Colonic Diverticulitis and Polycystic Kidney Disease: Common Diseases with an Atypical but Critical Relationship

Background:

Polycystic kidney disease (PKD) is a common genetically linked renal disorder affecting one in 1000 people in the USA. Colonic Diverticular disease occurs in twenty percent of the population and the majority of acute diverticulitis is treated in the inpatient setting. Studies have shown an increased incidence of diverticulitis in patients with PKD. However, the association between PKD and colonic diverticulitis is not well known to hospitalists. Colonic diverticular disease may be considered an extrarenal manifestation of PKD.

Case report:

A fifty‐five year old African‐American man with a history of PKD, bilateral nephrectomy, on immunosuppressive therapy for a right pelvic renal transplant eight years earlier was admitted to the hospital with a one week history of abdominal pain and three days of nausea, vomiting and fever. On physical exam, he had diffuse rebound abdominal tenderness. Labs showed leukocytosis, mild prerenal azotemia and normal urine analysis. An ultrasound of the transplanted pelvic kidney showed no stones, hydronephrosis or masses. CT of the abdomen and pelvis revealed multiple diverticula throughout the colon with stranding of pericolonic fat adjacent to the descending colon reflecting acute diverticulitis. He was treated conservatively with intravenous fluids and antibiotics. Surgical consultation was obtained and the patient was discharged home in three days.

Discussion:

Literature reviews suggest that 83% of patients with chronic renal failure and PKD had diverticulosis compared with 32% of patients with chronic renal failure without PKD. Patients with renal transplant with polycystic kidney disease have a significantly higher rate of complicated diverticulitis compared to other transplant patients. Patients with PKD also have more complicated diverticulitis and perforations. Complicated diverticulitis is unrelated to immunosupression. The evaluation of PKD patients with or without renal transplant with abdominal pain remains challenging due to confounding variables. These include hemorrhage into renal cysts, pyelonephritis, transplant rejection and varying presentations of classic diverticulitis due to immunosupression. A delay in the diagnosis and management of diverticulitis in patients with PKD with or without transplant may increase morbidity and mortality. Early surgical consultation and intervention is critical to avoid complications of diverticulitis.

Conclusion:

Hospitalists need to be aware of the relationship between PKD and colonic diverticular disease and its higher rate of complications. A high index of clinical suspicion is warranted for diverticulitis in patients with PKD who present with abdominal pain irrespective of their age and other risk factors for diverticular disease. Early screening for diverticuli warrants further research in the patients with PKD.

Author Disclosure Block:

H.Q. Rana, None; N. Enyinna, None; A. Chaaya, None; V. Rajput, None.