One of my patients, a former high-school baseball coach, has autosomal dominant polycystic kidney disease (ADPKD), as do some of his siblings and various other members of his extended family. I had been treating both Coach and the extended family for years and just figured that they realized they had the gene for ADPKD and never really thought much more about it.
One day, a student of mine was doing a history and physical examination on Coach, and the student started asking about Coach’s original diagnosis and how he found out he had ADPKD.
Coach described being on the first-base line one day when he felt an incredible pain in his back. He turned around to yell at the teenager who had just beaned him with a ball, but there was no one there. The kids insisted that they had not hit him with a ball, or a bat, or anything. But Coach had been teaching teenagers for too many years to take the denial at face value.
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The next day, Coach was urinating blood. As you can imagine, he went to the emergency department (ED) immediately. The ED staff noted Coach’s hypertension but just ignored it because Coach was so mad at the kids.
Since Coach described trauma, an ultrasound of the kidneys was done. The radiology tech said, “Oh, it must just be one of your cysts that burst and that is why you are urinating blood.” Coach looked at the tech like the tech had two heads. But that is how the family found out that they carried the gene for ADPKD, and how Coach found out that teenagers do not always lie. (192-2)
Kim Zuber, PA-C, oversees patients in seven dialysis centers for Metropolitan Nephrology Associates, based in Clinton, Md.
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