polycystic kidney disease - usmle68

[ArchivalUser]

A 52-year-old woman comes for a routine evaluation. She was diagnosed with autosomal-dominant polycystic kidney disease (ADPKD) at 25 years of age. She is asymptomatic and has no history of hypertension, hematuria, or infection. Screening tests for cerebral aneurysms have been negative. Two siblings have ADPKD. Her father also had ADPKD and died of a ruptured cerebral aneurysm at 42 years of age. She takes no medications and does not follow a restricted diet.

On physical examination, temperature is normal, blood pressure is 110/72 mm Hg, pulse rate is 72/min, and respiration rate is 16/min. BMI is 28. Cardiopulmonary examination is normal. Abdominal examination reveals no organomegaly.

Laboratory studies:
Complete blood count

Normal
Liver chemistry studies

Normal
Blood urea nitrogen

11 mg/dL (3.9 mmol/L)
Serum creatinine

1.0 mg/dL (88.4 µmol/L)
Urinalysis

Normal
Urine protein-creatinine ratio

0.1 mg/mg

On abdominal ultrasound, the kidneys are 14.5 cm bilaterally. Multiple cysts are seen on the liver. Estimated total kidney volume is 550 cm3 (normal total kidney volume 230 cm3).

Which of the following is the most appropriate next step in this patient’s management?
A.Enalapril
B. Enalapril and low-protein diet
C. Sirolimus
D. No change in management

[ArchivalUser]

DD.

[ArchivalUser]

Yes!...Answer D for me too...

[ArchivalUser]

D is right.
pt has no HTN, no need to treat with ACEIs.
PCKD is not affected by protein intake, therefore, no need to restrict protein in diet.