NEPHRECTOMY IN AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE

A 50 year gentleman a known case of ADPKD came with abdominal distension, pain and  respiratory distress because of mas effect from the phenomenally large  kidneys.He was end stage renal disease on maintenance dialysis. 

He was referred to our centre for nephrectomy of a symptomatic kidney.The patient was considered for open nephrectomy as we thought laparoscopic nephrectomy would be difficult for want of space in the abdomen.The other option of renal angioembolisation was also not preferred for the fear of postinfarction sequel  and there was a consensus that the removal of renal mass would only be the best relief for distension and the respiratory distress because of the mass.

The both kidneys were 28 cm (left) and 22 cm( right ) respectively.He was symptomatic on the right side so we preferred for right nephrectomy.

The rooftop incision was given and the colon was reflected .The right kidney was huge and was crossing the midline over the great vessels.The lower part of the kidney was solid ( haemorrhagic cyst).The kidney was mobilised all around and the hilum was secured and renal mass was removed.

We went for marsupialisation also on left side for two prominent cysts at the same time( around 6 cm each two cysts).

The incision was closed with a drain in situ after achieving haemostasis. The patient is recovering uneventfully and has been put on haemodialytic therapy.