[Management of a patient with polycystic kidney disease]

Management of a patient with polycystic kidney disease. In patients with autosomal dominant polycystic kidney disease, the nephrologist is typically asked to treat hypertension, urological complications (pain, stones, infections), progressive renal failure and its consequences, and finally initiate renal replacement therapy (hemodialysis, peritoneal dialysis, kidney transplant) for those reaching end-stage renal failure, most often in the second part of their life. We should now consider a more modern vision: in at risk subjects, an early diagnosis (around 20 years of age) will help to provide dietary advice (water intake, salt and protein intake), detect hypertension, fight against cardiovascular risk factors, detect intracranial aneurysms; in women, to give advice on contraception, pregnancies, and to detect massive polycystic liver disease; finally, to discuss advances in cystic blocking research and to propose the first of these, tolvaptan, to eligible patients. The early implementation of all these measures will likely allow a new generation of patients to have, compared to their elders, a less progressive renal disease and a reduced rate of extra-renal complications.