MRCP2-4034
A 40-year-old man presents to renal clinic for a follow-up appointment. He has been under surveillance for autosomal dominant polycystic kidney disease for the past 8 years. The patient is currently asymptomatic but worried about the ongoing decline in his renal function as monitored by his general practitioner. He has no significant medical history and is not allergic to any medications. The patient is taking ramipril 5 mg daily.
During the clinical examination, bilateral palpable kidneys with a euvolaemic fluid status were noted. The patient’s blood pressure in clinic was 110/75 mmHg. The following are the serial renal function and ultrasound results over the period of follow-up:
Date Estimated glomerular filtration rate mL/min/1.73 m3
8 years previous 68
5 years previous 62
2 years previous 59
Present 41
Date Increase in total kidney volume relative to previous measurement
8 years previous +2%
5 years previous +2%
2 years previous +7%
Present +12%
What is the appropriate management plan to slow down the rate of decline in the patient’s renal function?