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Tolvaptan Response Monitoring ADPKD — ESENeph MCQ

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ModeratePolycystic Kidney DiseaseTolvaptan Response Monitoring ADPKDESENeph

A 50-year-old man with ADPKD has total kidney volume of 1800 mL/m and eGFR 42. He has been on Tolvaptan for 1 year. How is treatment response monitored?

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Correct answer: E — Response is assessed by serial htTKV measurement (MRI, typically annually) and eGFR trajectory – slowing of kidney volume growth and reduced eGFR decline rate indicate treatment benefit; additionally serum sodium, osmolality, LFTs, and hydration status are monitored

Tolvaptan treatment monitoring in ADPKD includes: (1) efficacy: serial height-adjusted total kidney volume (htTKV) by MRI – the primary outcome measure (slowing of kidney growth indicates benefit); eGFR trajectory (reduced annual decline rate); (2) safety: LFTs monthly for 18 months then 3-monthly (hepatotoxicity); serum sodium and osmolality (risk of hypernatraemia); hydration status and urine output (aquaresis management); (3) tolerability: patient-reported outcomes regarding polyuria, nocturia, and thirst impact on quality of life. MRI is preferred over ultrasound for TKV measurement as it is more reproducible and accurate.

Reference: NICE TA877 2022 – Tolvaptan; Chapman et al 2015 – ADPKD Management