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Phys Clinical Casesrenal

Phys Clinical Cases · renal

Polycystic Kidney Disease (ADPKD) — DCE Clinical Case

DCE short-case station: the abdominal examination in ADPKD — bilateral ballotable renal masses, cystic hepatomegaly, hernias, blood pressure and hypertensive fundi — with presentation template and probing questions.

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Target exams

FRACP DCEMRCP Part 2
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Target exams

FRACP DCEMRCP Part 2
Prompt
DCE short-case station: the abdominal examination in ADPKD — bilateral ballotable renal masses, cystic hepatomegaly, hernias, blood pressure and hypertensive fundi — with presentation template and probing questions.

Approach — what the examiner is testing

This station is not "palpate an abdomen". It tests whether you can find bilateral renal masses correctly, stage their consequences, and survey the extrarenal disease — then synthesise rather than list. The ballotable kidney is a vanishingly rare sign in modern medicine and ADPKD is its classic source, so examiners watch your ballottement technique closely [7].

Before touching the patient: blood pressure measured properly, both arms, after rest — hypertension is the earliest manifestation of ADPKD and the most modifiable driver of progression, so measuring it yourself is part of the examination, not an afterthought [2].

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References7ShowHide
  1. [1]Pei Y, Obaji J, Dupuis A, et al. Unified criteria for ultrasonographic diagnosis of ADPKD J Am Soc Nephrol, 2009.PMID 18945943
  2. [2]Schrier RW, Abebe KZ, Perrone RD, et al. Blood pressure in early autosomal dominant polycystic kidney disease N Engl J Med, 2014.PMID 25399733
  3. [3]Irazabal MV, Huston J 3rd, Kubly V, et al. Extended follow-up of unruptured intracranial aneurysms detected by presymptomatic screening in patients with autosomal dominant polycystic kidney disease Clin J Am Soc Nephrol, 2011.PMID 21551026
  4. [4]Hossack KF, Leddy CL, Johnson AM, et al. Echocardiographic findings in autosomal dominant polycystic kidney disease N Engl J Med, 1988.PMID 3419455
  5. [5]Lederman ED, McCoy G, Conti DJ, et al. Diverticulitis and polycystic kidney disease Am Surg, 2000.PMID 10695753
  6. [6]Kidney Disease: Improving Global Outcomes (KDIGO) ADPKD Work Group KDIGO 2025 Clinical Practice Guideline for the Evaluation, Management, and Treatment of Autosomal Dominant Polycystic Kidney Disease (ADPKD) Kidney Int, 2025.PMID 39848759
  7. [7]Ong AC, Devuyst O, Knebelmann B, et al. Autosomal dominant polycystic kidney disease: the changing face of clinical management Lancet, 2015.PMID 26090645
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