A MOTHER TO
THE RESCUE

Bilateral Nephrectomy saves 48-year-old man
suffering from Chronic kidney disease

Polycystic Kidney Disease (PKD) are inherited diseases that cause an irreversible decline in kidney function. Polycystic Kidney Disease may be inherited as an autosomal dominant or recessive trait. The Autosomal Dominant form (ADPKD) is the most common genetic cause of Chronic Kidney Disease (CKD). Majority of the individuals with Polycystic Kidney Disease eventually require Renal Replacement Therapy.

Patients with Autosomal Dominant Polycystic Kidney Disease are usually present with Hypertension, Hematuria, Renal insufficiency or Flank pain

attributable to Renal Haemorrhage, Calculi, or Urinary Tract Infection. Patients may also be present with symptoms that are secondary to cysts in other organs such as the liver or pancreas. Renal function usually remains normal until the fourth decade. Thereafter, Glomerular Filtration Rate (GFR) declines on an average by 4.4 to 5.9 ml/min per year.

Promising specific therapies include vasopressin receptor antagonists (tolvaptan) and increasing fluid intake to suppress plasma vasopressin levels. Early usage of pravastatin in the paediatric Autosomal Dominant

Polycystic Kidney Disease population may slow the progression of the disease. Patients with Autosomal Dominant Polycystic Kidney Disease and Renal Failure are most commonly treated with Hemodialysis or undergo Renal Transplantation.

A 48-year-old man suffering from Chronic Kidney Disease (CKD V) Hypertension, due to Autosomal Dominant Polycystic Kidney Disease, was admitted to Nanavati Super Speciality Hospital with high-grade fever, chills and serum creatinine of 14mg%. He was diagnosed with cyst infection and was initiated on dialysis for uremia. He was treated for cyst infection for 14 days with antibiotics but had a recurrent infection. He was then counselled about Renal Transplant, the best form of treatment for his case. In view of persistently infected cyst


"The high requirement of anti-hypertensives to control the patient's blood pressure in pre, intra, and post operations made his case a rare and critical scenario. However, excellent post operative recovery encourages us to take such challenging cases in future."

in kidney bilaterally, he underwent Bilateral Nephrectomy. Each kidney was 36 cm in length. Post-operative, his anti hypertensive requirement increased to 3 times and he was put on 6 different types of anti hypertensives with a total of 24 pills per day for BP control. His 72-year-old mother came forward as the donor after a full work up. Considering the donor’s age, the Urology and Nephrology team was extremely cautious.

The recipient was taken to the operation theatre with on-flow NTG to control blood pressure which later was tapered and stopped. Intra-operative, Basiliximab was used for induction

and Tacrolimus MMF/Steroids for maintenance. Post-operation, the patient’s anti-hypertension requirement decreased to 10% and creatinine on follow up was 1 mg%. Both the donor and recipient were fine after the surgery.

Though Bilateral Nephrectomy is rare nowadays in Autosomal Dominant Polycystic Kidney Disease, however, in this case, the patient underwent Bilateral Nephrectomy for recurrent cyst infection and mega size of the kidney. His anti-hypertensive requirement was increased to 3 times. He also required NTG infusion to control blood pressure in pre, intra, and post operations, along with 24 pills per 24 hours. Till his last follow up after Renal Transplant, his blood pressure medicine requirement reduced to 10%, with normal renal function. Mega anti-hypertensive requirement makes this case a rare scenario and excellent post-operative recovery encourages us to take such challenging cases in the future.