A 40 year old male followed up in renal clinic

A 40 year old male followed up in renal clinic. His creatinine clearance (measured) 76ml/min. A recent USS of his renal tract shows enlarged kidneys bilaterally, multiple renal cysts. His father required dialysis at age of 45 years. On examination, his pressure 149/88 mmHg.Which of following statements incorrect?

1 ) An ACE inhibitor would be appropriate control his hypertension

2 ) He should maintain a high fluid intake

3 ) Ciprofloxacin should be prescribed upper urinary tract infections

4 ) Genetic counselling should be offered

5 ) He should be informed of probable need dialysis in 5 7 years

Comments: This patient Autosomal Dominant Polycystic Kidney Disease (ADPKD). On average, patients progress end stage renal failure between ages of 40 60 years. In these patients renal function usually deteriorates in a gradual fashion, usually a drop in creatinine clearance of 5/6ml/min/year (at least 10 years this patient). Treatment should include a high fluid intake (to prevent formation of renal stones clots) regular follow up of pressure renal function. Loin pain should be treated symptomatically, hypertension should be managed standard anti hypertensive medications. Haematuria should be treated conservatively. Urinary tract infections should be treated lipophillic drugs (e.g. Ciprofloxacin, Trimethoprim sulphamethoxazole) as they have best penetration into cyst fluid. It an autosomal dominant disease, therefore offspring of an affected patient a 50% chance of inheriting disease. The patient should be offered genetic counselling, despite fact disease a variable clinical course even between affected family members.