When to Opt for Imaging When Presented with Pain, Early Onset Hypertension


Dr. Neera Dahl explains that patients with autosomal dominant polycystic kidney disease (ADPKD) are often referred to a nephrologist when imaging is done for another concern.

High blood pressure, or hypertension, is associated with a multitude conditions and can be an early marker of autosomal dominant polycystic kidney disease (ADPKD), according to Neera Dahl, MD, PhD, Director, Nephrology Clinical Trials Program, Professor of Medicine, Yale School of Medicine, Section of Nephrology.

"Often when the patients get referred to us, it's because the imaging was done for a different reason," she said in an interview with HCPLive.

While ADPKD is a commom inherited condition it can go undiagnosed until the cysts start to impact kidney function and symptoms begin to present. However, primary symptoms like back and abdominal pain, or hypertension are nonspecific without a diagnosis. Dahl emphasized the importance of routine workups and the need for imaging.

"The key is—if you see big cystic kidneys—to think that this could be a genetic disease and that those patients should be referred."

Primary Care Physicians (PCPs) have a pivotal role in identifying the signs of the disease because primary care is typically the first place a patient goes. Because ADPKD is a progressive disease, it's best to opt for imaging and refer a patient to a nephrologist for further evaluation or to begin treatment as early as possible.

"If there's a CT, or an ultrasound, or some kind of imaging that was done that shows that there are cysts in the kidneys, then we would like to see the patient at that point," Dahl said. "And the reason is, what we really are focused on now from a nephrology perspective is providing prognostic information to that patient."

Based on the kidney size, clinical features, and sometimes the genotype nephrologists have the ability to assess the risk of end stage kidney disease. With specific therapy for ADPKD available, the goal is to get that therapy to the patients who need it at the initial diagnosis.

"The message is: if you see someone with early onset hypertension, think of that secondary hypertension workup and really consider getting kidney imaging to make sure that there isn't PKD, especially if there's a family history of kidney disease—that would be important," Dahl said.

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