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Borghol AH, Bou Antoun MT, Hanna C, Salih M, Rahbari-Oskoui FF, Chebib FT. Autosomal dominant polycystic kidney disease: an overview of recent genetic and clinical advances. Ren Fail 2025; 47:2492374. [PMID: 40268755 PMCID: PMC12020221 DOI: 10.1080/0886022x.2025.2492374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2025] [Revised: 03/24/2025] [Accepted: 04/07/2025] [Indexed: 04/25/2025] Open
Abstract
Autosomal Dominant Polycystic Kidney Disease (ADPKD) is the most common inherited kidney disease, characterized by the progressive development of multiple kidney cysts, leading to a gradual decline in kidney function. ADPKD is also the fourth leading cause of kidney failure (KF) in adults. In addition to kidney manifestations, ADPKD is associated with various extrarenal features, including liver cysts, cardiovascular abnormalities, intracranial aneurysms, and chronic pain with significant impact on patients' quality of life. While several disease-modifying agents have been tested in ADPKD, tolvaptan remains the only approved drug by the US Food and Drug Administration. The Mayo Imaging Classification is currently the most practical tool for predicting rate of kidney disease progression in ADPKD. This review provides a comprehensive overview of ADPKD, focusing on its genetics, pathophysiology, clinical presentation, management, and prognostic tools. Advances in diagnostic imaging and genetic testing have improved the early detection of ADPKD, allowing better classification of patients and prediction of KF. The review also discusses current therapeutic approaches to ADPKD, including tolvaptan, a vasopressin V2-receptor antagonist. Additionally, we address specific issues in children and pregnant individuals with ADPKD. Despite substantial progress in understanding ADPKD, there is a large need for additional effective treatments and prognostic markers to provide a more personalized care for these patients.
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Affiliation(s)
- Abdul Hamid Borghol
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
- Mayo Clinic Florida PKD Center of Excellence, Jacksonville, FL, USA
| | - Marie Therese Bou Antoun
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
- Mayo Clinic Florida PKD Center of Excellence, Jacksonville, FL, USA
| | - Christian Hanna
- Division of Pediatric Nephrology and Hypertension, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mahdi Salih
- Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Fouad T. Chebib
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
- Mayo Clinic Florida PKD Center of Excellence, Jacksonville, FL, USA
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Borghol AH, Alkhatib B, Zayat R, Ravikumar NPG, Munairdjy Debeh FG, Ghanem A, Mina J, Mao MA, Dahl NK, Hickson LJ, Aslam N, Torres VE, Brown RD, Tawk RG, Chebib FT. Intracranial Aneurysms in Autosomal Dominant Polycystic Kidney Disease: A Practical Approach to Screening and Management. Mayo Clin Proc 2025:S0025-6196(25)00080-1. [PMID: 40319406 DOI: 10.1016/j.mayocp.2025.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Revised: 01/22/2025] [Accepted: 02/07/2025] [Indexed: 05/07/2025]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD), the most prevalent genetic kidney disorder, is characterized by diffuse kidney cysts, hypertension, and progressive kidney function decline, often leading to kidney failure by the age of 60 years. Compared with the general population, patients with ADPKD have an increased risk for development of saccular intracranial aneurysms (IAs), which can lead to intracranial bleeding and result in significant disability and mortality. Of both modifiable and nonmodifiable risk factors, the most significant is a family history of IAs or aneurysm rupture. Other contributing factors include hypertension, cigarette smoking, age, and sex. Most IAs currently detected during screening tests are small and located in the anterior circulation. Intracranial aneurysms can be manifested with thunderclap headache, which may be indicative of subarachnoid hemorrhage. Less commonly, IAs cause symptoms related to mass effect with focal neurologic deficits. Subarachnoid hemorrhage is particularly concerning, given its high case-fatality rate, which remains around 35% despite advances in neurologic care. Therefore, control of risk factors, early detection, and treatment when indicated are important to prevent adverse outcomes. Screening for IAs in ADPKD remains controversial and can be approached either universally (screening of all ADPKD patients) or selectively (screening of high-risk patients). The preferred imaging modality is brain magnetic resonance angiography without contrast enhancement or alternatively computed tomography angiography. This review provides a practical guide for medical teams managing patients with ADPKD, detailing the characteristics of IAs and their associated symptoms. It presents an algorithm for risk assessment and screening along with recommendations for treatment and follow-up care.
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Affiliation(s)
- Abdul Hamid Borghol
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL; Mayo Clinic Florida PKD Center of Excellence, Jacksonville, FL
| | - Bassel Alkhatib
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL; Mayo Clinic Florida PKD Center of Excellence, Jacksonville, FL
| | - Roaa Zayat
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL; Mayo Clinic Florida PKD Center of Excellence, Jacksonville, FL
| | | | - Fadi George Munairdjy Debeh
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL; Mayo Clinic Florida PKD Center of Excellence, Jacksonville, FL
| | - Ahmad Ghanem
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL; Mayo Clinic Florida PKD Center of Excellence, Jacksonville, FL
| | - Jonathan Mina
- Department of Internal Medicine, Staten Island University Hospital, Northwell Health, NY
| | - Michael A Mao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL
| | - Neera K Dahl
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
| | - LaTonya J Hickson
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL
| | - Nabeel Aslam
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL
| | - Vicente E Torres
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Robert D Brown
- Department of Neurology (R.D.B.), Mayo Clinic, Rochester, MN
| | - Rabih G Tawk
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL
| | - Fouad T Chebib
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL; Mayo Clinic Florida PKD Center of Excellence, Jacksonville, FL.
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Campbell RE, Edelstein CL, Chonchol M. Overview of ADPKD in Pregnancy. Kidney Int Rep 2025; 10:1011-1019. [PMID: 40303224 PMCID: PMC12034866 DOI: 10.1016/j.ekir.2024.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Revised: 12/16/2024] [Accepted: 12/20/2024] [Indexed: 05/02/2025] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is a systemic disorder that often affects patients in their third to fifth decades of life and is characterized by kidney cysts, chronic kidney disease (CKD), hypertension, and hepatic cysts. The development of clinical symptoms often coincides with childbearing years. Consequently, there are several considerations regarding pregnant patients with ADPKD. In this review, we detail the effects and management of ADPKD in the peripartum period and discuss family planning options, including assisted reproductive techniques (ART) and preimplantation genetic testing.
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Affiliation(s)
- Ruth E. Campbell
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Charles L. Edelstein
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michel Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Holton S, Nelson C, Rasmussen B, Levidiotis V. Co-design of a question prompt list about pregnancy and childbearing for women with polycystic kidney disease: an exploratory sequential mixed-methods study. BMC Pregnancy Childbirth 2023; 23:852. [PMID: 38082383 PMCID: PMC10714568 DOI: 10.1186/s12884-023-06154-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Although women with polycystic kidney disease (PKD) generally have healthy pregnancies and babies, pregnancy is associated with a greater risk of maternal complications and requires planning and management of their condition. Given these possible complications, routine communication about childbearing between women with PKD and their treating team is important. A question prompt list (QPL), a structured list of questions used by patients during consultations with healthcare providers, may be beneficial in assisting women with PKD to discuss their childbearing concerns with, and seek related information from, their treating team. The aims of this study were to co-design a QPL about pregnancy and childbearing for women with PKD, and evaluate its comprehensibility, salience, and acceptability. METHODS An exploratory sequential mixed-methods study of women of reproductive age with PKD living in Australia, using an experience-based co-design approach with two phases. Women were recruited from a metropolitan public health service and via social media and invited to complete an anonymous online survey about the development of the PKD QPL (phase one) and participate in an online discussion group about its refinement (phase two). RESULTS Sixteen women completed the development survey and seven participated in the evaluation discussion group. Participants reported that women with PKD would value and use a QPL to prompt discussions with and seek further information about pregnancy and childbearing from their healthcare providers. Women identified four main topics for the QPL: 'thinking about having a baby', 'pregnancy', 'my medications' and 'after my baby is born'. Within each section a series of questions was developed. Based on the findings, a QPL about pregnancy and childbearing for women with PKD was co-designed. CONCLUSIONS Women with PKD often find it difficult to access information and have discussions with their health care providers about pregnancy and childbearing. The PKD QPL co-designed in this study was perceived to be an acceptable tool which will, from the perspectives of participants, assist women with PKD to access information more easily about pregnancy, childbearing and PKD; ask more targeted questions of their treating team; and make informed childbearing decisions.
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Affiliation(s)
- Sara Holton
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, VIC, 3220, Australia.
- The Centre for Quality and Patient Safety Research in the Institute of Health Transformation, Deakin University - Western Health Partnership, St Albans, VIC, 3021, Australia.
| | - Craig Nelson
- Department of Nephrology, Western Health, St Albans, VIC, 3021, Australia
- Department of Medicine - Western Health, University of Melbourne, Parkville, VIC, 3010, Australia
- Western Health Chronic Disease Alliance, Western Health, St Albans, VIC, 3021, Australia
- Department of Medicine, Deakin University, Geelong, VIC, 3220, Australia
| | - Bodil Rasmussen
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, VIC, 3220, Australia
- The Centre for Quality and Patient Safety Research in the Institute of Health Transformation, Deakin University - Western Health Partnership, St Albans, VIC, 3021, Australia
- Faculty of Health Sciences, University of Southern Denmark and Steno Diabetes Center, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vicki Levidiotis
- Department of Nephrology, Western Health, St Albans, VIC, 3021, Australia
- Department of Medicine - Western Health, University of Melbourne, Parkville, VIC, 3010, Australia
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Sagar PS, Rangan GK. Cardiovascular Manifestations and Management in ADPKD. Kidney Int Rep 2023; 8:1924-1940. [PMID: 37850017 PMCID: PMC10577330 DOI: 10.1016/j.ekir.2023.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/27/2023] [Accepted: 07/24/2023] [Indexed: 10/19/2023] Open
Abstract
Cardiovascular disease (CVD) is the major cause of mortality in autosomal dominant polycystic kidney disease (ADPKD) and contributes to significant burden of disease. The manifestations are varied, including left ventricular hypertrophy (LVH), intracranial aneurysms (ICAs), valvular heart disease, and cardiomyopathies; however, the most common presentation and a major modifiable risk factor is hypertension. The aim of this review is to detail the complex pathogenesis of hypertension and other extrarenal cardiac and vascular conditions in ADPKD drawing on preclinical, clinical, and epidemiological evidence. The main drivers of disease are the renin-angiotensin-aldosterone system (RAAS) and polycystin-related endothelial cell dysfunction, with the sympathetic nervous system (SNS), nitric oxide (NO), endothelin-1 (ET-1), and asymmetric dimethylarginine (ADMA) likely playing key roles in different disease stages. The reported rates of some manifestations, such as LVH, have decreased likely due to the use of antihypertensive therapies; and others, such as ischemic cardiomyopathy, have been reported with increased prevalence likely due to longer survival and higher rates of chronic disease. ADPKD-specific screening and management guidelines exist for hypertension, LVH, and ICAs; and these are described in this review.
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Affiliation(s)
- Priyanka S. Sagar
- Michael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
- Department of Renal Medicine, Nepean Hospital, Nepean Blue Mountains Local Health District, Sydney, New South Wales, Australia
| | - Gopala K. Rangan
- Michael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
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Al Sayyab M, Chapman A. Pregnancy in Autosomal Dominant Polycystic Kidney Disease. ADVANCES IN KIDNEY DISEASE AND HEALTH 2023; 30:454-460. [PMID: 38032583 DOI: 10.1053/j.akdh.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disorder occurring in approximately 1:1000 individuals. ADPKD is characterized by gradual cyst expansion and kidney enlargement and is a slowly progressive disorder where patients typically initiate renal replacement therapy in the sixth decade of life. The vast majority of women with ADPKD become pregnant in the third or fourth decade, often before knowing that they have ADPKD, in the setting of normal kidney function or chronic kidney disease Stage 1. In ADPKD, pregnancy outcomes for mother and baby differ from the general population, and long-term consequences of maternal complications from pregnancy are common in ADPKD. In the current era of genetic testing, options to consider pre-implantation genetic screening are becoming more available. This chapter will review renal physiologic and anatomic changes that occur in pregnancy, the potential impact of ADPKD on maternal and fetal outcomes, medical management during pregnancy, the impact of pregnancy on long-term outcomes in women with ADPKD, and options for families with ADPKD planning to undergo pregnancy with regard to genetic testing.
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Affiliation(s)
- Mina Al Sayyab
- Department of Medicine, University of Chicago, Chicago, IL
| | - Arlene Chapman
- Department of Medicine, University of Chicago, Chicago, IL.
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Peces R, Mena R, Peces C, Cuesta E, Lapunzina P, Selgas R, Nevado J. Birth of two healthy girls following preimplantation genetic diagnosis and gestational surrogacy in a rapidly progressive autosomal dominant polycystic kidney disease case using tolvaptan. Clin Kidney J 2021; 14:1987-1989. [PMID: 34345424 PMCID: PMC8323138 DOI: 10.1093/ckj/sfab082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 04/20/2021] [Indexed: 12/02/2022] Open
Affiliation(s)
- Ramón Peces
- Servicio de Nefrología, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma, Madrid, Spain
| | - Rocío Mena
- Instituto de Genética Médica y Molecular, IdiPAZ, Hospital Universitario La Paz, Universidad Autónoma, Madrid, Spain
| | - Carlos Peces
- Area de Tecnologías de la Información, SESCAM, Toledo, Spain
| | - Emilio Cuesta
- Servicio de Radiología, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma, Madrid, Spain
| | - Pablo Lapunzina
- Instituto de Genética Médica y Molecular, IdiPAZ, Hospital Universitario La Paz, Universidad Autónoma, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain, and ITHACA-European Reference Network
| | - Rafael Selgas
- Servicio de Nefrología, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma, Madrid, Spain
| | - Julián Nevado
- Instituto de Genética Médica y Molecular, IdiPAZ, Hospital Universitario La Paz, Universidad Autónoma, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain, and ITHACA-European Reference Network
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Saini AK, Saini R, Singh S. Autosomal dominant polycystic kidney disease and pioglitazone for its therapy: a comprehensive review with an emphasis on the molecular pathogenesis and pharmacological aspects. Mol Med 2020; 26:128. [PMID: 33308138 PMCID: PMC7731470 DOI: 10.1186/s10020-020-00246-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/23/2020] [Indexed: 12/12/2022] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is an inherited chronic kidney disorder (CKD) that is characterized by the development of numerous fluid-filled cysts in kidneys. It is caused either due to the mutations in the PKD1 or PKD2 gene that encodes polycystin-1 and polycystin-2, respectively. This condition progresses into end-stage renal disorder if the renal or extra-renal clinical manifestations remain untreated. Several clinical trials with a variety of drugs have failed, and the only Food and Drugs Administration (FDA) approved drug to treat ADPKD to date is tolvaptan that works by antagonizing the vasopressin-2 receptor (V2R). The pathology of ADPKD is complex and involves the malfunction of different signaling pathways like cAMP, Hedgehog, and MAPK/ERK pathway owing to the mutated product that is polycystin-1 or 2. A measured yet substantial number of preclinical studies have found pioglitazone to decrease the cystic burden and improve the renal function in ADPKD. The peroxisome proliferator-activated receptor-gamma is found on the epithelial cells of renal collecting tubule and when it gets agonized by pioglitazone, confers efficacy in ADPKD treatment through multiple mechanisms. There is only one clinical trial (ongoing) wherein it is being assessed for its benefits and risk in patients with ADPKD, and is expected to get approval from the regulatory body owing to its promising therapeutic effects. This article would encompass the updated information on the epidemiology, pathophysiology of ADPKD, different mechanisms of action of pioglitazone in the treatment of ADPKD with preclinical and clinical shreds of evidence, and related safety updates.
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Affiliation(s)
- Aryendu Kumar Saini
- Department of Pharmacy, Chaudhary Sughar Singh College of Pharmacy, Etawah, Uttar Pradesh, India.
| | - Rakesh Saini
- Department of Pharmacy, Chaudhary Sughar Singh College of Pharmacy, Etawah, Uttar Pradesh, India
| | - Shubham Singh
- Department of Pharmacy, Shri Ram Lakhan Tiwari College of Pharmacy, Etawah, Uttar Pradesh, India
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