Pain syndromes in autosomal dominant polycystic kidney disease
- Theodore I Steinman, MD
Theodore I Steinman, MD
- Professor of Medicine
- Harvard Medical School
- Samir M Parikh, MD
Samir M Parikh, MD
- Associate Professor of Medicine
- Harvard Medical School
Over 60 percent of patients with autosomal dominant polycystic kidney disease (ADPKD) have abdominal and flank pain . Abdominal pain is typically related to the kidney cysts but may also be related to liver cysts. Pain may be acute or chronic.
Most patients can be effectively treated, but a minority develop chronic pain that is debilitating .
A thorough history provides the best clues to the underlying cause of pain, and radiographic studies are an important adjunct to making the diagnosis. Pain is often not well managed, because there is the reflex response of many clinicians to give narcotics for complaints of pain without understanding the etiology.
This topic provides an overview of the pathophysiology and common presentations of pain in ADPKD and a stepwise approach to its initial management, focusing on pain related to the kidneys.
The general management and the renal and extrarenal manifestations of ADPKD are discussed separately. (See "Course and treatment of autosomal dominant polycystic kidney disease" and "Renal manifestations of autosomal dominant polycystic kidney disease" and "Extrarenal manifestations of autosomal dominant polycystic kidney disease".)
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- PATHOPHYSIOLOGY OF KIDNEY-RELATED PAIN
- PAIN SYNDROMES
- Acute pain
- - Infection
- - Cyst rupture/hemorrhage
- - Nephrolithiasis
- Chronic pain
- - Renal cysts
- - Hepatic cysts
- - Mechanical back pain
- Abdominal and/or flank pain
- Back pain
- Recurrent pain
- PAIN MANAGEMENT
- Noninvasive approaches
- - Physical maneuvers
- - Non-narcotic analgesics
- - Opioids
- - Other interventions
- Invasive management
- SUMMARY AND RECOMMENDATIONS