A Case of Acquired Cystic Kidney Disease From Chronic Renal Failure Without Dialysis

The kidneys play a vital role in maintaining homeostasis by filtering the blood of waste products and toxins, maintaining a delicate balance of fluids and electrolytes, and closely regulating blood pressure via the juxtaglomerular apparatus. Cystic kidney disease is a pathology of the kidneys that can be either acquired or congenital. This case report introduces a seventy-eight-year-old male with a medical history of a myocardial infarction and heart valve replacements who presented to the emergency department due to a recent fall at home unrelated to syncope. As he rose from his chair, the patient fell forward but was able to pick himself up from the ground. Upon further review, lab work revealed end-stage renal disease with a creatinine of 19.7 mg/dL (reference range: 0.6-1.2 mg/dL) and blood urea nitrogen of 186 mg/dL (reference range: 7-18 mg/dL). Potassium was 5.2 mmol/L (reference range: 3.5-5.1 mmol/L) and the electrocardiogram showed normal sinus rhythm. Urinalysis showed proteinuria of 100 mg/dL with high white blood cells 28/High-power field and red blood cells (RBCs) 3/HPF but no bacteria. Trace blood and leukocyte esterase were also noted. Microscopic analysis was significant only for epithelial cells 1/HPF. The patient also had symptomatic anemia with a hemoglobin of 6.4 g/dL, which contributed to his symptoms on presentation. Computed tomography of the abdomen and pelvis without intravenous or per oral contrast revealed numerous bilateral renal parenchymal cysts. After receiving two units of packed RBCs for severe anemia, he underwent several dialysis treatments during his stay. The patient denied a family history of polycystic kidney disease, though he had a deceased sister with unspecified "kidney problems." Acquired cystic kidney disease (ACKD) before dialysis is a rare phenomenon that prompts a careful history, physical exam, and diagnostic evaluation to avoid misdiagnosis and improper treatment. Although rare and not cited often in the literature, ACKD should be entertained in the differential diagnosis of this presentation.