Management of Kidney Stones in ADPKD

Medical Management

• Medical management of nephrolithiasis in ADPKD patients should follow the same protocols used in the general population, but obstructing stones require referral to specialized centers with expertise in ADPKD due to increased technical complexity 1

Diagnostic Approach

• Ultrasonography is the first-line imaging modality to rule out stones or urinary tract obstruction 2
• Investigate additional risk factors for stone disease when stones are identified 2

Critical Clinical Considerations

• UTIs must be differentiated from cyst hemorrhage or kidney stones in ADPKD patients presenting with pain 3
• Recurrent gross hematuria before age 30-35 years is associated with worse renal survival and may indicate higher stone risk 2

Special Considerations with Tolvaptan

• Tolvaptan reduces the incidence of kidney stones in ADPKD patients (demonstrated in TEMPO 3:4 trial) 4
• Tolvaptan must be interrupted during stone episodes if volume depletion risk exists 4

Referral Indications

• Obstructing kidney stones mandate management by centers of expertise due to the technical challenges posed by massively enlarged polycystic kidneys, difficulty in anatomical localization, and increased complication risk 1
• Complicated nephrolithiasis may also be an indication for native nephrectomy in transplant candidates, though this should only occur at or after transplantation 4