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Heart failure with reduced ejection fraction — UKMLA MCQ

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HardCardiologyHeart failure with reduced ejection fractionUKMLAMRCGP AKTPARAMRCEM SBAMRCP Part 1PSA

A 42-year-old with autosomal dominant polycystic kidney disease has CKD G3a and serial imaging plus eGFR decline demonstrate rapid progression. Blood pressure and renin-angiotensin blockade are optimised. Which disease-modifying treatment is a NICE option at this stage?

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Correct answer: E — Start tolvaptan through an ADPKD specialist service

The best answer is “Start tolvaptan through an ADPKD specialist service”. NICE recommends tolvaptan for adults with evidence of rapidly progressing ADPKD who have CKD stage 2 or 3 when treatment begins; CKD G3a therefore remains within the starting window. Finerenone has a diabetic-CKD pathway, whereas sparsentan and targeted-release budesonide address primary IgA nephropathy. Atrasentan does not replace the appraisal criteria. The need to recognise both rapid progression and the permitted CKD stage makes simple identification of renal cysts insufficient.

Reference: NICE TA358, Tolvaptan for autosomal dominant polycystic kidney disease: https://www.nice.org.uk/guidance/ta358/chapter/1-Recommendations