Once you’ve confirmed an ADPKD diagnosis Taking a holistic assessment can identify appropriate patients for JYNARQUE® (tolvaptan)

Yes No eGFR appears normal Truncating Overweight and obesity, BMI ≥25 kg/m • Hypertension before age 35 • Urologic events before age 35 (gross hematuria, cyst infection, or flank pain related to cysts) • Proteinuria and microalbuminuria • Family history of ESKD at or before age 58 Kidney length 1,5 Total kidney volume (TKV)* Gold Standard Method 4 PKD1 mutation Be on the lookout for any ONE of these independently validated risk factors associated with rapid progression 1,7-9 : >16.5 cm at <45 years means patient is at risk of rapid progression When MRI/CT-calculated TKV is not available, ultrasound can be used to measure kidney length If yes If yes If yes Use htTKV and age to plot along the Mayo Classification chart—a patient in Class 1C, 1D, or 1E is at high risk of rapid progression 2 5,6 5,6 MRI/CT reliably measures kidney size to calculate TKV Kidney size is a strong predictor of risk of rapid progression before eGFR begins to decline 2,3 Other factors There is a significant delay between when evidence of kidney function decline is visible and when kidney damage has occurred 2 Evidence of rapidly progressing ADPKD While eGFR appears normal, it may not be telling the whole story eGFR decline of ≥5 mL/min/1.73 m within 1 year OR eGFR decline of ≥2.5 mL/min/1.73 m per year over a period of 5 years 2 2 Does your patient have rapidly declining eGFR? 1 That means they could be an appropriate patient for treatment. Learn about Bob and see his treatment journey That means they could be an appropriate patient for treatment. Learn about Tim and see his treatment journey That means they could be an appropriate patient for treatment. Learn about Julia and see her treatment journey
eGFR decline of ≥5 mL/min/1.73 m 2 within 1 year OR eGFR decline of ≥2.5 mL/min/1.73 m 2 per year over a period of 5 years Does your patient have rapidly declining eGFR? 1 No While eGFR appears normal, it may not be telling the whole story That means they could be an appropriate patient for treatment. Learn about Bob and see his treatment journey • Truncating PKD1 mutation Overweight and obesity, BMI ≥25 kg/m 2 • Hypertension before age 35 • Urologic events before age 35 (gross hematuria, cyst infection, or flank pain related to cysts) • Proteinuria and microalbuminuria • Family history of ESKD at or before age 58 Be on the lookout for any ONE of these independently validated risk factors associated with rapid progression 1,7-9 : MRI/CT reliably measures kidney size to calculate TKV 5,6 Use htTKV and age to plot along the Mayo Classification chart— a patient in Class 1C, 1D, or 1E is at high risk of rapid progression 5,6 Total kidney volume (TKV)* Kidney size is a strong predictor of risk of rapid progression before eGFR begins to decline 2,3 There is a significant delay between when evidence of kidney function decline is visible and when kidney damage has occurred 2 Gold Standard Method 4 Other factors When MRI/ CT-calculated TKV is not available, ultrasound can be used to measure kidney length >16.5 cm at <45 years means patient is at risk of rapid progression Kidney length 1,5 That means they could be an appropriate patient for treatment. Learn about Tim and see his treatment journey If yes If yes That means they could be an appropriate patient for treatment. Learn about Julia and see her treatment journey Other factors eGFR appears normal Yes Evidence of rapidly progressing ADPKD