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The patient with polycystic kidney disease (PKD) may experience one or more complications, including pain, hypertension, urinary tract infections, hematuria, and kidney stones. Each complication is managed individually.

Pain

Pain in polycystic kidney disease is attributable to many sources and may be treated in different ways. Evaluating pain for duration, location, and which positions bring relief can help delineate the source of the pain and help determine treatment options.

Since chronic pain is usually very difficult to treat, it is important for patients not to raise their level of expectation to becoming pain free. Treatments used to alleviate pain include:

• Benign therapies
• Drug therapy
• Surgery

Benign Therapies

• Hot compresses
• Massage
• Behavior modification
• Physical therapy for spinal pain

Drug Therapy

• Acetaminophen (e.g., Tylenol) is the least potentially toxic agent and is the first analgesic of choice recommended by the National Kidney Foundation
• NSAIDs (non-steroidal anti-inflammatory drugs) are used with caution since extended use can be toxic for people with kidney damage or impaired renal function. NSAIDs are usually not the first-line of treatment because of their potential effect on blood pressure and other parameters of PKD. When they are used, the duration and dosage of treatment may be minimized to avoid adverse side effects.
• Tramadol - a pain reliever
• Clonidine - often used together with spinal blocks to prolong and intensify the effects of anesthesia
• Narcotics can be administered orally or transdermally such as in Fentanyl patches.
• Injection of opioids into the area surrounding the spinal cord - A catheter may be implanted for long term delivery of opioid medications. This is an invasive procedure and is usually employed only after other interventions have failed to achieve adequate results. It is very important that a skilled, experienced physician perform this procedure.

Surgery

If pain from renal infections and other complications related to polycystic disease does not resolve from conservative treatments, surgery may be an option for relief of the PKD patient. While open surgery is still widely performed, increasing numbers of surgeons are using laparoscopic (minimally invasive) procedures because they are associated with fewer complications and shorter hospitalization. Most surgical options for PKD provide temporary relief and do not prevent growth and development of new cysts.

Surgical intervention may also be indicated if the liver becomes very enlarged due to large cysts. Procedures range from unroofing the cysts to partial removal of the liver (hepatectomy).

It is important for the patient undergoing any surgical procedure to carefully check the experience and qualifications of the surgeon being considered to perform the operation.

There are several different types of surgical procedures undertaken for treatment of PKD:

• Surgical Drainage of Cysts/Cyst Decompression - This surgery reduces the size of the cysts and the resulting pressure. There are several techniques that are used to decompress the cysts. One of them involves decortication (unroofing and drainage) where cysts are opened and drained if they are infected, bleeding, not responding to other pain relieving measure, or are causing an obstruction. No studies have proven long-term efficacy for this type of surgery and the medical opinion is that the dangers outweigh temporary benefit.