if patient has tumor somewhere else and taking treatment...
back pain-meta, malaise, anorexia - all paraneoplastic symptoms.
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  #9  
Old 04-23-2011
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is it possible to enlarge the image somewhat?

It is a pyelogram and not an XRay so those probably arent renal cysts...but I am still a little confused about the options, but if it was the exam and i wasnt being penalised I would go for C
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Old 04-24-2011
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hang on.... could this be APKD tht progressed on to renal cell carcinoma seeing tht the signs of anorexia etc point to RCC but his IVP to me is APKD!!!

whats the answer? this is killing me!!
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  #11  
Old 04-24-2011
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Default Retroperitoneal fibrosis related to ergotamine

The IVP shows right hydronephrosis (can be bilateral) due to ureteral compression; note how the ureter is tapered and characteristically drawn medially by the fibrotic process.

This characteristic medial deviation of the ureter at the L4–L5 vertebral level is a classic radiographic picture of retroperitoneal fibrosis. Given a likely drug associated with this condition, ergotamine for the treatment of migraine this diagnosis is the most likely cause of RPF!

Here we go!!!!
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Old 04-24-2011
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dat was really a tough call.....
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  #13  
Old 04-24-2011
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Quote:
Originally Posted by 1TA2B View Post
The IVP shows right hydronephrosis (can be bilateral) due to ureteral compression; note how the ureter is tapered and characteristically drawn medially by the fibrotic process.

This characteristic medial deviation of the ureter at the L4–L5 vertebral level is a classic radiographic picture of retroperitoneal fibrosis. Given a likely drug associated with this condition, ergotamine for the treatment of migraine this diagnosis is the most likely cause of RPF!

Here we go!!!!
wow good one....The IVP picture of RPF is characteristic as you say... but the association with Migraine and its treatment would not have struck me

I was going for ureteral compression due to tumor
thanks...
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