Which of the following is the first step in treating autosomal dominant polycystic kidney disease?

In treating autosomal dominant polycystic kidney disease (ADPKD), the first step focuses on managing one of its most significant complications: hypertension. Patients with ADPKD often experience high blood pressure due to multiple mechanisms, including increased renin production and vascular changes associated with renal cysts.

Using antihypertensive medications, especially angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), is essential not only because they help to control blood pressure effectively, but they also provide renoprotective benefits. ACE inhibitors and ARBs may slow the progression of kidney disease in patients with ADPKD by reducing glomerular hypertension and hyperfiltration.

While antibiotics might be indicated for urinary tract infections that can occur in patients with cystic kidney disease, treating infections does not address the underlying progression of the disease itself. Dialysis management is generally reserved for advanced renal failure, which would occur much later in the disease course. Dietary modifications can be beneficial as part of a comprehensive management plan but do not serve as a first-line intervention by themselves in the management of ADPKD. Focusing on controlling hypertension with appropriate medications provides a foundation for managing the disease effectively.