Renal Complications: Pain, Infection, and Nephrolithiasis

More than 60% of patients with autosomal dominant polycystic kidney disease (ADPKD) experience abdominal or flank pain of variable severity and frequency during their lifetime. Pain is a vastly under recognized problem, representing a major cause of PKD-related morbidity and having significant impact on patients’ quality of life and productivity. Health-care providers often fail to address pain adequately during brief outpatient clinic visits. Understanding the innervation of the genitourinary tract and the pathophysiology of the comorbid conditions affecting the kidneys in ADPKD is critical in evaluating patient symptoms. In this chapter, we systematically approach PKD-related pain by occurrence patterns (acute versus chronic), as well as by the specific clinico-pathologic setting. This includes the differential diagnosis of acute pain scenarios under the circumstances of cyst infection, hemorrhage, rupture, and nephrolithiasis. Further, we discuss chronic pain syndromes related to individual cyst mass effect, total kidney volume, as well as PKD-specific comorbidities. Diagnostic approaches based on careful history taking and physical examination and prudent use of imaging are outlined. In addition to treatments targeting specific etiologies, a stepwise approach to pharmacologic and non-pharmacologic management of chronic pain is provided.