Med Surg Case Study #22: Polycystic Kidney Disease

Kevin Smith | 35 years old

Chief Complaint: Kevin presents with abdominal fullness and flank pain.

Medical History:

• Hypertension

• Family history of polycystic kidney disease (PKD)

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0800

Nurse's Note: Kevin complains of abdominal fullness and intermittent flank pain. He reports a family history of PKD. Abdominal examination reveals bilateral palpable masses consistent with enlarged kidneys.

Vital Signs:

• Blood pressure: 150/95 mmHg

• Heart rate: 80 bpm

• Respiratory rate: 18 breaths/min

• Temperature: 98.4°F (36.9°C)

Provider Orders:

• Perform renal ultrasound.

• Administer analgesics as needed for pain relief.

• Order complete blood count (CBC) and renal function tests.

1030

Nurse's Note: Kevin’s renal ultrasound confirms the presence of multiple cysts in both kidneys consistent with PKD. He experiences worsening flank pain.

Vital Signs

• Blood pressure: 160/100 mmHg

• Heart rate: 85 bpm

• Respiratory rate: 20 breaths/min

• Temperature: 98.6°F (37°C)

Provider Orders:

• Initiate antihypertensive therapy with lisinopril 10 mg orally daily.

• Provide education on dietary sodium restriction.

• Order urine analysis and culture to assess for urinary tract infection (UTI).

1345

Nurse's Note: Kevin reports dysuria and urgency. Urine analysis indicates presence of leukocytes and bacteria consistent with UTI. He continues to experience flank pain despite analgesic administration.

Vital Signs:

• Blood pressure: 150/90 mmHg

• Heart rate: 90 bpm

• Respiratory rate: 16 breaths/min

• Temperature: 99.0°F (37.2°C)
  

Provider Orders:

• Prescribe antibiotic therapy with ciprofloxacin 500 mg orally twice daily for 7 days.

• Increase analgesic dose to manage pain.

• Schedule follow-up appointment with nephrologist for further management.

Question 1: What are the common clinical manifestations of polycystic kidney disease (PKD)?

Question 2: Why is antihypertensive therapy initiated in patients with PKD?

Question 3: What is the rationale behind ordering urine analysis and culture in this case?

Answers to Questions Below

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Answers

Question 1: What are the common clinical manifestations of polycystic kidney disease (PKD)?

Common manifestations include abdominal fullness, flank pain, hematuria, polyuria, hypertension, renal calculi formation, and urinary tract infections (UTIs) due to cyst compression and obstruction of the urinary tract.

Question 2: Why is antihypertensive therapy initiated in patients with PKD?

Antihypertensive therapy is initiated to control blood pressure and reduce the risk of further kidney damage. Hypertension is a common complication of PKD and contributes to progression of renal dysfunction.

Question 3: What is the rationale behind ordering urine analysis and culture in this case?

Urine analysis and culture are ordered to assess for urinary tract infections (UTIs), which are common complications of PKD due to urinary stasis caused by cyst compression. Prompt detection and treatment of UTIs are essential to prevent worsening of symptoms and potential kidney damage.

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