UROLOGY · CONDITIONS
Polycystic Kidney Disease
Genetic disorder characterised by progressive bilateral renal cyst growth , leading to chronic kidney disease, hypertension, and eventually renal failure in many patients.
ABOUT THIS CONDITION
What is Polycystic Kidney Disease
Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited renal condition, characterised by bilateral renal cyst enlargement that progressively destroys functioning nephrons. It causes hypertension, chronic pain, haematuria, recurrent cyst infections, and renal failure in approximately 50% of patients by age 60. Liver cysts and cerebral aneurysms are associated extrarenal manifestations. Dr. Vipin manages the urological complications of PKD , pain management, infected cyst drainage, laparoscopic cyst decortication for large symptomatic cysts, nephrectomy prior to transplantation, and coordination with nephrology and the transplant team for patients approaching ESRD.
SIGNS TO WATCH
Common Symptoms
Symptoms that need attention
WHY IT HAPPENS
Causes & Risk Factors
- PKD1 gene mutation (chromosome 16) , 85% of ADPKD
- PKD2 gene mutation (chromosome 4) , 15%, slower progression
- Autosomal dominant inheritance , 50% risk per child
- Autosomal recessive PKD (ARPKD) , presents in infancy
- De novo mutations account for a minority of cases
- Environmental factors do not cause PKD but may accelerate progression
CLINICAL DETAILS
Key Facts
Target <130/80 mmHg with ACE inhibitor or ARB , slows progression most effectively.
V2 receptor antagonist approved for rapidly progressing ADPKD , reduces kidney growth rate.
High fluid intake (2.5–3 L/day) reduces ADH-driven cyst growth and prevents stone formation.
PKD1/PKD2 testing confirms diagnosis and allows family screening of at-risk relatives
Laparoscopic cyst decortication for refractory pain , does not halt progression but provides relief.
Renal transplantation for ESRD , excellent outcomes. Native kidneys removed if massively enlarged.
HOW WE TREAT IT
Treatment Approach
Renal Transplantation
Placement of a living or cadaveric donor kidney as definitive treatment for ADPKD-related end-stage renal disease , transplantation provides the best long-term survival and quality of life compared to dialysis.
- 1
Medical Management
Blood pressure controlled to <130/80 with ACE inhibitor or ARB. High fluid intake encouraged. Tolvaptan offered to eligible rapidly progressing patients.
- 2
Complication Treatment
Infected cysts: IV antibiotics penetrating cyst wall (fluoroquinolones). Haemorrhage: rest and hydration. Nephrolithiasis: standard stone management.
- 3
Surgical Intervention
Laparoscopic decortication for large symptomatic cysts causing pain. Nephrectomy for massive kidneys before transplantation.
- 4
Transplant Planning
A temporary DJ stent may be placed to ensure drainage. Most patients are discharged thEarly referral to the transplant team when GFR falls below 20 mL/min. Living donor transplantation offered where possible for best outcomes. e same day and resume normal activities within 48 hours.
AVAILABLE TREATMENTS
Treatment Options
Laparoscopic Cyst Decortication
Multiple cysts unroofed laparoscopically to reduce kidney volume and relieve pain , provides symptomatic relief without halting PKD progression.
Nephrectomy (pre-transplant)
Removal of massively enlarged polycystic kidneys to create space for the transplant kidney in the retroperitoneum or pelvis.
Renal Transplantation
Percutaneous kidney access to remove large (>2 cm) or staghorn stones , gold standard for complex renal calculi.
COMMON QUESTIONS
Frequently Asked
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