Polycystic Kidney Disease Treatment in Malaysia

• Clinical assessment:
  • Medical and Nephrological Evaluation: A detailed history assesses family history of PKD, blood pressure, urinary symptoms, flank or abdominal pain, kidney stones, urinary infections, blood in the urine and symptoms of declining kidney function.
  • Kidney Function Assessment: Blood tests, including serum creatinine and estimated glomerular filtration rate (eGFR), assess kidney function. Urinalysis and urine protein or albumin measurements may help identify additional kidney abnormalities.
  • Blood Pressure Assessment: Regular blood-pressure measurement is important because hypertension is common in ADPKD and can contribute to faster kidney-function decline and cardiovascular complications.
  • Family and Genetic Assessment: A detailed family history can help identify inherited disease. Genetic testing may be considered when the diagnosis is uncertain, when there is no clear family history, for selected living kidney donors, or when information is needed for family or reproductive counselling.
  • Risk and Prognostic Assessment: In adults with ADPKD, clinicians may assess the likelihood of rapid progression using kidney size, eGFR trajectory, age, and the PROPKD score. These assessments can help determine whether to consider disease-modifying treatment.
• Imaging Tests:
  • Renal Ultrasound: Commonly used to detect kidney cysts and assess kidney size and structure.
  • Magnetic Resonance Imaging (MRI): Provides detailed assessment of kidney and cyst volume and can support Mayo Imaging Classification for risk stratification.
  • Computed Tomography (CT): May provide detailed anatomical information and can help evaluate kidney stones, bleeding, cyst complications or other abdominal conditions. Low-dose CT may also be considered for kidney-volume assessment when MRI is unavailable or unsuitable.
  • Liver Imaging: Ultrasound, CT, or MRI may evaluate liver cysts and other abdominal complications.
  • Brain Vascular Imaging: Magnetic resonance angiography (MRA) may be considered in selected patients to evaluate intracranial aneurysms, particularly when clinical or family-history factors indicate increased risk.

MediRehab (a chain of Rehab centres, part of MediGence) provides comprehensive tele-rehabilitation services designed to support Polycystic Kidney Disease patients in Malaysia. These Services include:

• Physical Activity and Exercise: Regular, appropriate physical activity can help maintain strength, cardiovascular health and healthy body weight. Adapt activities when enlarged kidneys, pain, or other complications limit certain movements.
• Pain and Mobility Management: Physiotherapy may help patients manage chronic musculoskeletal discomfort, improve posture and maintain safe mobility. Patients with significantly enlarged or symptomatic kidneys may need individual assessment for high-impact or contact activities.
• Nutritional Support: A renal dietitian can guide sodium intake, healthy weight management, hydration, and other dietary considerations based on kidney function and blood pressure.
• Fatigue and Energy Management: Activity planning, adequate sleep, appropriate exercise and management of anemia or advanced kidney disease can help reduce the effect of fatigue on daily activities.
• Psychological and Long-Term Support: Counselling, genetic counselling and patient education can help individuals and families cope with an inherited condition, long-term monitoring, reproductive considerations and the possibility of future kidney replacement therapy.

• Medicines for PKD are used to control blood pressure, manage symptoms and, in selected patients with rapidly progressive ADPKD, slow the decline in kidney function. ACE inhibitors or ARBs may be used for blood-pressure control, while other antihypertensive medicines may be added when required. Prescribers may prescribe pain medicines and antibiotics for cyst-related pain, infections, or other complications, depending on the underlying cause.