MedifocusHealth

• Removal of Kidney Stones and/or Ureteral Stones - Small kidney stones can be removed using extracorporeal shock wave lithotripsy (SWL). During this procedure, performed on an outpatient basis under intravenous sedation, sound waves are directed at the targeted stone reducing it to small particles that are easily passed through the urine.
  
  If the patient does not respond to SWL (approximately 10-20% of patients) or if the stone is too large for SWL, the surgeon may opt for:

  • Ureteroscopy - uses laser to fragment the stone via an instrument passed through the ureter

  • Percutaneous surgery - a small incision in the back provides direct access to the kidney for removal of the stones

  • Nephrectomy - Removal of both kidneys is an option in patients receiving dialysis or a kidney transplant. This procedure may be performed either as open or laparoscopic surgery.

Hypertension

High blood pressure puts additional strain on the kidneys since they have to work even harder to get rid of the extra salt and water in the blood. Control of blood pressure is a cornerstone of therapy for PKD since evidence suggests that it may slow the loss of kidney function.

There are two types of medications that are used to reduce blood pressure antihypertensive medications and diuretics.

Antihypertensive Medications

• Angiotensin Converting Enzyme (ACE) Inhibitors

  • Captopril
  • Enalapril
  • Lisinopril

Side effects of ACE inhibitors may include: dry cough; diarrhea; headache; loss of taste or a taste of stainless steel in your mouth; loss of appetite; upset stomach; skin that is sensitive to sunlight; fatigue; dizziness, lightheadedness, or fainting; fever; joint pain; numbness or tingling in hands or feet.

• Angiotensin II receptor blockers

  • Losartin
  • Irbesartan
  • Candesartan

Side effects may include: headache; cough; fever; sore throat; dizziness; back pain; diarrhea; fatigue; upset stomach; nervousness; heartburn.

Debate continues regarding which type of medication (ACE inhibitors or Angiotensin II receptor blockers) is more effective for controlling hypertension in PKD and which is more effective in slowing the progression to chronic renal failure. Researchers are examining the possibility that both types of drugs combined may be more effective than either drug given alone.

The general consensus is that therapy for hypertension should begin as soon as there is any indication of elevated blood pressure. There are some indications that early treatment may also reduce ventricular hypertrophy (enlarged ventricles of the heart) in patients who are hypertensive.

• Diuretics

  • Aquatensen
  • Hydromax

Diuretic medications lower the amount of salt and water in the body by increasing urine output thereby reducing blood pressure. Patients taking diuretics must be carefully monitored to prevent dehydration.

Side effects may include: weakness; muscle cramps; skin rash; increased sensitivity to sunlight; nausea/vomiting; diarrhea; cramps; dizziness or lightheadedness; joint pain; impotence or decreased sexual desire; irregular heartbeat (arrhythmia).

Urinary Tract Infections

Patients with polycystic kidney disease, especially women, tend to have frequent urinary tract infections (UTI). It is important to begin treatment with antibiotics at the earliest sign of infection in order to prevent the spreading of bacteria from the urinary tract back up to the kidney and into the cysts. Urinary tract infections are treated with special antibiotics that are effective in penetrating cysts. In some resistant cases that do not respond to antibiotics, surgical drainage of the infected cysts (which may be the source of infection) may be necessary.