A 36-year-old woman was seen in a renal clinic for follow up of her autosomal dominant polycystic kidney disease (ADPKD). She was in good health and had no other medical conditions. On imaging, the right kidney measured 20.5 cm in length and the left kidney measured 18.5 cm in length (Figure 1). Total kidney volume (TKV) adjusted by height was 665.2 mL/m. Her ADPKD risk classification was 1C based on TKV. Her serum creatinine was 1.1 mg/dL and her estimated glomerular filtrate rate (eGFR) was 67 mL/min/1.73 m2. Her urine albumin-to-creatinine ratio was 320 mg/g. Liver function tests were normal.

Her blood pressure was well controlled, and less than 110/75 mm Hg on low-dose lisinopril. She reported that she was currently working from home, allowing her to better control dietary salt intake and maintain water intake of at least 3 liters a day. A 24-hour urine test was performed recently and results are listed below:

  • Urine volume 3.5 L
  • Urine osmolality 230 mosmol/L
  • Urine sodium 85 mmol/day (equals 1.9 g/day) She would like to know what additional therapeutic options are available to her.

Figure 1. Large kidneys with many cysts were observed on MRI of the abdomen.

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