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ADPKD — RACP Adult Medicine MCQ

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HardNephrologyADPKDRACP Adult Medicine

A 45-year-old with autosomal dominant polycystic kidney disease has eGFR 62 mL/min/1.73 m2, Mayo imaging class 1D and a sustained eGFR decline of 4 mL/min/year. Blood pressure and lifestyle measures are optimised. Which disease-modifying option should be discussed?

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Correct answer: B — Tolvaptan after confirming rapid-progression risk and counselling about aquaresis, liver monitoring and pregnancy precautions

The best answer is “Tolvaptan after confirming rapid-progression risk and counselling about aquaresis, liver monitoring and pregnancy precautions”. Tolvaptan can slow decline in adults with ADPKD who are at risk of rapid progression; imaging class and observed eGFR trajectory support that risk here. Treatment has substantial aquaretic burden and requires liver-test monitoring and shared decision-making. It is not prescribed to every patient, while nephrectomy, chronic dehydration and mTOR inhibition do not provide routine disease modification.

Reference: CARI Guidelines: Living guidelines for autosomal dominant polycystic kidney disease: https://www.cariguidelines.org/living-guidelines/ Kidney Health Australia: CKD Management in Primary Care, 5th edition: https://kidney.org.au/health-professionals/ckd-management-handbook/