Improve and remove
Improve and remove
This thesis of Paul Geertsema investigates autosomal dominant polycystic kidney disease (ADPKD), a hereditary disorder characterized by early development of multiple kidney cysts that enlarge over time, causing pain, infections, gastrointestinal symptoms, bleeding, kidney stones, and gradual loss of kidney function. Since 2017, tolvaptan has been available to slow disease progression, delaying end-stage renal failure by about one year after four years of treatment, though it causes “aquaretic” side effects such as high urine output, thirst, and nocturia.
Long-term tolvaptan therapy reduces kidney function decline by up to 24% compared with untreated controls, with stronger effects in patients showing greater vasopressin blockade. Dietary reduction of salt and protein modestly decreases urine volume by 11%, especially in those with high baseline output.
A restrictive approach to pre-transplant nephrectomy is supported: only about one-third of patients require kidney removal before transplantation, with no difference in survival or surgical complications compared to post-transplant procedures. Quality of life improves after transplantation and nephrectomy regardless of timing, and bilateral nephrectomy yields better physical outcomes than unilateral removal.
A systematic review and collaboration with European kidney and urology societies produced a guideline recommending routine imaging to assess kidney size, shared decision-making, a preference for unilateral minimally invasive surgery when space is limited, and the practice point that prophylactic nephrectomy before transplantation is unnecessary.
Finally, a stepwise, multidisciplinary pain management protocol (from non-pharmacologic to surgical interventions) effectively reduced pain and opioid use in patients with chronic kidney-related pain, demonstrating broader applicability beyond ADPKD.