1. ¹Department of Medicine, University of Colorado School of Medicine, Denver, Colorado
2. ²Denver Health Medical Center, Denver, Colorado

Correspondence: Dr. Robert W. Schrier, University of Colorado Health Sciences Center, 4200 East Ninth Avenue, C283, Denver, CO 80262 E-mail: Robert.Schrier@uchsc.edu

^*This research was supported by grant P01 DK34039 awarded by the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health (Bethesda, MD); grants MO1 RR00051 and M01 RR00069 from the General Clinical Research Centers Program of the National Center for Research Resources, National Institutes of Health; and the Zell Family Foundation, Two North Riverside Plaza, Suite 600, Chicago, IL 60606-2639.

Received 2 December 2003; Revised 10 February 2004; Accepted 9 June 2004.

Abstract

Background: Patients with autosomal dominant polycystic kidney disease (ADPKD) often develop hypertension before any abnormalities in renal function are detected clinically. Therefore, standard screening (serum creatinine and urinalysis) of young individuals with unexplained hypertension to exclude renal parenchymal disease would rarely detect ADPKD.

Methods: Data from 516 subjects with ADPKD (217 male and 299 female), aged newbornto 55 years with a normal serum creatinine and no proteinuria based on urine dipstick, studied between 1985 and 2000, were compared with data from similar subjects from the National Health and Nutrition Examination Survey (NHANES) III (1988–1994) and NHANES IV (1999–2000) data, by gender.

Results: There was a highly significant occurrence of hypertension in young patients with ADPKD when compared to patients aged 20 to 34 years in the U.S. population. The hypertension in patients with ADPKD occurred in the absence of abnormal renal function or abnormal urinalysis.

Conclusions: These data indicate that renal ultrasound screening of young hypertensive individuals (aged 20 to 34 years) should be considered when searching for causes of secondary hypertension. Identifying affected ADPKD individuals early in their disease will permit aggressive blood pressure treatment and early inhibition of the renin-angiotensin-aldosterone system, which has been shown to reverse left ventricular hypertrophy, an important cardiovascular risk factor. In the present era of renal replacement therapy, cardiovascular complications are the main cause of death in patients with ADPKD.