ADPKD Chronic Kidney Pain Unresponsive to Opioids or Minimally Invasive Therapies
This protocol applies to people with autosomal dominant polycystic kidney disease (ADPKD) who continue to experience severe, intractable chronic kidney pain — flank, abdominal, or back pain lasting longer than 3 months — despite having progressed through earlier lines of pain management without adequate relief.
Clinical scenario
Chronic flank, abdominal, or back pain thought to be related to the kidneys, lasting longer than 3 months, in a person with ADPKD. Management follows a stepwise approach, escalating when each line fails to provide adequate relief.
Previous treatment line — failure condition
The prior step employed opioids or minimally invasive therapies, indicated for individuals who had not responded to non-opioid or non-invasive options. The treatment goal — adequate relief of chronic kidney pain — was not achieved, necessitating escalation to this next line.
Next-step approach
For selected individuals with severe intractable chronic kidney pain that has not responded to other modalities, the approach at this stage involves a definitive surgical intervention — typically reserved for those with advanced kidney disease or in the context of kidney failure. The goal remains adequate relief of chronic kidney pain. Full eligibility criteria and clinical decision guidance are detailed in the complete protocol.
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.
Nephrectomy is a treatment option reserved for severe intractable chronic kidney pain in selected people, typically with advanced kidney disease or after kidney failure, who have failed to respond to other modalities.
DOI: 10.1016/j.kint.2024.07.010
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