Skill Checkup: A 41-Year-Old Man With New-Onset Abdominal and Flank Pain

Vecihi Batuman, MD

Disclosures

February 02, 2023

Under the Mayo imaging classification (MIC) system, ADPKD may be categorized as typical (MIC 1) and atypical (MIC 2). Typical or MIC 1 disease is defined as bilateral and diffuse renal cystic disease, as seen in this patient. MIC 1 is further divided into five subcategories (MIC 1A through 1E) that predict the rate of kidney volume growth by adjusting HtTKV to age. Patients with MIC 1C, 1D, or 1E are considered at risk for rapid progression (though there is debate on how to treat MIC 1C). Among such patients, the prediction is that eGFR decline is ≥ 2.5 mL/min/1.73 m2 per year, and mean age of ESKD onset is ≤ 54 years.

In contrast, atypical or MIC 2 disease is defined by either unilateral, focal, asymmetric cystic involvement (MIC 2A) or bilateral cystic involvement with kidney atrophy (MIC 2B) but does not put a patient at risk for rapid progression.

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