ADPKD with Persistent Chronic Kidney Pain After Tramadol and Clonidine

This protocol applies to patients with autosomal dominant polycystic kidney disease (ADPKD) who have ongoing chronic flank, abdominal, or back pain related to the kidneys — lasting longer than 3 months — that was not adequately relieved by prior stepwise pharmacologic treatment including tramadol and clonidine.

Clinical scenario

Chronic kidney pain in ADPKD is flank, abdominal, or back pain thought to be related to the kidneys, lasting longer than 3 months. Stepwise pharmacologic treatment is indicated when earlier pharmacologic and noninvasive measures have not adequately relieved pain.

Prior treatment line — goal not achieved

The previous treatment line included tramadol as a next-line or adjunctive analgesic, and clonidine when acetaminophen and tramadol were not effective or were contraindicated.

That line failed to achieve adequate relief of chronic kidney pain, which triggers escalation to this next-step protocol.

Next-step approach (partial)

For patients who have not responded to nonopioid or noninvasive therapies, the evidence-based approach moves to a further tier of intervention. The full selection criteria, decision pathway, and complete options are in the structured protocol — only a partial summary is shown here.

Instant Access to Structured Evidence-Based Regimens

References

Chronic kidney pain in ADPKD is defined as flank, abdominal, or back pain that is thought to be related to the kidneys and lasts longer than 3 months.

Stepwise pharmacologic treatment for chronic kidney pain in people with ADPKD should be implemented when nonpharmacologic, noninvasive interventions do not adequately relieve pain.

Opioids or minimally invasive therapies are options for people with no response to nonopioids or noninvasive therapies (Figure 15).

DOI: 10.1016/j.kint.2024.07.010

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