Fast Five Quiz: Autosomal Dominant Polycystic Kidney Disease (ADPKD)

Neera K. Dahl, MD, PhD

Disclosures

August 06, 2021

Current treatment modalities cannot reverse the progression of ADPKD, making it necessary to employ therapies target the clinical manifestations of the disease. ACEIs are recommended as first-line agents for managing hypertension. ARBs are alternatives for patients who are unable to tolerate ACEIs. Recently, a post hoc study of the TEMPO 3:4 trial showed the V2-receptor antagonist tolvaptan may slow disease progression and gradually lower blood pressure in patients with ADPKD. Calcium channel blockers should not be first-line therapy for treating hypertension in patients with ADPKD, but they are appropriate for use in difficult-to-control hypertension.

A blood pressure goal of < 130/85 mm Hg is recommended for patients who have developed chronic kidney disease; outside of the presence of chronic kidney disease, blood pressure targets remain the same as those for the general population. Patients with advanced renal disease who are taking ACEIs or ARBs should undergo regular monitoring of serum chemistry values because these agents can exacerbate renal failure or increase serum potassium levels.

Infected renal cysts frequently yield urine culture results positive for Escherichia coli (74% of cases). Staphylococcus aureus, Enterococcus, Lactobacillus, and anaerobic bacteria account for most of the remaining cases. Antibiotics with the ability to penetrate renal cysts include fluoroquinolones, third-generation cephalosporins (penetrate cysts poorly but with good parenchymal penetration), and trimethoprim/sulfamethoxazole. If infected renal or hepatic cysts do not respond to conventional antibiotic therapy, surgical drainage may be necessary.

Learn more about the management of patients with ADPKD.

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