This protocol addresses the next step for patients with ADPKD who experience persistent chronic kidney pain — flank, abdominal, or back pain lasting longer than 3 months — that has not responded adequately to first-line pharmacologic treatment.
Chronic flank, abdominal, or back pain related to the kidneys in a person with ADPKD, present for more than 3 months, and not adequately controlled by nonpharmacologic measures or first-line pharmacologic therapy. A stepwise escalation of analgesic treatment is indicated at this stage.
The previous treatment line consisted of acetaminophen as the primary analgesic, with tricyclic antidepressants or gabapentin as analgesic adjuvants. This regimen failed to achieve the treatment goal: adequate relief of chronic kidney pain. The present protocol defines the structured next-line approach following this failure.
This protocol incorporates an alternative analgesic agent that may be used as either a next-line or adjunctive option, along with a second-choice agent reserved for situations in which the preceding therapies are not effective or are contraindicated. The complete regimen — including sequencing, selection criteria, and monitoring — is available in the full structured protocol.
Adequate relief of chronic kidney pain.
DOI: 10.1016/j.kint.2024.07.010