Treatment

• Based on Brenda’s Mayo risk category 1B, her age, and a history of decline in eGFR of ≥5 mL/min/1.73 m  per year, Brenda is an appropriate patient for disease-modifying therapy with tolvaptan (7).

• In clinical trials, tolvaptan was associated with a 26% to 35% decrease in annual change in eGFR in patients of similar age and eGFR as Brenda (12-15).

• Brenda began tolvaptan 20 months ago. She completed her initial safety laboratory monitoring and now undergoes monitoring of hepatic transaminases every 3 months.

 

Management of Brenda’s ADPKD 

• Early recognition and management of ADPKD renal manifestations such as hematuria, infection, nephrolithiasis, and pain.

• Maintenance of blood pressure goal, hydration, and normal BMI; management of hypercholesterolemia; and moderation of sodium and protein intake.

• Surveillance for intracranial aneurysms; repeat MRA every 5 years.

 

Ongoing Care

• Brenda’s most recent laboratory results showed that her LDL was 115 mg/dL; she may benefit from reviewing exercise and diet recommendations or revisiting her statin regimen to achieve the recommended level of <100 mg/dL.

• Reducing Brenda’s BMI may benefit her progression (5).