Photo Quiz 7

What is this finding in a case of CKD? How will you manage this condition?

Answer:

1. This is an aneurysm in the AV Fistula which was made for hemodialysis. You can see the scar of the surgery in the typical site of a radiocephalic fistula. True aneurysms occur very commonly in native fistulas and generally cause no problems. Surgical intervention is required only if the aneurysms compromises the arterial anastomosis or shows rapid expansion raising a danger of dissection or rupture.
2. The reported incidence of this complication is around 5-6%.
3. Procedures which have been described in treating this condition are:

•  Surgical excision of the aneurysm with restoration of the continuity of the artery.
• Stapling across the aneurysm.
• Excising the excess wall and preserving the fistula.
• Excising the aneurysm and creating a new AVF

The last 2 procedures keeps the AVF intact.

Photo Quiz 6

What is this NCCT finding in a patient with recurrent UTI since childhood and CKD? What are the other associated renal anomalies that can be seen in this condition?

Answer:

1. NCCT KUB films showing a atrophic left kidney (A) with a calculi in the upper pole, and duplex right kidney with partial duplication of the right ureter till the upper third (D) with hydroureteronephrosis.
2. Associated anomalies seen are renal dysplasia, ureteral obstruction, VUR, ectopic ureter and ureterocele. Complete double ureters are commonly associated with vesicoureteral reflux due to their ectopic opening into the urinary bladder or the ureterocele

Weekly Photo quiz 5

This 23 year old male patient with a very strong family history of renal disease, What is this finding? What is the abnormality in this condition? Waht are the inheritance patterns?

Answer:
1. This is a finding seen in a case with keratoconus. Known as MUNSONs sign, it is observed as a indentation in the lower eyelid produced by the keratoconus when the patient looks downwards.
2. The basic diagnosis is Alport syndrome.
3. Most common inheritence pattern of Alport syndrome is X-linked. However, there are autosomal recessive and Autosomal dominant forms as well.