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

Vecihi Batuman, MD


February 02, 2023

Regardless of risk for progression, patients with ADPKD should take caution to slow progression to chronic kidney disease with BP control, dietary sodium and caloric intake limitation, hydration, and dyslipidemia management.

BP in patients with ADPKD aged 18-50 years who are at risk for rapid progression should be targeted to < 110/75 mmHg, potentially slowing the TKV growth rate and decline in eGFR. In all other patients with ADPKD, a BP target of < 130/80 mmHg is acceptable.

For managing hypertension in the setting of ADPKD, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are first-line therapy and would be appropriate for this patient. Patients should also moderately restrict dietary sodium and daily dietary protein intake.

Because water intake to suppress vasopressin levels might be associated with slower TKV growth and eGFR decline, all patients with ADPKD should target a urine osmolality of < 280 mOsm/L.

Editor's Note: Skill Checkups are wholly fictional or fictionalized clinical scenarios intended to provide evidence-based educational takeaways.

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