Polycystic kidney disease medical therapy: Difference between revisions
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{{Polycystic kidney disease}} | {{Polycystic kidney disease}} | ||
{{CMG}} {{AE}} | {{CMG}}; {{AE}} {{MKA}} | ||
==Overview== | ==Overview== | ||
Patients with polycystic kidney disease are treated with [[lisinopril]] or [[telmisartan]] for control of [[hypertension]], [[tolvaptan]] for slowing disease progression, [[hydration]], [[analgesia]] and [[bed rest]]. The treatment is targeted more towards managing symptoms and disease complications rather than slowing [[cyst]] formation. | |||
== | ==Medical Therapy== | ||
*Patients with polycystic kidney disease are treated with [[lisinopril]] or [[telmisartan]] for control of [[hypertension]], [[tolvaptan]] for slowing disease progression, [[hydration]], [[analgesia]] and [[bed rest]]. The treatment is targeted more towards managing symptoms and disease complications rather than slowing [[cyst]] formation.<ref name="pmid18832246">{{cite journal| author=Grantham JJ| title=Clinical practice. Autosomal dominant polycystic kidney disease. | journal=N Engl J Med | year= 2008 | volume= 359 | issue= 14 | pages= 1477-85 | pmid=18832246 | doi=10.1056/NEJMcp0804458 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18832246 }} </ref> | |||
=== | ===Polycystic kidney disease=== | ||
=== | * 1 '''Hypertension''' | ||
** 1.1 '''Adult''' | |||
===Pain=== | *** Preferred regimen (1): [[Lisinopril]] 5-10 mg PO q24h '''(Maximum dose 40mg in 24h)'''<ref name="pmid19696226">{{cite journal |vauthors=Schrier RW |title=Renal volume, renin-angiotensin-aldosterone system, hypertension, and left ventricular hypertrophy in patients with autosomal dominant polycystic kidney disease |journal=J. Am. Soc. Nephrol. |volume=20 |issue=9 |pages=1888–93 |date=September 2009 |pmid=19696226 |doi=10.1681/ASN.2008080882 |url=}}</ref><ref name="pmid253997332">{{cite journal |vauthors=Schrier RW, Abebe KZ, Perrone RD, Torres VE, Braun WE, Steinman TI, Winklhofer FT, Brosnahan G, Czarnecki PG, Hogan MC, Miskulin DC, Rahbari-Oskoui FF, Grantham JJ, Harris PC, Flessner MF, Bae KT, Moore CG, Chapman AB |title=Blood pressure in early autosomal dominant polycystic kidney disease |journal=N. Engl. J. Med. |volume=371 |issue=24 |pages=2255–66 |date=December 2014 |pmid=25399733 |pmc=4343258 |doi=10.1056/NEJMoa1402685 |url=}}</ref> | ||
*** Alternative regimen (1): [[Telmisartan]] 20-40 mg PO q24h '''(Maximum dose 80mg in 24h)'''<ref name="pmid25399733">{{cite journal |vauthors=Schrier RW, Abebe KZ, Perrone RD, Torres VE, Braun WE, Steinman TI, Winklhofer FT, Brosnahan G, Czarnecki PG, Hogan MC, Miskulin DC, Rahbari-Oskoui FF, Grantham JJ, Harris PC, Flessner MF, Bae KT, Moore CG, Chapman AB |title=Blood pressure in early autosomal dominant polycystic kidney disease |journal=N. Engl. J. Med. |volume=371 |issue=24 |pages=2255–66 |date=December 2014 |pmid=25399733 |pmc=4343258 |doi=10.1056/NEJMoa1402685 |url=}}</ref> | |||
=== | * 2 '''Slowing disease progression (Vasopressin receptor antagonist)''' | ||
*: '''Note (1):''' Before initiating therapy fluid intake needs to be restricted for 10-14 hours. | |||
=== | ** 2.1 '''Adult''' | ||
*** Preferred regimen (1): [[Tolvaptan]] 60mg PO q24h for 7 days '''(45mg upon awakening and 15mg 8hrs later)'''<ref name="pmid23121377">{{cite journal |vauthors=Torres VE, Chapman AB, Devuyst O, Gansevoort RT, Grantham JJ, Higashihara E, Perrone RD, Krasa HB, Ouyang J, Czerwiec FS |title=Tolvaptan in patients with autosomal dominant polycystic kidney disease |journal=N. Engl. J. Med. |volume=367 |issue=25 |pages=2407–18 |date=December 2012 |pmid=23121377 |pmc=3760207 |doi=10.1056/NEJMoa1205511 |url=}}</ref><ref name="pmid21903984">{{cite journal |vauthors=Higashihara E, Torres VE, Chapman AB, Grantham JJ, Bae K, Watnick TJ, Horie S, Nutahara K, Ouyang J, Krasa HB, Czerwiec FS |title=Tolvaptan in autosomal dominant polycystic kidney disease: three years' experience |journal=Clin J Am Soc Nephrol |volume=6 |issue=10 |pages=2499–507 |date=October 2011 |pmid=21903984 |pmc=3359559 |doi=10.2215/CJN.03530411 |url=}}</ref> | |||
***:After 7 days increase to 90mg PO for 7days '''(60mg upon awakening and 30mg 8hrs later)''' | |||
***:After 7 days increase to 120mg PO '''(90mg upon awakening and 30mg 8hrs later)''' | |||
* 3 '''Hematuria''' | |||
** [[Pain management]]<ref name="pmid18832246">{{cite journal| author=Grantham JJ| title=Clinical practice. Autosomal dominant polycystic kidney disease. | journal=N Engl J Med | year= 2008 | volume= 359 | issue= 14 | pages= 1477-85 | pmid=18832246 | doi=10.1056/NEJMcp0804458 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18832246 }} </ref> | |||
** [[Hydration]] | |||
** [[Bed rest]] | |||
* 4 '''Dietary sodium restriction''' | |||
** Restrict dietary [[sodium]] intake to a maximum of 2 grams per day<ref name="pmid21088290">{{cite journal |vauthors=Torres VE, Grantham JJ, Chapman AB, Mrug M, Bae KT, King BF, Wetzel LH, Martin D, Lockhart ME, Bennett WM, Moxey-Mims M, Abebe KZ, Lin Y, Bost JE |title=Potentially modifiable factors affecting the progression of autosomal dominant polycystic kidney disease |journal=Clin J Am Soc Nephrol |volume=6 |issue=3 |pages=640–7 |date=March 2011 |pmid=21088290 |pmc=3082424 |doi=10.2215/CJN.03250410 |url=}}</ref> | |||
** This slows progression of disease and helps with the control of [[hypertension]] as well<ref name="pmid27993381">{{cite journal |vauthors=Torres VE, Abebe KZ, Schrier RW, Perrone RD, Chapman AB, Yu AS, Braun WE, Steinman TI, Brosnahan G, Hogan MC, Rahbari FF, Grantham JJ, Bae KT, Moore CG, Flessner MF |title=Dietary salt restriction is beneficial to the management of autosomal dominant polycystic kidney disease |journal=Kidney Int. |volume=91 |issue=2 |pages=493–500 |date=February 2017 |pmid=27993381 |pmc=5237414 |doi=10.1016/j.kint.2016.10.018 |url=}}</ref> | |||
==References== | ==References== | ||
{{ | {{Reflist|2}} | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Up-To-Date]] | |||
[[Category:Medicine]] | |||
[[Category:Nephrology]] | |||
Latest revision as of 23:46, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: M. Khurram Afzal, MD [2]
Overview
Patients with polycystic kidney disease are treated with lisinopril or telmisartan for control of hypertension, tolvaptan for slowing disease progression, hydration, analgesia and bed rest. The treatment is targeted more towards managing symptoms and disease complications rather than slowing cyst formation.
Medical Therapy
- Patients with polycystic kidney disease are treated with lisinopril or telmisartan for control of hypertension, tolvaptan for slowing disease progression, hydration, analgesia and bed rest. The treatment is targeted more towards managing symptoms and disease complications rather than slowing cyst formation.[1]
Polycystic kidney disease
- 1 Hypertension
- 1.1 Adult
- Preferred regimen (1): Lisinopril 5-10 mg PO q24h (Maximum dose 40mg in 24h)[2][3]
- Alternative regimen (1): Telmisartan 20-40 mg PO q24h (Maximum dose 80mg in 24h)[4]
- 1.1 Adult
- 2 Slowing disease progression (Vasopressin receptor antagonist)
- Note (1): Before initiating therapy fluid intake needs to be restricted for 10-14 hours.
- 3 Hematuria
- 4 Dietary sodium restriction
- Restrict dietary sodium intake to a maximum of 2 grams per day[7]
- This slows progression of disease and helps with the control of hypertension as well[8]
References
- ↑ 1.0 1.1 Grantham JJ (2008). "Clinical practice. Autosomal dominant polycystic kidney disease". N Engl J Med. 359 (14): 1477–85. doi:10.1056/NEJMcp0804458. PMID 18832246.
- ↑ Schrier RW (September 2009). "Renal volume, renin-angiotensin-aldosterone system, hypertension, and left ventricular hypertrophy in patients with autosomal dominant polycystic kidney disease". J. Am. Soc. Nephrol. 20 (9): 1888–93. doi:10.1681/ASN.2008080882. PMID 19696226.
- ↑ Schrier RW, Abebe KZ, Perrone RD, Torres VE, Braun WE, Steinman TI, Winklhofer FT, Brosnahan G, Czarnecki PG, Hogan MC, Miskulin DC, Rahbari-Oskoui FF, Grantham JJ, Harris PC, Flessner MF, Bae KT, Moore CG, Chapman AB (December 2014). "Blood pressure in early autosomal dominant polycystic kidney disease". N. Engl. J. Med. 371 (24): 2255–66. doi:10.1056/NEJMoa1402685. PMC 4343258. PMID 25399733.
- ↑ Schrier RW, Abebe KZ, Perrone RD, Torres VE, Braun WE, Steinman TI, Winklhofer FT, Brosnahan G, Czarnecki PG, Hogan MC, Miskulin DC, Rahbari-Oskoui FF, Grantham JJ, Harris PC, Flessner MF, Bae KT, Moore CG, Chapman AB (December 2014). "Blood pressure in early autosomal dominant polycystic kidney disease". N. Engl. J. Med. 371 (24): 2255–66. doi:10.1056/NEJMoa1402685. PMC 4343258. PMID 25399733.
- ↑ Torres VE, Chapman AB, Devuyst O, Gansevoort RT, Grantham JJ, Higashihara E, Perrone RD, Krasa HB, Ouyang J, Czerwiec FS (December 2012). "Tolvaptan in patients with autosomal dominant polycystic kidney disease". N. Engl. J. Med. 367 (25): 2407–18. doi:10.1056/NEJMoa1205511. PMC 3760207. PMID 23121377.
- ↑ Higashihara E, Torres VE, Chapman AB, Grantham JJ, Bae K, Watnick TJ, Horie S, Nutahara K, Ouyang J, Krasa HB, Czerwiec FS (October 2011). "Tolvaptan in autosomal dominant polycystic kidney disease: three years' experience". Clin J Am Soc Nephrol. 6 (10): 2499–507. doi:10.2215/CJN.03530411. PMC 3359559. PMID 21903984.
- ↑ Torres VE, Grantham JJ, Chapman AB, Mrug M, Bae KT, King BF, Wetzel LH, Martin D, Lockhart ME, Bennett WM, Moxey-Mims M, Abebe KZ, Lin Y, Bost JE (March 2011). "Potentially modifiable factors affecting the progression of autosomal dominant polycystic kidney disease". Clin J Am Soc Nephrol. 6 (3): 640–7. doi:10.2215/CJN.03250410. PMC 3082424. PMID 21088290.
- ↑ Torres VE, Abebe KZ, Schrier RW, Perrone RD, Chapman AB, Yu AS, Braun WE, Steinman TI, Brosnahan G, Hogan MC, Rahbari FF, Grantham JJ, Bae KT, Moore CG, Flessner MF (February 2017). "Dietary salt restriction is beneficial to the management of autosomal dominant polycystic kidney disease". Kidney Int. 91 (2): 493–500. doi:10.1016/j.kint.2016.10.018. PMC 5237414. PMID 27993381.