DISCUSSION

Adult or autosomal dominant polycystic kidney disease (ADPKD) has an incidence of between 1 in 500 and 1 in 1,000. ADPKD remains an important cause of renal failure, accounting for 10% to 15% of patients who receive hemodialysis. Most cases of ADPKD are identified between the ages of 30 and 50 years and are associated with cysts of the liver, spleen, and lungs and berry aneurysms of the Circle of Willis. The two genes thought to be responsible for ADPKD are PKD1 and PKD2, found on chromosomes 16 and 4, respectively. 2 Pre-existing renal pathological disease is thought to increase the risk of renal injury secondary to abdominal trauma. This theory was postulated by Nation and Massey in 1963 after their review of 258 cases of renal trauma. 2, 3 Their explanation being that the gross pyelographic distortion produced by diseased or abnormal kidneys increases the risk of injury after all types of trauma. Injury to polycystic kidneys after trauma is rare. Large series looking specifically at blunt renal trauma have reported only four cases of injury to polycystic kidneys. Of those four cases, three required open exploration with two cases requiring nephrectomy. 4–6 A case report by Leslie et al. 3 cites the first documented case of bilateral polycystic kidney rupture, which was treated with open exploration. At laparotomy, a large multicystic mass was detected in the left flank. The cyst wall had ruptured and was bleeding from its inferior pole. The cyst wall was rapidly oversewn and hemostasis was achieved. Postoperatively, however, the patient became hypotensive and on further open exploration, bilaterally ruptured and bleeding cysts were found, necessitating bilateral nephrectomy. Our case demonstrates that the effective use of selective embolization in a patient who has active bleeding from a traumatized polycystic kidney, prevented the need for open exploration and probable nephrectomy.