Polycystic kidney disease medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
Overview
Treatment
Treatment of ADPKD is targeted at managing symptoms and disease complications. There have been no treatments associated with disease regression or slowing of cysts formation.[1]
Hypertension
Up to 75% of patients with ADPKD on imaging without any renal insufficiency are hypertensive.[2] Even in young patients, 50% of those aged 20-34 years are hypertensive despite normal renal function.[3] Treatment is recommended when blood pressure exceeds 130/80 mm Hg for adults, or sex and age adjusted norms for children. ACE inhibitors and ARBs are highly recommended as observational studies have shown better preservation of renal function with these agents. Eventual resistance or blunting of the effects of the these agents with increased volume retention can be encountered. Salt restriction, with addition of thiazide diuretics initially or loop diuretics as a second line, is justified.[1]
Hematuria
Gross hematuria with significant renal colic secondary to collecting system clots is not uncommon. Treatment usually involves analgesia, bed rest and hydration to increase urinary flow rate to 2-3 liters daily. In most patients, gross hematuria regresses to microscopic hematuria in a few days. Patients should be advised to avoid sports with risk of abdominal trauma to prevent recurrent episodes.[1]
Urinary Tract Infections
Women are at a higher risk for UTIs and cyst infections with gram negative rods being the most common pathogens. Symptomatic cyst infections or acute pyelonephritis require hospital admission with floroquinolone therapy until pain, fever, and leukocytosis resolve.[4]
Pain
Kidney Stones
Renal Failure
References
- ↑ 1.0 1.1 1.2 Grantham JJ (2008). "Clinical practice. Autosomal dominant polycystic kidney disease". N Engl J Med. 359 (14): 1477–85. doi:10.1056/NEJMcp0804458. PMID 18832246.
- ↑ Gabow PA (1990). "Autosomal dominant polycystic kidney disease--more than a renal disease". Am J Kidney Dis. 16 (5): 403–13. PMID 2239929.
- ↑ Kelleher CL, McFann KK, Johnson AM, Schrier RW (2004). "Characteristics of hypertension in young adults with autosomal dominant polycystic kidney disease compared with the general U.S. population". Am J Hypertens. 17 (11 Pt 1): 1029–34. doi:10.1016/j.amjhyper.2004.06.020. PMID 15533729.
- ↑ Gibson P, Watson ML (1998). "Cyst infection in polycystic kidney disease: a clinical challenge". Nephrol Dial Transplant. 13 (10): 2455–7. PMID 9794537.