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ADTKD vs ADPKD Imaging — ESENeph MCQ

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HardTubular DisordersADTKD vs ADPKD ImagingESENeph

A 38-year-old with rapidly progressive ADPKD is beginning disease-modifying treatment under NICE TA358. Which safety issue requires explicit counselling before tolvaptan?

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Correct answer: C — Counsel about polyuria, thirst and liver-function surveillance

The best answer is “Counsel about polyuria, thirst and liver-function surveillance”. Tolvaptan antagonizes vasopressin V2 receptors, so polyuria, thirst and nocturia are expected, while potentially serious hepatic injury requires the specified monitoring programme. “Counsel about irreversible hypoglycaemia after the first dose” is less appropriate because this is not its characteristic toxicity. “Counsel about predictable severe hyperkalaemia in all recipients” does not describe the principal counselling issue. “Counsel about permanent suppression of endogenous cortisol” is less appropriate because this is not the drug mechanism. “Counsel about mandatory nephrectomy before treatment begins” is less appropriate because nephrectomy is not part of NICE eligibility or preparation.

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