Recommendations

  1. We recommend that in current clinical practice, patients with a TKV measurement be categorized in terms of their risk of progression as per the Mayo Clinic classification or other validated clinical tools. We highlight that the application of the Mayo Classification to clinical practice has not yet been delineated; however, it appears to be the most robust clinical prediction tool as it pertains to the important marker of htTKV.
  2. Currently available TKV-based prognostication tools should not be applied to class 2 (atypical morphology) patients, as we suggest that these patients are unlikely to be rapid progressors. Certain patients may require further clinical evaluation.
  3. We suggest that patients who are classified as Mayo class 1C, D, or E be considered to be at risk of rapid progression of their ADPKD renal disease.

Risk Prediction Using Mayo Classification

The proposed Mayo Classification defines groups of patients with different risks for eGFR decline.29 As shown in Figure 2A, class 1 patients are categorized into subclasses 1A through 1E based on htTKV and age at baseline, which, in turn, predicts decline in eGFR, as shown in Figure 2B. The Mayo Classification, although a useful clinical tool, was developed with the aim of identifying patients eligible to participate in clinical trials.