INTERNATIONAL RENAL MEETING AND MAYO CLINIC DAY IN SARDINIA - - PowerPoint PPT Presentation

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INTERNATIONAL RENAL MEETING AND MAYO CLINIC DAY IN SARDINIA - - PowerPoint PPT Presentation

Mar 09, 2024 225 likes •354 views

INTERNATIONAL RENAL MEETING AND MAYO CLINIC DAY IN SARDINIA AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE 1. THERAPEUTIC ROLE OF mTOR INHIBITORS 2. TESTING OF RELATIVES AT RISK: ASYMPTOMATIC CHILDREN 3. HYPERTENSION: WHICH IS THE BEST

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SLIDE 1

AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE

INTERNATIONAL RENAL MEETING AND MAYO CLINIC DAY IN SARDINIA

1. THERAPEUTIC ROLE OF mTOR INHIBITORS 2. TESTING OF RELATIVES AT RISK: ASYMPTOMATIC CHILDREN 3. HYPERTENSION: WHICH IS THE BEST METHOD OF MONITORING BP?

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SLIDE 2

Sirolimus at a daily target dose of 2 mg did not halt polycystic kidney growth Everolimus slowed the increase in TKV but did not slow the progression of renal impairment

mTOR INHIBITORS IN ADPKD

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SLIDE 3

mTOR INHIBITORS IN ADPKD

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SLIDE 4

Do mTOR inhibitors still have a future in ADPKD?

(Perico and Remuzzi, 2010)

mTOR INHIBITORS IN ADPKD

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SLIDE 5

TESTING OF RELATIVES AT RISK

At present, there is no indication for testing

  • f asymptomatic children.

This may change in the future, if and when effective therapies are found.

Harris PC and Torres VE, GeneReviews, 2011

ADPKD IN CHILDREN

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SLIDE 6

ADPKD and HYPERTENSION IN CHILDREN

  • HYPERTENSION: 10-20% of ADPKD children
  • AMBULATORY BP MEASUREMENT (ABPM): 34% of hypertension
  • OFFICE BP MEASUREMENT: 16%
  • NON-DIPPERS: 25% of ADPKD boy

Chapman, 2010; Cadnapaphornchai, 2009

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SLIDE 7

HYPERTENSIVE ADPKD CHILDREN ARE AT HIGH RISK FOR DECREASED RENAL FUNCTION

Cadnapaphornchai M A et al. CJASN 2009;4:820-829

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SLIDE 8

HYPERTENSION IN ADPKD CHILDREN

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SLIDE 9

ADPKD IN CHILDREN

TESTING OF RELATIVES AT RISK

Should we change the traditional approach? Should we check children of ADPKD families for blood pressure?

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SLIDE 10

HYPERTENSION IS ASSOCIATED WITH A FASTER PROGRESSION TO ESRD. Gabow, 1992

HYPERTENSION: A MODIFIABLE RISK FACTOR IN ADPKD

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SLIDE 11

CURRENT APPROACHES TO THE ANTI-HYPERTENSIVE TREATMENT 1)early recognition of hypertension 2)aggressive control of BP (< 130/80 mmHg ) 3) inhibitors of the RAAS: first line 4)appropriate lifestyle modifications

HYPERTENSION IN ADPKD ADULTS

WAITING FOR THE RESULTS OF HALT PKD CLINICAL TRIALS (2013)

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SLIDE 12
  • 1. OFFICE BLOOD PRESSURE MONITORING (OBPM)

White Coat Hypertension (30%) 717mmHg higher for SBP 514mmHg higher for DBP vs. ABPM and HBPM

  • 2. HOME BLOOD PRESSURE MONITORING (HBPM)

Frequency of hypertension measured by HBPM not determined Predict End-organ Damage more Reliably than OBPM More Reproducible than OBPM

  • 3. 24-H AMBULATORY BLOOD PRESSURE MONITORING

(ABPM)

Circadian Differences in Blood Pressure Nondipping Associated with End-organ Damage

WHICH IS THE BEST NON-INVASIVE METHODS OF BP MONITORING?