This protocol covers the management of autosomal dominant polycystic kidney disease (ADPKD) when complicated by kidney cyst infection — a specific clinical scenario defined by fever above 38 °C alongside acute abdominal or flank pain and laboratory signs of infection.
People with ADPKD who present with fever (>38 °C), acute abdominal or flank pain, and an elevated white blood cell count and/or C-reactive protein (CRP) should be worked up for kidney cyst infection. This triad of findings is the diagnostic trigger for this management pathway.
When kidney cyst infection is confirmed in the setting of ADPKD, antibiotic selection must account for the ability of the chosen agent to penetrate cyst fluid. An extended course of antibiotic therapy using a lipid-soluble antibiotic is the recommended approach — a shorter course is not favoured. The primary treatment goal is clinical response with resolution of fever.
DOI: 10.1016/j.kint.2024.07.010
People with ADPKD who present with fever, acute abdominal or flank pain, and increased white blood cells and/or C-reactive protein (CRP) should be worked up for kidney cyst infection (Figure 16).
In people with ADPKD and kidney cyst infection, we suggest treatment with 4–6 weeks of antibiotic therapy rather than a shorter course (2D).
A lipid-soluble antibiotic (e.g., fluoroquinolones, trimethoprim-sulfamethoxazole) should be used to treat kidney cyst infection in people with ADPKD, if possible.
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