Management of Autosomal Dominant Polycystic Kidney Disease (ADPKD) During Pregnancy: Risks and Challenges

Figures & data

Figure 1 Prognosis of CKD by GFR and Albuminuria Categories.

Notes: Green indicates low risk, yellow indicates moderate risk, orange indicates high risk, red indicates very high risk. Image reproduced with permission from NKF KDOGI Guidelines 2012. Available from https://kdigo.org/guidelines/ckd-evaluation-and-management/⁸

Abbreviations: CKD, chronic kidney disease; GFR, glomerular filtration rate; KDIGO, Kidney Disease: Improving Global Outcomes.

Figure 2 Algorithm for Pregnancy Management in Women with ADPKD.

Abbreviations: ADPKD, autosomal dominant polycystic kidney disease; CKD, chronic kidney disease; PGD, pre-implantation genetic diagnosis; BP, blood pressure; UTI, urinary tract infection; ACEi, angiotensin-converting enzyme; ARB, angiotensin receptor blocker; ICA, intra-cranial aneurysm; TKV, total kidney volume.

Figure 3 Suggested model of pregnancy care for women with ADPKD.

Abbreviations: ADPKD, autosomal dominant polycystic kidney disease; PGD, pre-implantation genetic diagnosis.

Table 1 Preferred Antihypertensive Medications in Pregnancy. Adapted from SOMANZ⁵¹ and Hypertension Canada⁶⁴ Guidelines of Hypertension Management in Pregnancy. Additional Information sourced from Australian Medicines Handbook⁷⁶

Antihypertensive Medication	Dosage		Mechanism of Action		Contra-Indications	Practice Points/Side Effects
First Line
Labetalol	100–400mg TDS		Non-selective beta-blocker with mild alpha vasodilator effect		Bradycardia, heart block, bronchospasm	Side effects include bradycardia, bronchospasm, headache, nausea, scalp tingling
Nifedipine XR	20–60mg BD		Dihydropyridine calcium channel blocker		Aortic stenosis	Side effects include headache, flushing, constipation, peripheral oedema, tachycardia
Methyl-dopa	250–750mg TDS		Centrally acting alpha adrenergic agonist		Depression	Slow onset of action Side effects include dry mouth, sedation, blurred vision, and depression (recommend ceased early in the post-partum period)
Second-Line
Clonidine	75–300 µg TDS		Centrally acting alpha antagonist		Bradycardia, depression	Withdrawal effects with rebound hypertension; Avoid in breastfeeding (may cause reduced prolactin)
Hydralazine	25–50 mg q8H		Arteriolar vasodilator		Idiopathic SLE/related diseases	Side effects include flushing, headache, nausea, oedema, reflex tachycardia
Prazosin	0.5–5mg TDS		Alpha-1 blocker		Aortic stenosis	First-dose hypotension, orthostatic hypotension

Abbreviations: BD, twice daily; TDS, three times daily; q8H, 8 hourly; SLE, systemic lupus erythematosus.

Table 2 Summary of Causes of Acute Abdominal Pain in Pregnancy

Obstetric	Non-Obstetric	Exacerbated by Pregnancy	Extra-Abdominal
Early Pregnancy: Ectopic pregnancy Molar pregnancy Ovarian cyst: torsion, hemorrhage, rupture Degeneration of uterine fibroids Round ligament pain Late Pregnancy: Placental abruption Acute fatty liver of pregnancy Abdominal pregnancy Hemolysis elevated liver enzymes low platelet count syndrome Preeclampsia Ruptured uterus Fibroid degeneration Fallopian tube torsion Uterine torsion Ruptured rectus muscle Polyhydramnios Symphysis diastasis Intraperitoneal bleed	Surgical: Appendicitis Cholecystitis Biliary colic Acute pancreatitis Peptic ulcer Urolithiasis Intestinal obstruction Inflammatory bowel disease Ruptured aneurysm, including of splenic artery Trauma Medical: Gastroenteritis Porphyria Sickle cell crisis Deep vein thrombosis Cystic complications including rupture, hemorrhage and infection in ADPKD	Gastro-esophageal reflux disease Gallbladder disease Cystitis Pyelonephritis Musculoskeletal pain	Cardiac pain Non-specific abdominal pain Pleuritic pain Psychological drug abuse or withdrawal Herpes zoster infection

Note: Copyright © 2019. Adapted from Zachariah SK, Fenn M, Jacob K, Arthungal SA, Zachariah SA. Management of acute abdomen in pregnancy: current perspectives. Int J Womens Health. 2019;11:119–134.⁹¹

Abbreviation: ADPKD, Autosomal dominant polycystic kidney disease.

Inker LA, Astor BC, Fox CH, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. Am J Kidney Dis. 2014;63(5):713–735. doi:10.1053/j.ajkd.2014.01.416

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Zachariah SK, Fenn M, Jacob K, Arthungal SA, Zachariah SA. Management of acute abdomen in pregnancy: current perspectives. Int J Womens Health. 2019;11:119–134. doi:10.2147/IJWH.S151501

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