Brenda

• Brenda is a 60-year-old woman who was diagnosed with Autosomal Dominant Polycystic Kidney Disease (ADPKD) in her fifth decade of life.

• She works as a clinical toxicologist at a university hospital.

• She was told of a family history of ADPKD in her 20s and experienced stage 2 hypertension at age 34 (1).

• Although Brenda had no ADPKD symptoms, her hypertension and family history prompted her primary care provider to refer her to a nephrologist for assessment, and she was diagnosed with ADPKD at age 42. 

• Genetic testing revealed she has a PKD2 missense mutation  (2).

• During treatment for carotid artery occlusion, Brenda was found to have 2 intracranial aneurysms (ICAs). Magnetic resonance angiography (MRA) revealed a 3-mm and 4-mm basilar artery aneurysm. Endovascular coil placement was followed by MRA surveillance every 5 years (3).  

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Family History

• Brenda’s mother has ADPKD. She was diagnosed in her seventh decade of life. She had pancreatic cysts and underwent a pancreatoduodenectomy in her late 60s.

• Brenda’s maternal uncle was diagnosed with ADPKD in his 50s.

• She has no known family history of ICA or subarachnoid hemorrhage.
   

Comorbidities

• Hypertension

• Prediabetes

• Hypercholesterolemia

• GERD

• Obesity

 

Current Medications

• Telmisartan 60 mg/d

• Rosuvastatin 20 mg/d

• Rabeprazole 20 mg/d

• Calcium supplement

• Vitamin D (5000 IU/d)

• Tolvaptan 60 mg at waking, 30 mg after 8 hours (90 mg daily)