Figure 930

Autosomal-dominant polycystic kidney disease (ADPKD): renal replacement therapy. Transplantation nowadays is considered in any ADPKD patient with a life expectancy of more than 5 years and with no contraindications to surgery or immunosuppression. Pretransplant workup should include abdominal CT, echocardiogra-phy, myocardial stress scintigraphy, and, if needed (see Figure 9-26), screening for intracranial aneurysm. Pretransplant nephrectomy is advised for patients with a history of renal cyst infection, particularly if the infections were recent, recurrent, or severe. Patients not eligible for transplantation may opt for hemodialysis or peritoneal dialysis. Although kidney size is rarely an impediment to peritoneal dialysis, this option is less desirable for patients with very large kidneys, because their volume may reduce the exchangeable surface area and the tolerance for abdominal distension. Outcome for ADPKD patients following renal replacement therapy is similar to that of matched patients with another primary renal disease [29, 30].

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