PAIN IN RIGHT FLANK IN A CASE OF ADPKD

A 35 year old gentleman came with ADPKD came with right flank pain and feeling of heaviness on right side.

On evaluation he had accelerated hyperetension of 180/110 mm Hg ; he was a known case of hypertension on Losar -H.

Cardiological evaluation was done and his ECHO/ ECG were grossly normal and the cardiologist added him on extra antihypertensives for control of the blood pressure.

His CECT revealed rt lower ureteric calculi and bilateral renal calculi of 6-8 mm.He had a cyst in right upper pole of the kidney about 7 cm and there was upper polar caliectasis on CT Urolography.

We took him up for URS and LASER LITHOTRIPSY and cleared the ureteric calculi.Then we did RGP to find out the cause for right upper polar caliectasis. There was apparently no cause. We attributed it to extrinsic pressure by the upper polar cyst of the ADPKD.

We did stenting with upper end into the upper calyx and planning to monitor him for hypertension and flank pain.If the pain persists and BP remain high on multidrug regime then we are planning to laparoscopic deroofing of the upper polar cyst to ease pressure on the upper calyceal infundibulum.