What are the recommended monitoring protocols for patients with autosomal dominant polycystic kidney disease (ADPKD) in primary care?

Recommended monitoring protocols for patients with autosomal dominant polycystic kidney disease (ADPKD) in primary care:

• Offer a renal ultrasound scan to adults with a family history of polycystic kidney disease who are older than 20 years to assess kidney structure and cyst burden.
• Agree the frequency of monitoring kidney function (eGFR) and albumin:creatinine ratio (ACR) with the patient, tailoring it according to their GFR and ACR categories, rate of progression, and other risk factors.
• Use the CKD staging categories (GFR and ACR) to guide the minimum frequency of monitoring, with more frequent checks for those with more advanced CKD or higher albuminuria.
• Monitor for accelerated progression defined as a sustained decrease in GFR of 25% or more and a change in GFR category within 12 months, or a sustained decrease in GFR of 15 ml/min/1.73 m2 per year, by obtaining at least 3 eGFR measurements over a minimum of 90 days.
• Assess and manage risk factors for progression such as hypertension, proteinuria, cardiovascular disease, and avoid nephrotoxic drugs like NSAIDs.
• Arrange specialist referral if there is accelerated progression, uncontrolled hypertension despite multiple drugs, or if GFR falls below 30 ml/min/1.73 m2 (CKD category G4 or G5).
• Provide education and information tailored to the severity and cause of CKD, including ADPKD, and support self-management.

These monitoring protocols align with general CKD management principles but include specific recommendations for ADPKD such as family history-based ultrasound screening and close monitoring of progression markers in primary care.

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