What is it?
Polycystic kidney disease (PKD) is the name for a range of life-threatening inherited disorders that can cause kidney failure and damage to other organs.
Faulty genes cause fluid-filled cysts to develop and grow in the kidneys. This can happen at any point during childhood or adulthood and as they get bigger they cause the kidneys to enlarge – sometimes to three or four times their normal size.
In the UK there are about 70,000 adults and children with PKD. It affects both sexes and all races equally. It can sometimes be life-threatening.
Causes
The two major forms of PKD are:
- Autosomal dominant polycystic kidney disease (ADPKD)
- Autosomal recessive polycystic kidney disease (ARPKD)
ADPKD is the most common form of PKD and the most common inherited condition to affect the kidneys. Cysts tend to develop in the kidneys and liver (and sometimes the pancreas) in late childhood or early adulthood.
It is caused by mutations in genes called PKD1 and PKD2. There is a one in two (50%) chance that an affected parent will pass on ADPKD to their child, but sometimes it can occur for the first time in a person with no family history of the condition. This new mutation can then be passed to the next generation.
Symptoms
When the cysts have multiplied and enlarged they can caused a range of symptoms including:
- a swollen stomach
- pain in the abdomen, side or back
- blood in urine caused by blood vessel breakage in the cysts or possible kidney damage
- high blood pressure
- fever caused by a cyst infection
- potentially serious urinary tract infections (UTIs) caused by a possible cyst infection
- kidney stones
- cystic liver disease is a frequent finding alongside ADPKD, and may increase problems with abdominal swelling and pain.
- very rarely, ADPKD can cause abnormal blood vessels within the brain, which may cause bleeding into the brain (brain haemorrhage)
Diagnosis
Imaging tests (such as abdominal ultrasound, CT or MRI scans) may be used to confirm the presence of cysts in your kidneys or other organs. Blood and urine tests will also be used to gauge your kidney function and look for the presence of protein in your urine – a sign of kidney damage.
Diagnosis of your particular type of ADPKD usually requires analysis of your DNA. A kidney specialist will be able to give you advice about the chances of family members being affected, and whether screening should be offered to them.
Treatment
ADPKD is now commonly treated by a drug called Tolvaptan, which has been available across the UK since early 2016. Tolvaptan slows the progression of cyst development and helps protect kidney function. In most cases this is likely to significantly delay the need for dialysis or a kidney transplant for ADPKD patients.
Other treatments may also include:
- medications such as ACE Inhibitors and ARBs to control blood pressure.
- painkillers such as paracetamol for loin pains – but you may be advised to avoid non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen and diclofenac which can reduce the blood supply to the kidneys.
- antibiotics (to treat any UTIs).
- a range of methods to break up and remove kidney stones.
You may also be advised to:
- exercise regularly but avoid contact sports (such as rugby or football) which could cause cysts to rupture and bleed.
- eat a healthy balanced low-salt diet.
ARPKD
ARPKD is a rare condition caused by a genetic fault that disrupts normal development of the kidneys and liver. It may present in very young children or later in adulthood. Over time one or more of these organs may fail. Whilst there is no cure for ARPKD, there are various treatments that can help manage the disease, including dialysis and kidney transplantation. The PKD Charity website https://www.pkdcharity.org.uk/about-arpkd contains more information.
Resources
If you have been diagnosed with PKD and have any questions or concerns about your illness, don’t hesitate to speak to your kidney specialist or your nurse specialist at your kidney unit.
- You can also find further information, advice and helpful tips in our Just diagnosed and How can I help myself? sections.
- The PKD Charity was established in December 2000 by patients, professionals and members of families affected by PKD.
- ADPKD – NHS: https://www.nhs.uk/conditions/autosomal-dominant-polycystic-kidney-disease-adpkd/
- ADPKD – RareRenal.org http://rarerenal.org/patient-information/autosomal-dominant-polycystic-kidney-disease-patient-information/
Reviewed April 2019
"I'm delighted to be funded by Kidney Research UK to develop our drug repurposing programme to now include preclinical testing in organoid models.”
Professor Colin Johnson
Researcher spotlight
Professor Colin A Johnson and his team are looking for novel treatments for autosomal dominant polycystic kidney disease (ADPKD).
Their approach is looking to use drugs that are already used in one condition in the treatment of another condition, it is known as repurposing and could be faster and cheaper than developing a totally new drug.
Colin's research could result in much needed novel treatments for ADPKD.
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