Complications
As cardiovascular disease is the main cause of mortality in this patient population, this should be a major focus of disease management.
Nearly half of hypertensive patients with autosomal-dominant PKD (ADPKD) have left ventricular hypertrophy (LVH) before end-stage renal disease. LVH is a clinical factor known to be associated with increased risk of major cardiovascular events.
The following are more common in ADPKD: biventricular diastolic dysfunction; aortic root dilation; mitral valve prolapse; mitral regurgitation; aortic incompetence; tricuspid incompetence or prolapse; pericardial effusion.
Increased left ventricular mass and LVH have been found in early stages of ADPKD.
Only rarely do they require valve replacement.
Screening echocardiography is not required unless a murmur is detected on examination.
H2 antagonists and proton pump inhibitors may be considered to treat the symptoms of GORD in patients with hepatomegaly.
Severe or unusual headaches should always be investigated in autosomal-dominant PKD.
Likelihood is higher in patients with previous aneurysm or family history of intracranial aneurysm.
In a bacteraemic patient with negative urine cultures, and with the source of the infection being uncertain, the clinical differential of infected renal cyst or hepatic cysts should be considered.
Imaging should be performed whenever there is concern for a complicated urinary tract infection.
Fluid is aspirated whenever possible if a cyst is seen that is suspected to be infected.
Maternal and fetal complications are higher in autosomal-dominant PKD (ADPKD) pregnancies.
Gestational hypertension, oedema, and pre-eclampsia occur more commonly in women with ADPKD than in unaffected pregnant women. These women are also more likely to develop chronic hypertension.
Approximately 16% of women develop new-onset hypertension during pregnancy and up to 25% will have a hypertensive complication during pregnancy.
Women with hypertension are at increased risk of adverse fetal and maternal outcomes.[117]
Women with pre-pregnancy serum creatinine of 106 micromols/L or more (1.2 mg/dL or more) have higher risk of fetal or maternal complications.
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