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ADPKD Pain NSAIDs Avoidance — ESENeph MCQ

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EasyPolycystic Kidney DiseaseADPKD Pain NSAIDs AvoidanceESENeph

A 45-year-old woman with known polycystic kidney disease develops recurrent urinary tract infections. She also has hepatic cysts but is most troubled by persistent pain from massively enlarged kidneys (right 22 cm, left 20 cm). MRI shows no evidence of cyst infection. She has tried paracetamol, codeine, and amitriptyline without adequate pain relief. What pain management approach should be AVOIDED?

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Correct answer: D — Regular NSAIDs

Regular NSAIDs should be avoided in ADPKD patients, especially those with CKD. NSAIDs impair renal autoregulation (reducing GFR), promote sodium retention, and may accelerate CKD progression. Additionally, they increase hypertension risk and can mask signs of cyst infection. ADPKD-related chronic pain is challenging to manage and requires a multimodal approach: paracetamol (first-line), referral to a pain management team, consideration of cyst aspiration/sclerotherapy for dominant symptomatic cysts, and in severe cases, laparoscopic renal denervation or nephrectomy. Opioids should be used cautiously with a clear endpoint. TENS and psychological support are also appropriate.

Reference: Chapman et al 2015 – ADPKD Complications; UKKA 2019 – CKD Pain Management