Complications

Complications table
Complication Timeframe Likelihood

cardiac complications

long term high

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 LVH before ESRD. 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 exam.

gastroesophageal reflux disease (GERD)

long term low

H2 antagonists and proton pump inhibitors may be considered to treat the symptoms of GERD in patients with hepatomegaly.

gastroesophageal reflux disease (GERD)

ruptured intracranial aneurysm

variable low

Severe or unusual headaches should always be investigated in autosomal-dominant PKD (ADPKD).

Likelihood is higher in patients with previous aneurysm or family history of intracranial aneurysm.

sepsis

variable low

In a bacteremic 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 UTI.

CT is best to identify stones, perinephric abscess, complicated pyelonephritis, or cyst infection. Indium leukocyte scan may be helpful in localizing the infected cyst. [111]

Fluid is aspirated whenever possible if a cyst is seen that is suspected to be infected.

complications during pregnancy

variable low

Maternal and fetal complications are higher in autosomal-dominant PKD (ADPKD) pregnancies.

Gestational hypertension, edema, and preeclampsia 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. [112]

Women with pre-pregnancy serum creatinine of 1.2 mg/dL or more have higher risk of fetal or maternal complications.

Prenatal diagnosis is usually not done for ADPKD because it is not usually a fatal disease and women do not usually choose termination of pregnancy if ADPKD is diagnosed. [113]

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