Polycystic Kidney Disease (ADPKD) — Viva Defence

Opening statement (SASPOP, delivered aloud)

"Ms Kowalski is a 40-year-old woman with ADPKD whose disease is now demonstrably fast: her eGFR has fallen 16 mL/min over 4 years, and her height-adjusted total kidney volume places her in Mayo class 1D — a rapid-progression class — on typical bilateral imaging. Her main problems are: rapid progression with enough preserved function to protect, which makes her a genuine tolvaptan candidate under the TEMPO and REPRISE evidence; a family history of intracranial aneurysm in an affected sister, which is a selective-screening indication she has not yet acted on; hypertension that is currently well controlled on an ACE inhibitor; and a young family in whom the inheritance question is unresolved. My plan is to confirm her progression stage, run the tolvaptan shared-decision conversation properly — benefit quantified against aquaresis, monitoring and cost — arrange her MR angiography, and open the family counselling with her children's testing deferred until they can decide for themselves." ^{[1] [2] [5]}