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

Vecihi Batuman, MD


February 02, 2023

Disease-modifying therapy would be the most appropriate option in this patient at high risk for kidney function decline. In 2018, the US Food and Drug Administration approved the vasopressin V2 receptor antagonist tolvaptan to treat ADPKD in patients between the ages of 18 and 55 years at risk for rapid progression to kidney failure. Risk for progression is determined by HtTKV and risk for rapid GFR decline in the future (MIC 1C, 1D, and 1E) with an eGFR > 25 mL/min.

Data have also pointed to the value of tolvaptan in patients aged 55-62 years, though shared decision-making is recommended in this age group even with evidence of rapid disease progression (ie, MIC 1C, 1D, or 1E with an average eGFR rate of decline ≥ 2.5 mL/min/yr over the past 5 years).

Surgical drainage may be indicated in situations where infected renal or hepatic cysts do not respond to antibiotic therapy. Phosphate binders would be indicated to maintain phosphate levels in renal failure.


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