S TAN1, T GREEN1, R JUNEJA1, J GLEADLE1,2
1Department of Nephrology, Flinders Medical Centre, Adelaide, Australia, 2College of Medicine & Public Health, Flinders University, Adelaide, Australia
Background: We describe a rare case of extensive lower limb deep venous thrombosis (DVT) secondary to compression of the common iliac vein by a large renal cyst in a patient with autosomal dominant polycystic kidney disease (ADPKD).
Case Report: A 41-year-old haemodialysis patient with ADPKD presented with a subacute history of progressive left leg swelling. Ultrasound demonstrated DVT above and below the knee and extending into the external iliac vein. A computed tomography (CT) scan confirmed that a dominant renal cyst was compressing the left common iliac vein, likely causing stasis and subsequent development of thrombus. Management included placement of an inferior vena cava (IVC) filter to prevent proximal embolization of the thrombus before he underwent a nephrectomy to relieve the compression. Surveillance imaging showed new IVC compression by the remaining kidney and he underwent a right nephrectomy to prevent further thrombus formation
Conclusions: This case describes an uncommon complication of ADPKD necessitating bilateral nephrectomies and emphasises the rare but important effects of large volume polycystic kidneys with implications for ongoing management and transplantation.
Sarah is a second year renal registrar at Flinders Medical Centre.