Polycystic kidney disease: treatment and prognosis

At the present stage, specific treatment of polycystic kidney is not developed. In recent years (early 2000), attempts have been made to develop a pathogenetic approach to treatment, which considers this pathology from the standpoint of the neoplastic process. Treatment of polycystic kidney disease in mice with antitumor drugs (paclitaxel) and tyrosine kinase inhibitor, inhibiting cell proliferation, led to inhibition of cyst formation and a reduction in the available cysts. These methods of treatment are tested in an experiment and have not yet been introduced into clinical practice.

Treatment of polycystic kidneys in adults requires the use of a symptomatic approach and the use of drugs that inhibit the progression of chronic kidney failure.

[1], [2], [3], [4], [5]

Control of arterial hypertension

Effective control of arterial hypertension with the achievement of the target level of arterial pressure 130/80 mm Hg. - one of the main tasks both in terms of treatment of polycystic kidney disease, and in terms of preventing rapid progression of renal failure. The drugs of the first line are ACE inhibitors or angiotensin 2 receptor blockers of type 1. They should be prescribed at the first detection of high blood pressure and taken continuously. The early use of ACE inhibitors not only makes it possible to successfully control blood pressure, but also slows the development of renal failure. The appointment of these drugs against the background of already reduced renal function does not lead to inhibition of chronic renal failure. This is evidenced by data from a controlled MDRD study.

[6], [7], [8], [9]

ACE inhibitors:

• Captopril 25-50 mg 4 times a day;
• enalapril 2.5-20 mg / day;
• lisinopril 5-40 mg / day;
• fosinopril 10-40 mg / day;
• ramipril 1.25-20 mg / day.

[10], [11], [12], [13], [14], [15],

Angiotensin receptor blockers:

• losartan 25-100 mg / day;
• candesartan 4-16 mg / day;
• irbesartan 75-300 mg / day;
• telmisartan 40-80 mg / day;
• valsartan 80-320 mg / day;
• Eprosartan 300-800 mg / day.

Among other antihypertensive drugs in polycystic kidneys of adults use blockers of slow calcium channels of long-acting, beta-blockers. Diuretics are not indicated due to inversion of sodium pumps and polycythemia.

[16], [17], [18], [19]

Treatment of infected cysts

• If possible, aspirate fluid from an infected kidney or liver cyst.
• It is necessary to use lipophilic antibiotics with a dissociation constant that allows them to penetrate into the acidic cyst environment within 1-2 weeks:
  • fluoroquinolones:
    • ciprofloxacin 250-500 mg / day;
    • levofloxacin 250-500 mg / day;
    • norfloxacin 400 mg / day;
    • ofloxacin 200-400 mg / day;
  • co-trimoxazole at 960 mg twice a day;
  • chloramphenicol 500 mg 3-4 times a day.
• If the fever and purulent process against the background of antibiotic therapy are progressing, surgical treatment is indicated.
• With prolonged fever, obstruction of the urinary tract by concrement should be avoided, purulent paranephritis.

Treatment of nephrolithiasis

• Consumption of an adequate amount of liquid (at least 2 liters per day).
• Determination of metabolic changes that led to the formation of stones.
• For the prevention and treatment of the most common stones (from urates and calcium oxalates), the administration of potassium citrate at a dose of 20-60 meq / day is used.

Pain relief syndrome

For relief of acute pain use spasmoanalgesics, opioids; in acute occlusion, drainage of the upper urinary tract is indicated.

In chronic pain, analgesics such as paracetamol and tramadol, tricyclic antidepressants (amitriptyline 50-150 mg / day, pipothezin 50-150 mg / day) are used; opioids; autonomic blockade of nerves, acupuncture.

When they are ineffective, invasive and surgical laparoscopic methods of treating polycystic kidney are used - decompression and excision of cysts, nephrectomy.

To reduce pain, NSAIDs are not shown due to nephrotoxicity and the risk of reducing renal function. Sclerosing substances (alcohol) were not justified either. Aspiration of the fluid from the cysts brings temporary relief, however, in carrying out repeated similar activities, the periods of painless periods are drastically reduced.

Treatment of polycystic kidney in the stage of terminal chronic renal failure includes chronic hemodialysis and kidney transplantation. Survival of patients on hemodialysis and after kidney transplantation practically does not differ from that in other chronic diffuse kidney diseases.

Prognosis of polycystic kidney disease in adults

The prognosis of polycystic kidneys determines the genetic variant of this disease in adults. At 1-m type the forecast is less favorable, than at 2-nd type; The prognosis of the disease is worse in males.

The prognosis of polycystic kidney depends on:

• presence of arterial hypertension;
• state of kidney function;
• rate of progression of renal failure;
• concomitant pyelonephritis;
• presence of complications - infection of cysts, cerebral aneurysms.

In the absence of arterial hypertension and preserved kidney function, the prognosis of the disease is favorable.

In the presence of renal failure, the prognosis is determined by the rate of progression of chronic renal failure, which is significantly slowed down:

• a constant control of arterial hypertension, started in the stage of preserved kidney function, - target blood pressure level 130/80 mm Hg. (salt restriction, use of ACE inhibitors and / or angiotensin receptor blockers);
• restriction in the diet of dietary protein to 0.8 g / kg;
• restriction of fat consumption.

The prognosis of polycystic kidney disease is unfavorable in the presence of infected cysts and urinary tract infections, as well as in multiple aneurysms of cerebral vessels.