Interpretation of key points in 2025 KDIGO Clinical Practice Guideline for the Evaluation，Management，and Treatment of Autosomal Dominant Polycystic Kidney Disease

doi:10.16150/j.1671-2870.2025.03.003

Abstract

Abstract:

Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common hereditary renal cystic disorders and a major cause of end-stage renal disease requiring renal replacement therapy. In February 2025, Kidney Disease: Improving Global Outcomes (KDIGO) released the first clinical practice guideline specifically for ADPKD entitled "KDIGO Clinical Practice Guideline for the Evaluation, Management, and Treatment of Autosomal Dominant Polycystic Kidney Disease". The guideline comprises 10 chapters covering nomenclature, diagnosis, prognosis, and prevalence of ADPKD; renal manifestations; management and progression of chronic kidney disease, renal failure, and renal replacement therapy; treatments to delay renal disease progression; polycystic liver disease; intracranial aneurysms and other extrarenal manifestations; lifestyle and psychosocial considerations; pregnancy and reproductive problems; pediatric problems; and approaches to ADPKD patient management. It highlights early diagnosis, risk stratification, integrated management, and application of the new drug tolvaptan. Additionally, the guideline introduces a new nomenclature system based on pathogenic genes for the first time, along with more stringent blood pressure management plans. By integrating guideline highlights, evidence-based medicine, and China's clinical practice, this study interprets two key clinical issues in the updated guideline: "early diagnosis and risk stratification of ADPKD" and "treatment and daily management of kidney-related symptoms." A thorough analysis of the guideline's implications and limitations is conducted, aiming to promote standardized diagnosis and therapy for ADPKD.

Key words: Kidney Disease: Improving Global Outcomes, Autosomal dominant polycystic kidney disease, Evaluation, Management, Guideline

CLC Number:

R596
R692

WU Shuangcheng, YU Shengqiang. Interpretation of key points in 2025 KDIGO Clinical Practice Guideline for the Evaluation，Management，and Treatment of Autosomal Dominant Polycystic Kidney Disease[J]. Journal of Diagnostics Concepts & Practice, 2025, 24(03): 255-262.

Figures/Tables 4

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诊断方法	年龄	诊断标准	排除标准
超声检查	15~39岁	总囊肿数≥3个	总囊肿数<1个
	40~59岁	每侧肾囊肿数≥2个	总囊肿数<2个
	≥60岁	每侧肾囊肿数≥4个	-
MRI检查	16~40岁	总囊肿数>10个	总囊肿数<5个

年龄	基本情况	推荐目标
18~49岁	CKD G1-G2，血压>130/85 mmHg	家测血压（如耐受）<110/75 mmHg
	CKD G1-G2，血压（110/75）~（130/85） mmHg	个体化控制
	CKD G3-G5	收缩压（如耐受）<120 mmHg
≥50岁	CKD G1-G5	收缩压（如耐受）<120 mmHg