K FAULL 1, J SCHROERS 1, S MAY 1
1Tamworth Rural Referral Hospital, HNELHD, NSW Australia,
Background:There are many extra-renal manifestations in Autosomal Dominant Polycystic Kidney Disease (ADPCKD). Pleural effusion has been described in ADPCKD patients but is not a well-recognised
Case Report: We report the case of a 47 year old female with ADPCKD with extensive kidney and liver cysts who developed a large left sided pleural effusion two months prior to starting haemodialysis. She had no evidence of fluid overload, cardiac failure or liver failure. Aspiration revealed protein 35 gm/L, lactate dehydrogenase 149 u /L, BSL 5.7 mmol/L, cholesterol 1.2 mmol/L and serum protein was 67g/L. This was reported as equivocal for exudate versus transudate. Infection was excluded and cytology showed reactive mesothelial cells. A pleural biopsy was negative for malignancy. Two years later, she underwent a left nephrectomy for anorexia secondary to massive kidney enlargement. Four years following the left nephrectomy her left pleural effusion recurred. The effusion was refractory to multiple aspirations, eventually requiring decortication and talc pleurodesis. Renal transplant was performed 11 years after the initial pleural effusion and there has been no further recurrence
Conclusion: This case demonstrates an idiopathic pleural effusion in a patient with ADPCKD who had extensive liver and kidney cysts. Case studies of pleural effusions in patients with ADPCKD are usually right sided and left sided effusions are rare. Recurrence after left nephrectomy implies that the cause is less likely to be kidney related but possibly due to another ADPCKD aetiology.
Kaylise Faull is a junior doctor at Tamworth Rural Referral Hospital. She studied at the University of Newcastle, graduating with a Bachelor of Medicine with Distinction in 2020.