Polycystic kidney disease

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Polycystic kidney disease

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nida
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Topics: 23
Posts: 87

07/16/06 - 01:49 PM

Harrison's Q

A clinic patient who has a diagnosis of polycystic kidney disease has been doing research on the Internet. She is asymptomatic and has no significant family history. She asks you for screening for intracranial aneurysms. You recommend which of the following?
A. Head CT scan without contrast
B. CT angiogram
C. Cerebral angiogram
D. Magnetic resonance angiogram
E. No further testing

cyra
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Topics: 29
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07/16/06 - 02:52 PM

I am thinking E here...not sure.

drk1980
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07/16/06 - 02:58 PM

since she has diagnosed APKD and has made this trip to the office....i'd gv her a CT angiogram

msyamp
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07/16/06 - 03:07 PM

E

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som
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07/16/06 - 07:58 PM

B? or D?

docofthebigapple
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07/16/06 - 08:55 PM

We have to pick a test suitable for screening. I think A. CT head without contrast can be a good choice for screening for this case. However i am doubtful of the sensitivity of CT to pick up an aneurism before a catastrophic incidence. It is cheaper than the rest of the tests and is the only Non-invasive test in choices here.

However MRA would be my test of choice to detect an aneurysm at the earliest. It is the most sensitive.

I go with D.

MAZI
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07/17/06 - 09:58 AM

frank100
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07/17/06 - 12:05 PM

(E), according to kaplan, there are anly three diseases preventable by screening test (that have been proven to work) 1.breast ca, 2.colon ca, and 3.cervix ca.

other screening tests have not proven to be affective. (including prostate)!

sorry if i´m wrong.

drk1980
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07/18/06 - 03:27 PM

JASN article and its views on Intracerebral Aneurysms in teh ADPKD population

In patients with a positive family history (documented ruptured ICA or stroke before age 50 yr), we explain the risks of harboring an unruptured ICA, as well as the benefits and risks of screening:
>in case of negative screening, reassurance but also the risk of missing a tiny ICA
>in case of positive screening, periodic surveillance of a small ICA or arteriography followed by appropriate treatment of ICA >10 mm in diameter.

Patients without family history of ICA are not screened, except the rare individuals who firmly request it.

On the Imaging choice:
When current MR and helical CT angiography techniques are used, a skilled neuroradiologist can detect virtually all ICA measuring 5mm dia or more and even some as small as 2mm. MR angiography is the most convenient test and carries essentially no risk, because it does not require intravascular administration of contrast material. We may conclude that MR angiography is currently the first-choice screening test for ICA.

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