FIGURE 1.

Genetic predisposition to CKD in the elderly. Kidney sonography of an 85-year-old male who had been diagnosed with primary hypertension and CKD due to hypertensive nephropathy at the ages of 74 and 77 years, respectively. Sonography at age 81 years showed multiple bilateral renal cysts and enlarged kidneys without parameters for polycystic kidney disease. At age 85 years, the sonography shown in the image was reviewed by a second radiologist, with evidence of polycystic kidney disease. The final diagnosis was a primary nephropathy (polycystic kidney disease) with secondary hypertension and was incorporated into the patient's records at age 88 years. This case illustrates the potential misdiagnosis of primary hypertension in patients with hypertension secondary to kidney disease, especially at early CKD stages when renal function is relatively well preserved, as well as the potential for genetic kidney disease to lead to advanced CKD in the ninth decade of life and the fact that physicians do not think of hereditary kidney disease at this age even when imaging provides the diagnosis.