A 68-year-old woman with uremia and "renal salt wasting" improved greatly with sodium repletion. Several family members had died of renal failure. Multiple, bilateral corticomedullary cysts were seen on high-dose excretory urography with nephrotomography. A 67-year-old brother with normal urinalysis and creatinine clearance values also showed corticomedullary cysts on excretory urography. Despite long-term sodium supplementation, uremia progressed inexorably and death occurred 3 1/4 years after clinical onset of disease. Cystic disease of the renal medulla was confirmed at time of autopsy. The triad of a positive family history, renal salt wasting, and progressive chronic uremia strongly suggests the diagnosis of cystic disease of the renal medulla, irrespective of the age of the patient.
(JAMA 228:1401-1404, 1974)
Swenson RS, Kempson RL, Friedland GW. Cystic Disease of the Renal Medulla in the Elderly. JAMA. 1974;228(11):1401–1404. doi:10.1001/jama.1974.03230360031019