ADPKD aneurysm screening — ESENeph MCQ
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Correct answer: A — Offer tolvaptan after counselling and baseline safety assessment
The best answer is “Offer tolvaptan after counselling and baseline safety assessment”. NICE recommends tolvaptan for adults who start treatment in CKD stage 2 or 3 and have evidence of rapidly progressing ADPKD. Aquaretic effects, water access, liver monitoring, interactions and pregnancy considerations are assessed before treatment. “Wait until CKD G4 before considering tolvaptan” is less appropriate because NICE requires initiation in CKD stage 2 or 3 “Use tolvaptan because every adult with ADPKD is eligible” is less appropriate because rapid progression as well as the CKD-stage condition must be established “Use somatostatin analogue therapy as the NICE-approved alternative” is less appropriate because this is not the NICE disease-modifying technology appraisal recommendation “Delay treatment until dialysis education begins” is less appropriate because this would miss the NICE initiation window and the aim of slowing progression
Reference: NICE TA358: tolvaptan for ADPKD: https://www.nice.org.uk/guidance/ta358/chapter/1-Recommendations