Table 2. Polycystic kidney disorders with possible prenatal onset.
ARPKD | ADPKD | HNF1B -related disease | NPHP | TSC2-PKD1 microdeletion | |
---|---|---|---|---|---|
Prevalence | 1:20,000 | 1:500–1:1,000 | Not known | 1:50,000–1:1,000,000 | Not known |
Gene(s) | PKHD1 |
PKD1
,
PKD2
GANAB , DNAJB11 |
HNF1B , deletion 17q12 | NPHP1 , INVS , NPHP3 , NPHP4 , IQCB1 , CEP290 , GLIS2 , NEK8 , TMEM67 , TTC21B a , WDR19 , ZNF423 a , CEP164 , ANKS6 , CEP83 , DCDC2 , MAPKBP1 | TSC2 , PKD1 |
Inheritance | AR | AD | AD | AR, AD a | AD |
Typical renal ultrasonography findings 19 |
Bilaterally enlarged kidneys with heterogeneous parenchymal echogenicity with a salt-and-pepper pattern
b
Other forms of the renal sonographic phenotype are possible: kidney size may range from normal to massively enlarged, hyperechogenicity can be limited by the medulla or diffuse, and cysts can appear as ductal dilatation or as macrocysts of variable size, number, and localization Prenatal US : large hyperechogenic kidneys and oligohydramnios in severe cases |
Multiple cortical and medullary cysts. Number of cysts increase with age Possible prenatal presentation with subtle cortical hyperechogenicity and renal enlargement |
Variable findings: uni- or bilateral cysts, hypo- or dysplasia, agenesis, or normal kidney imaging The most common cause of kidney hyperechogenicity at prenatal US and of kidney cysts in older children Can mimic ARPKD and other cystic nephropathies |
Nonspecific Juvenile NPHP: usually normal-sized or small kidneys and bilaterally increased echogenicity. Cysts are not mandatory for diagnosis. Cysts at the corticomedullary junction are suggestive for NPHP Infantile NPHP : usually enlarged kidneys with cortical microcysts |
Kidney phenotype with numerous bilateral large cysts (>2.5 cm) that appear early in life, replace the renal parenchyma, and lead to kidney enlargement |
Systemic hypertension | Severe, drug resistant in the first months of life | Before 15 years of life in early manifestation of ADPKD | No data | Not clinically relevant until late stage of the disease | No data |
Hepatic fibrosis | 100% | Rare | No | As extrarenal manifestation | No |
Liver enzymes | Within normal ranges with the exception of GGTP which might be elevated | No data | Elevated | No data | No data |
Median age of ESRD onset | 1–2 decade of life |
58.1 y (
PKD1
)
79.9 y ( PKD2 ) |
No data | Significant cause of ESRD <25 y | No data |
Extrarenal findings | Sporadically: intracranial or extracranial aneurysms, pancreatic cysts | Polycystic liver disease, pancreatic cysts, seminal vesicle cysts, arachnoid membrane cysts, intra-/extracranial aneurysms, abnormalities of the aorta and cardiac valves, colonic diverticulosis | Abnormalities of the genital tract (vaginal and uterine anomalies), pancreatic anomalies (atrophy, partial agenesis), endocrine/exocrine insufficiency, hypomagnesemia, increase liver enzymes | A broad spectrum of celiopathy-related extrarenal signs may occur (10–20% of patients) | Signs of tuberous sclerosis (e.g., cardiac rhabdomyoma in fetus, hypomelanotic macules, subependymal nodules) |
Abbreviations: AD, autosomal dominant inheritance; AR, autosomal recessive inheritance; ARPKD, autosomal recessive polycystic kidney disease; NPHP, nephronophthisis; PKD, polycystic kidney disease; US, ultrasound.
Nephronophthisis-related genes with possible autosomal dominant inheritance.
Salt-and-pepper pattern is typical for ARPKD but may also be seen in other ciliopathies. 20