SIADH — ESENeph MCQ

Correct answer: B — Mayo imaging class 1A with stable longitudinal eGFR

The best answer is “Mayo imaging class 1A with stable longitudinal eGFR”. NICE requires evidence of rapidly progressing disease. Mayo 1A and stable eGFR indicate low predicted risk, whereas classes 1C-1E and sustained decline strengthen eligibility. “Mayo imaging class 1D with age-adjusted large kidney volume” is less appropriate because this indicates a higher predicted growth and progression risk “Repeated eGFR decline exceeding 3 mL/min/1.73m² each year” is less appropriate because sustained decline supports rapid progression “Family kidney failure before age 55 with truncating PKD1 variation” is less appropriate because early familial kidney failure supports higher risk “Rapidly increasing height-adjusted total kidney volume on serial imaging” is less appropriate because serial enlargement supports progression

Reference: NICE TA358: tolvaptan for ADPKD: https://www.nice.org.uk/guidance/ta358/chapter/1-Recommendations