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Ubara Y, Suwabe T, Sawa N. Transcatheter arterial embolization therapy in patients with polycystic kidney disease and liver disease: review from case series. Clin Exp Nephrol 2025; 29:29-38. [PMID: 39565471 DOI: 10.1007/s10157-024-02597-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2024] [Accepted: 11/11/2024] [Indexed: 11/21/2024]
Abstract
We have achieved good results of renal transarterial embolization (TAE) therapy as an alternative to surgical nephrectomy to decrease renal size in autosomal polycystic kidney disease (ADPKD) patients with enlarged kidneys, but only in patients on dialysis. Renal transplantation is another treatment option, and patients who receive a donor kidney have achieved a reduction in kidney size after surgery. TAE has also been used in polycystic liver disease (PCLD), an extrarenal lesion of ADPKD. Although TAE is effective in some PCLD patients, others develop hepatomegaly, which leads to liver cyst infection and liver failure. Recently, liver transplantation has started to be performed in such patients. Initially, living donor liver transplants were performed from family members, but in 2010, deceased donor liver transplantation became available. This article gives an overview of the history of TAE for ADPKD and PCLD on the basis of our experience.
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Affiliation(s)
- Yoshifumi Ubara
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, 2-2-2, Toranomon, Minato, Tokyo, Japan.
| | - Tatsuya Suwabe
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, 2-2-2, Toranomon, Minato, Tokyo, Japan
| | - Naoki Sawa
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, 2-2-2, Toranomon, Minato, Tokyo, Japan
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Sui WF, Duan YX, Li JY, Shao WB, Fu JH. Safety and efficacy of transcatheter arterial embolization in autosomal dominant polycystic kidney patients with gross hematuria: Six case reports. World J Clin Cases 2024; 12:1954-1959. [PMID: 38660552 PMCID: PMC11036527 DOI: 10.12998/wjcc.v12.i11.1954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/30/2024] [Accepted: 03/19/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND To retrospectively report the safety and efficacy of renal transcatheter arterial embolization for treating autosomal dominant polycystic kidney disease (ADPKD) patients with gross hematuria. CASE SUMMARY The purpose of this study is to retrospectively report the safety and efficacy of renal transcatheter arterial embolization for treating ADPKD patients with gross hematuria. Materials and methods: During the period from January 2018 to December 2019, renal transcatheter arterial embolization was carried out on 6 patients with polycystic kidneys and gross hematuria. Renal arteriography was performed first, and then we determined the location of the hemorrhage and performed embolization under digital subtraction angiography monitoring. Improvements in routine blood test results, routine urine test results, urine color and postoperative reactions were observed and analyzed. Results: Renal transcatheter arterial embolization was successfully conducted in 6 patients. The indices of 5 patients and the color of gross hematuria improved after surgery compared with before surgery. No severe complication reactions occurred. CONCLUSION For autosomal dominant polycystic kidney syndrome patients with gross hematuria, transcatheter arterial embolization was safe and effective.
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Affiliation(s)
- Wei-Fan Sui
- Department of Interventional Radiology, Zhenjiang First People's Hospital, Zhenjiang 212000, Jiangsu Province, China
| | - Yun-Xin Duan
- Department of Interventional Radiology, Zhenjiang First People's Hospital, Zhenjiang 212000, Jiangsu Province, China
| | - Jian-Yun Li
- Department of Interventional Radiology, Zhenjiang First People's Hospital, Zhenjiang 212000, Jiangsu Province, China
| | - Wei-Bin Shao
- Department of Nephrology, Zhenjiang First People’s Hospital, Zhenjiang 212000, Jiangsu Province, China
| | - Jian-Hua Fu
- Department of Interventional Radiology, Zhenjiang First People's Hospital, Zhenjiang 212000, Jiangsu Province, China
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Nitta K, Oba Y, Ikuma D, Mizuno H, Sekine A, Hasegawa E, Yamanouchi M, Suwabe T, Tokue M, Shiba M, Sawa N, Ubara Y. A Case of Autosomal Dominant Polycystic Kidney Disease With Resolution of Massive Pericardial Effusion After Renal Transcatheter Artery Embolization. Am J Kidney Dis 2024; 83:260-263. [PMID: 37734686 DOI: 10.1053/j.ajkd.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 07/04/2023] [Accepted: 07/10/2023] [Indexed: 09/23/2023]
Abstract
A 68-year-old woman being treated with hemodialysis for autosomal dominant polycystic kidney disease was admitted for progressive dyspnea over 6 months. On chest radiography, her cardiothoracic ratio had increased from 52.2% 6 months prior, to 71%, and echocardiography revealed diffuse pericardial effusion and right ventricular diastolic insufficiency. A resultant pericardial tamponade was thought to be the cause of the patient's dyspnea, and therefore a pericardiocentesis was performed, with a total of 2,000mL of fluid removed. However, 21 days later the same amount of pericardial fluid had reaccumulated. The second pericardiocentesis was performed, followed by transcatheter renal artery embolization (TAE). The kidneys, which were hard on palpation before TAE, softened immediately after TAE. After resolution of the pericardial effusion was confirmed, the patient was discharged after 24 days in hospital. Twelve months later, the patient was asymptomatic, the cardiothoracic ratio decreased to 48% on chest radiography and computed tomography revealed no reaccumulation of pericardial effusion. This case illustrates a potential relationship between enlarged kidneys in autosomal dominant polycystic kidney disease and pericardial effusion.
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Affiliation(s)
- Kumi Nitta
- Nephrology Center +Okinaka Memorial Institute, Toranomon Hospital Kajigaya, Kanagawa, Japan.
| | - Yuki Oba
- Nephrology Center +Okinaka Memorial Institute, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Daisuke Ikuma
- Nephrology Center +Okinaka Memorial Institute, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Hiroki Mizuno
- Nephrology Center +Okinaka Memorial Institute, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Akinari Sekine
- Nephrology Center +Okinaka Memorial Institute, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Eiko Hasegawa
- Nephrology Center +Okinaka Memorial Institute, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Masayuki Yamanouchi
- Nephrology Center +Okinaka Memorial Institute, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Tatsuya Suwabe
- Nephrology Center +Okinaka Memorial Institute, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Masahide Tokue
- Cardiology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Masanori Shiba
- Cardiology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Naoki Sawa
- Nephrology Center +Okinaka Memorial Institute, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Yoshifumi Ubara
- Nephrology Center +Okinaka Memorial Institute, Toranomon Hospital Kajigaya, Kanagawa, Japan.
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Tanaka R, Sonomura T, Koike M, Sato H, Shimono R, Kumamoto A, Fukuda K, Higashino N, Ikoma A, Murata SI, Minamiguchi H. Comparison of Renal Damage Following Renal Artery Embolization with Three Different Embolic Mixtures in Swine. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2023; 8:154-160. [PMID: 38020457 PMCID: PMC10681758 DOI: 10.22575/interventionalradiology.2021-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 06/13/2023] [Indexed: 12/01/2023]
Abstract
Purpose Renal artery embolization is a minimally invasive and effective procedure for renal ablation, a complete necrosis of the renal parenchyma. This study aims to compare the extent of renal damage in swine following renal artery embolization with ethanol and N-butyl-2-cyanoacrylate, commonly used as embolic materials in renal ablation. Material and Methods Three different embolic mixtures were prepared for renal artery embolization in swine: 33% ethanol-Lipiodol mixture (ethanol:Lipiodol = 1:2; Group A), 67% ethanol-Lipiodol mixture (ethanol:Lipiodol = 2:1; Group B), and 10% N-butyl-2-cyanoacrylate-Lipiodol mixture (N-butyl-2-cyanoacrylate:Lipiodol = 1:9; Group C). Three swine were assigned to each group and underwent embolization of the unilateral renal artery. Renal arteriography was performed before, immediately after, and two days after renal artery embolization. After two days, the kidneys were removed to determine the macroscopic necrosis rate and for histologic examination. Dark tissue regions were considered necrotic. Results The macroscopic necrosis rate of the kidneys was 50.3%±7.4%, 100%±0%, and 100%±0% in Groups A, B, and C, respectively. The necrosis rates were higher in Groups B and C than in Group A. Histologically, the renal tubules were damaged in the necrotic areas. In addition, the glomeruli were damaged in Groups A and B but were preserved in Group C. Conclusions Sixty-seven percent ethanol-Lipiodol mixture and 10% N-butyl-2-cyanoacrylate-Lipiodol mixture are effective embolic materials in renal artery embolization for renal ablation in swine. Also, ethanol caused partial glomerular necrosis, whereas N-butyl-2-cyanoacrylate preserved the glomeruli. Therefore, ethanol should be used for renal ablation.
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Affiliation(s)
- Ryota Tanaka
- Department of Radiology, Wakayama Medical University, Japan
| | | | - Masataka Koike
- Department of Radiology, Wakayama Medical University, Japan
| | - Hirotatsu Sato
- Department of Radiology, Wakayama Medical University, Japan
| | - Ryuki Shimono
- Department of Radiology, Wakayama Medical University, Japan
| | | | - Kodai Fukuda
- Department of Radiology, Wakayama Medical University, Japan
| | | | - Akira Ikoma
- Department of Radiology, Wakayama Medical University, Japan
| | - Shin-Ichi Murata
- Department of Human Pathology, Wakayama Medical University, Japan
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Iguchi K, Iwai T, Kosoku A, Nishide S, Kabei K, Kumada N, Uchida J. Kidney Transplantation After Renal Transcatheter Arterial Embolization for Cyst Infection in a Hemodialysis Patient With Autosomal Dominant Polycystic Kidney Disease: A Case Report. Transplant Proc 2023:S0041-1345(23)00228-2. [PMID: 37121861 DOI: 10.1016/j.transproceed.2023.03.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 03/28/2023] [Indexed: 05/02/2023]
Abstract
A 31-year-old woman with autosomal dominant polycystic kidney disease (ADPKD) required antibiotic therapy for repeated renal cyst infections. The patient was scheduled for a living donor renal transplant with her mother as the donor. Two months before surgery, the patient was admitted to the hospital due to a severe renal cyst infection that improved with antibiotic treatment and percutaneous drainage, but the scheduled surgery was postponed. Transcatheter arterial embolization (TAE) was performed to control repeated renal cyst infections. Seven months after TAE, the patient underwent living donor renal transplantation. The postoperative course was uneventful, and the patient was discharged from the hospital on immunosuppressive medication 26 days after surgery with no evidence of recurrent infection or deterioration of renal function. Thirty months after transplantation, there has been no recurrence of infection.
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Affiliation(s)
- Keiko Iguchi
- Department of Urology, Osaka Metropolitan University Graduate School of Medicine, Japan.
| | - Tomoaki Iwai
- Department of Urology, Osaka Metropolitan University Graduate School of Medicine, Japan
| | | | - Shunji Nishide
- Department of Urology, Osaka City General Hospital, Japan
| | - Kazuya Kabei
- Department of Urology, Osaka Metropolitan University Graduate School of Medicine, Japan
| | | | - Junji Uchida
- Department of Urology, Osaka Metropolitan University Graduate School of Medicine, Japan
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Suwabe T, Ubara Y, Oba Y, Mizuno H, Ikuma D, Yamanouchi M, Sekine A, Tanaka K, Hasegawa E, Hoshino J, Sawa N. Acute renal intracystic hemorrhage in patients with autosomal dominant polycystic kidney disease. J Nephrol 2023; 36:999-1010. [PMID: 36753000 DOI: 10.1007/s40620-022-01562-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 12/25/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Renal cyst bleeding is a frequent problem in patients with autosomal dominant polycystic kidney disease (ADPKD). However, information is still limited on its frequency, causative factors, and effects on enlargement of polycystic kidneys in ADPKD. METHODS We investigated the total volume of acute renal intracystic hemorrhage and its association with total kidney volume (TKV) in a large series of patients with ADPKD on dialysis, referred for renal transcatheter arterial embolization. All patients had undergone CT scan and MRI scan before the procedure. We evaluated factors potentially associated with acute renal intracystic hemorrhage. The association between the volume of acute renal intracystic hemorrhage and the potential predisposing and associated factors was analysed by univariable and multivariable regressions. RESULTS: We enrolled 199 patients who underwent renal transcatheter arterial embolization from 2014 to 2018 (107 men, 92 women; mean age 59.1 ± 8.6 years). The median volume of acute renal intracystic hemorrhage was 97.3 ml (interquartile range 36.6-261.7 ml). Multivariable analysis revealed that body weight, kidney stones, systolic blood pressure, and total volume of acute renal intracystic hemorrhage were significantly associated with TKV; age, body mass index, smoking, renal cyst infection, serum alkaline phosphatase, and TKV were significantly associated with the volume of acute renal intracystic hemorrhage ; and sex, age, dialysis vintage, TKV, and total volume of acute renal intracystic hemorrhage were significantly associated with the number of microcoils required to achieve renal transcatheter arterial embolization. Total volume of acute renal intracystic hemorrhage was significantly associated with TKV (r = 0.15, p = 0.0325) and was greater in younger patients (r= - 0.32, p < 0.0001). Total volume of acute renal intracystic hemorrhage was also correlated with the number of microcoils required for renal transcatheter arterial embolization (r = 0.23, p = 0.0012). CONCLUSION Acute renal intracystic hemorrhage is frequent among ADPKD patients on dialysis, and total volume of acute renal intracystic hemorrhage significantly associated with TKV. Total volume of acute renal intracystic hemorrhage was greater in younger patients with higher renal artery luminal size. These results suggest that renal cyst bleeding and renal artery blood flow may synergistically accelerate the enlargement of polycystic kidneys in ADPKD patients on dialysis.
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Affiliation(s)
- Tatsuya Suwabe
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan.
- Department of Nephrology, Toranomon Hospital, 1-3-1 Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-0015, Japan.
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan.
| | - Yoshifumi Ubara
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
- Department of Nephrology, Toranomon Hospital, 1-3-1 Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-0015, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Yuki Oba
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
- Department of Nephrology, Toranomon Hospital, 1-3-1 Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-0015, Japan
| | - Hiroki Mizuno
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
- Department of Nephrology, Toranomon Hospital, 1-3-1 Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-0015, Japan
| | - Daisuke Ikuma
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
- Department of Nephrology, Toranomon Hospital, 1-3-1 Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-0015, Japan
| | - Masayuki Yamanouchi
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
- Department of Nephrology, Toranomon Hospital, 1-3-1 Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-0015, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Akinari Sekine
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Kiho Tanaka
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | - Eiko Hasegawa
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | - Junichi Hoshino
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
- Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Naoki Sawa
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
- Department of Nephrology, Toranomon Hospital, 1-3-1 Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-0015, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
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Nakayama Y, Sawa N, Suwabe T, Sekine A, Yamanouchi M, Ikuma D, Mizuno H, Oba Y, Hasegawa E, Hoshino J, Matoba S, Ubara Y. Development of an enterocutaneous fistula from an intestinal perforation in a patient with autosomal dominant polycystic kidney disease. CEN Case Rep 2023; 12:45-49. [PMID: 35789990 PMCID: PMC9892373 DOI: 10.1007/s13730-022-00716-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/03/2022] [Indexed: 02/05/2023] Open
Abstract
We herein report a case of enterocutaneous fistula in a patient with autosomal dominant polycystic kidney disease (ADPKD). A 37-year-old Japanese man was admitted to our hospital. Three months prior to transfer to our hospital, he developed intense flank pain with gross hematuria. His serum creatinine had decreased to 7.8 mg/dL and hemodialysis was started, but gross hematuria persisted and he developed hypotension. Upon admission, plain chest radiography did not reveal any free air, but computed tomography (CT) showed generalized ventral subcutaneous air from the head to the lower extremities and enlarged kidneys. Enterography showed leakage of contrast medium from the descending colon into the subcutaneous area. C-reactive protein was 23.1 mg/dL. A colostomy was placed in the transverse colon proximal to the perforation, and systemic subcutaneous drainage was performed. The fever subsequently resolved, and the C-reactive protein test became negative. Three months later, renal artery embolization was performed, and 12 months thereafter, CT showed a marked decrease in kidney size. We assume that a markedly enlarged kidney leaded to intestinal perforation, which developed into an enterocutaneous fistula. Consequently, intestinal fluid leaked into the subcutaneous cavity of the abdominal wall and spread systemically, resulting in extensive subcutaneous abscesses.
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Affiliation(s)
- Yuki Nakayama
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan.
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Tatsuya Suwabe
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Akinari Sekine
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Masayuki Yamanouchi
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Daisuke Ikuma
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Hiroki Mizuno
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Yuki Oba
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Eiko Hasegawa
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Junichi Hoshino
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Shuichiro Matoba
- Department of Gastrointestinal Surgery, Toranomon Hosipital, Tokyo, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan.
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan.
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Prudhomme T, Boissier R, Hevia V, Campi R, Pecoraro A, Breda A, Territo A. Native nephrectomy and arterial embolization of native kidney in autosomal dominant polycystic kidney disease patients: indications, timing and postoperative outcomes. Minerva Urol Nephrol 2023; 75:17-30. [PMID: 36094388 DOI: 10.23736/s2724-6051.22.04972-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common causes of a need of renal replacement therapy. The need (elective vs. systematic) and timing of native kidney nephrectomy (before, after or during kidney transplantation) is a matter of debate and alternatives to surgery, mainly transcatheter arterial embolization have been explored. We performed a systematic review to report all available evidence on postintervention outcomes of native nephrectomy and arterial embolization in ADPKD patients. EVIDENCE ACQUISITION A search on Medline, Embase, and Cochrane databases was performed to identify all studies reporting outcomes of native nephrectomy or arterial embolization in APKDs. EVIDENCE SYNTHESIS Concerning native nephrectomy, a total of 3626 patients in 37 studies were included with 735, 210 and 2681 patients who underwent native nephrectomy respectively before, after or during kidney transplantation. Major complications were 12.2% in unilateral nephrectomy before transplantation, 25.0% in bilateral nephrectomy before transplantation, 17.7% in unilateral nephrectomy during transplantation, 20.8% in bilateral nephrectomy during transplantation and 23.8% in unilateral and bilateral nephrectomy after transplantation. A total of 230 patients in 7 series of arterial embolization were included. All arterial embolization were performed before transplantation. Mean volume reduction ranged from 36.3% at 3 months to 49% at 6 months. The major postintervention complication rate was 1%. CONCLUSIONS Unilateral native nephrectomy before kidney transplantation was associated with the lowest major postoperative complication rate and appears to be the preferred strategy. Arterial embolization reduces kidney volume by 49% at 6 months. Arterial embolization could be considered when the reduction in size of the native kidney is not urgent.
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Affiliation(s)
- Thomas Prudhomme
- Department of Urology, Rangueil University Hospital, Toulouse, France -
| | - Romain Boissier
- Department of Urology, La Conception University Hospital, Marseille, France
| | - Vital Hevia
- Department of Urology, University Hospital Ramón y Cajal, Madrid, Spain
| | - Riccardo Campi
- Department of Urology, University Hospital of Florence, Florence, Italy
| | - Alessio Pecoraro
- Department of Urology, University Hospital of Florence, Florence, Italy
| | - Alberto Breda
- Unit of Oncology and Renal Transplant, Puigvert's Foundation, Barcelona, Spain
| | - Angelo Territo
- Unit of Oncology and Renal Transplant, Puigvert's Foundation, Barcelona, Spain
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Wu CH, Lai TS, Chen YM, Chen CM, Yang SC, Liang PC. Quantification of Abdominal Muscle Mass and Diagnosis of Sarcopenia with Cross-Sectional Imaging in Patients with Polycystic Kidney Disease: Correlation with Total Kidney Volume. Diagnostics (Basel) 2022; 12:diagnostics12030755. [PMID: 35328308 PMCID: PMC8947181 DOI: 10.3390/diagnostics12030755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/13/2022] [Accepted: 03/15/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Polycystic kidney disease (PKD) is an inherited disorder characterized by renal cysts that may mask lean body loss. This study quantified and compared muscle mass by using computed tomography (CT) and magnetic resonance imaging (MRI) images between the PKD and control groups and correlated muscle mass with total kidney volume (TKV). Methods: We retrospectively enrolled patients who had a new diagnosis of PKD from May 2015 to May 2016. The CT and MRI images at the third lumbar level were processed to measure the total abdominal muscle (TAM) area for the diagnosis of sarcopenia, and TKV was estimated using the ellipsoid formula. Results: We included 37 women and 25 men (mean age: 50.40 years) in the PKD group. There was no difference in body mass index and albumin levels, but significant differences in creatinine level (p < 0.001), TAM area (p = 0.047), and TKV (p < 0.001), were noted between the two groups. A significantly negative correlation was observed between TKV and TAM area after adjustment for body height (r = −0.217, p = 0.003). Conclusions: CT and MRI images can accurately diagnose sarcopenia, which may be masked by cysts in patients with PKD.
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Affiliation(s)
- Chih-Horng Wu
- Department of Medical Imaging, National Taiwan University Hospital, Taipei City 100, Taiwan; (C.-H.W.); (C.-M.C.); (S.-C.Y.)
| | - Tai-Shuan Lai
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City 100, Taiwan; (T.-S.L.); (Y.-M.C.)
| | - Yung-Ming Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City 100, Taiwan; (T.-S.L.); (Y.-M.C.)
| | - Chyi-Mong Chen
- Department of Medical Imaging, National Taiwan University Hospital, Taipei City 100, Taiwan; (C.-H.W.); (C.-M.C.); (S.-C.Y.)
| | - Shun-Chung Yang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei City 100, Taiwan; (C.-H.W.); (C.-M.C.); (S.-C.Y.)
| | - Po-Chin Liang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei City 100, Taiwan; (C.-H.W.); (C.-M.C.); (S.-C.Y.)
- Department of Medical Imaging, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City 302, Taiwan
- Correspondence: ; Tel.: +886-2-2312-3456
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Benjamin DT, Ioan G, Mickael O, Thaveau F, Sophie C, Nabil C, Anne L, Yannick G. Arterial Embolization of Polycystic Kidneys for Heterotopic Transplantation. J Endovasc Ther 2022; 29:885-892. [PMID: 35012405 DOI: 10.1177/15266028211067727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The purpose of this study was to evaluate the efficacy of polycystic kidney embolization, performed to reduce kidney volume before heterotopic kidney transplantation, as this technique could be an alternative to pretransplant nephrectomy. MATERIALS AND METHODS All patients who underwent pretransplant embolization of polycystic kidneys were included in a prospective register from June 2014 to February 2020. All patients underwent computed tomography (CT) scan with volumetric reconstruction (OsiriX, Bernex, Switzerland) before embolization and were then followed up at 3 and 6 months after embolization. Primary outcome was percentage of kidney volume reduction. Secondary outcomes were 30 day mortality and morbidity. RESULTS Thirty-one embolizations performed on 29 patients (medium age = 55.6; 62.1% male) were included between June 2014 and February 2020. All patients were under dialysis before embolization (9 peritoneal dialysis and 20 hemodialysis). Technical success was observed in 96.8% of cases. Mean procedural time was 65 minutes (range = 35-106 minutes) and mean length of in-hospital stay was 3.8 days (range = 3-6 days). A volume reduction allowing a kidney transplant was obtained for 28 patients (96.5%). The mean volume reduction was 39.9% (range = 6.01-68.2). The main observed complication was postembolization pain in 10 cases (32.2%). One patient needed complementary nephrectomy due to insufficient volume reduction. Twenty-three patients (79.3%) received renal transplant during follow-up with a mean delay of 19.5 month (range = 4-54). CONCLUSION Polycystic kidney embolization is an effective and safe minimally invasive technique. It can be proposed as the first-choice technique for kidney transplant recipients as an alternative to pretransplantation nephrectomy.
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Affiliation(s)
- Del Tatto Benjamin
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Gogeneata Ioan
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Ohana Mickael
- Department of Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Fabien Thaveau
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Caillard Sophie
- Department of Nephrology and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Chakfe Nabil
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Lejay Anne
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Georg Yannick
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
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11
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Cinacalcet may suppress kidney enlargement in hemodialysis patients with autosomal dominant polycystic kidney disease. Sci Rep 2021; 11:10014. [PMID: 33976330 PMCID: PMC8113347 DOI: 10.1038/s41598-021-89480-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 04/21/2021] [Indexed: 12/24/2022] Open
Abstract
A massively enlarged kidney can impact quality of life of autosomal dominant polycystic kidney disease (ADPKD) patients. A recent in vitro study demonstrated that an allosteric modulator of the calcium sensing receptor decreases adenosine-3′,5′-cyclic monophosphate, an important factor for kidney enlargement in ADPKD. Therefore, the present study was performed to determine whether cinacalcet, a calcium sensing receptor agonist, suppresses kidney enlargement in hemodialysis patients with ADPKD. Alteration of total kidney volume together with clinical parameters was retrospectively examined in 12 hemodialysis patients with ADPKD treated at a single institution in Japan. In the non-cinacalcet group with longer hemodialysis duration (n = 5), total kidney volume had an annual increase of 4.19 ± 1.71% during an overall period of 877 ± 494 days. In contrast, the annual rate of increase in total kidney volume in the cinacalcet group (n = 7) was significantly suppressed after cinacalcet treatment, from 3.26 ± 2.87% during a period of 734 ± 352 days before the start of cinacalcet to − 4.71 ± 6.42% during 918 ± 524 days after initiation of treatment (p = 0.047). The present findings showed that cinacalcet could be a novel therapeutic tool for suppression of kidney enlargement in hemodialysis patients with ADPKD.
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12
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Renal Artery Embolization Using an Ethanol-Lipiodol ® Mixture for Enlarged Polycystic Kidneys: Achieving Kidney Transplantation Without Nephrectomy. Cardiovasc Intervent Radiol 2020; 44:172-175. [PMID: 32978669 DOI: 10.1007/s00270-020-02641-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
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13
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Suwabe T. Cyst infection in autosomal dominant polycystic kidney disease: our experience at Toranomon Hospital and future issues. Clin Exp Nephrol 2020; 24:748-761. [PMID: 32700112 PMCID: PMC7474715 DOI: 10.1007/s10157-020-01928-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 07/06/2020] [Indexed: 12/22/2022]
Abstract
Cyst infection is a frequent and serious complication of autosomal dominant polycystic kidney disease (ADPKD) that is often difficult to treat and can be fatal. However, much is still unknown about cyst infection. Positron emission tomography (PET) is generally recommended for detecting infected cysts, but it has the disadvantages of limited availability, high cost, and radiation exposure. We have devised magnetic resonance imaging (MRI) diagnostic criteria for cyst infection. Lipid-soluble antibiotics such as fluoroquinolones show good penetration into cysts and are recommended for cyst infection. However, we reported that fluoroquinolone-resistant microorganisms showed a high prevalence in cyst infection. We should, therefore, reconsider the empirical use of fluoroquinolones for ADPKD patients with cyst infection. We have suggested a new antibiotic strategy according to the severity of cyst infection. It may be important to consider the drug half-life in serum in addition to the drug susceptibility when selecting antibiotics Cyst drainage is necessary for some patients with refractory cyst infection; however, cyst drainage can be associated with severe adverse events. We suggest adaptation criteria for cyst drainage in patients with cyst infection in ADPKD. Most causative bacteria of cyst infection are enterobacteria, and hematogenous spread via bacterial translocation in the intestine is considered the main cause of cyst infection. Therefore, intestinal flora may be important for cyst infection. The role of the intestinal flora in cyst infection in ADPKD is unknown and should be explored in future research.
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Affiliation(s)
- Tatsuya Suwabe
- Department of Nephrology, Toranomon Hospital Kajigaya, 1-3-1 Kajigaya, Takatsu-ku, Kawasaki-shi, Kanagawa-ken, 213-0015, Japan.
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, Japan.
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14
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Oda Y, Sawa N, Suwabe T, Hoshino J, Ubara Y. Renal Transcatheter Arterial Embolization for ADPKD. Kidney Int Rep 2020; 5:546-549. [PMID: 32274461 PMCID: PMC7136319 DOI: 10.1016/j.ekir.2020.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 12/21/2019] [Accepted: 01/20/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Yasuhiro Oda
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Tatsuya Suwabe
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Junichi Hoshino
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
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15
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Ikuma D, Oguro M, Hoshino J, Mizuno H, Sekine A, Kawada M, Hiramatsu R, Sumida K, Hasegawa E, Hayami N, Yamanouchi M, Suwabe T, Sawa N, Takaichi K, Ubara Y. Efficacy of Secukinumab for Plaque Psoriasis in a Patient on Hemodialysis. CEN Case Rep 2019; 9:55-58. [PMID: 31654299 PMCID: PMC6990267 DOI: 10.1007/s13730-019-00426-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 10/09/2019] [Indexed: 11/27/2022] Open
Abstract
Secukinumab is effective to treat plaque psoriasis. However, the safety and efficiency of secukinumab have not been clarified in patients on hemodialysis. We report a 60-year-old Japanese woman. Plaque psoriasis was diagnosed at the age of 25 years and hemodialysis was started at the age of 39 years. Her skin lesions persisted despite use of topical agents such as maxacalcitol and betamethasone. Accordingly, administration of secukinumab was started at a dose of 150 mg. The psoriasis area and severity index (PASI) score decreased from 49.8 to 14.8 after 2 weeks and to 0 after 6 weeks, with remission being maintained after 28 months. No adverse reactions were seen. This case indicates that secukinumab may be effective for severe psoriasis in patients on hemodialysis for end-stage renal disease.
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Affiliation(s)
- Daiuske Ikuma
- Nephrology Center, Toranomon Hospital, 2-2-2Minato-ku, ToranomonTokyo, 105-0001, Japan.
| | - Masahiko Oguro
- Nephrology Center, Toranomon Hospital, 2-2-2Minato-ku, ToranomonTokyo, 105-0001, Japan
| | - Junichi Hoshino
- Nephrology Center, Toranomon Hospital, 2-2-2Minato-ku, ToranomonTokyo, 105-0001, Japan
| | - Hiroki Mizuno
- Nephrology Center, Toranomon Hospital, 2-2-2Minato-ku, ToranomonTokyo, 105-0001, Japan
| | - Akinari Sekine
- Nephrology Center, Toranomon Hospital, 2-2-2Minato-ku, ToranomonTokyo, 105-0001, Japan
| | - Masahiro Kawada
- Nephrology Center, Toranomon Hospital, 2-2-2Minato-ku, ToranomonTokyo, 105-0001, Japan
| | - Rikako Hiramatsu
- Nephrology Center, Toranomon Hospital, 2-2-2Minato-ku, ToranomonTokyo, 105-0001, Japan
| | - Keiichi Sumida
- Nephrology Center, Toranomon Hospital, 2-2-2Minato-ku, ToranomonTokyo, 105-0001, Japan
| | - Eiko Hasegawa
- Nephrology Center, Toranomon Hospital, 2-2-2Minato-ku, ToranomonTokyo, 105-0001, Japan
| | - Noriko Hayami
- Nephrology Center, Toranomon Hospital, 2-2-2Minato-ku, ToranomonTokyo, 105-0001, Japan
| | - Masayuki Yamanouchi
- Nephrology Center, Toranomon Hospital, 2-2-2Minato-ku, ToranomonTokyo, 105-0001, Japan
| | - Tatsuya Suwabe
- Nephrology Center, Toranomon Hospital, 2-2-2Minato-ku, ToranomonTokyo, 105-0001, Japan
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital, 2-2-2Minato-ku, ToranomonTokyo, 105-0001, Japan
| | - Kenmei Takaichi
- Nephrology Center, Toranomon Hospital, 2-2-2Minato-ku, ToranomonTokyo, 105-0001, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital, 2-2-2Minato-ku, ToranomonTokyo, 105-0001, Japan
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16
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[Arterial embolization of polycystic kidneys as an alternative to ergonomic nephrectomy in renal pre-transplantation. Monocentric retrospective study]. Prog Urol 2019; 29:482-489. [PMID: 31383509 DOI: 10.1016/j.purol.2019.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 06/03/2019] [Accepted: 07/02/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aims at providing a retrospective assessment of the decrease in renal volume after renal artery embolization (RAE) among a group of patients with autosomal dominant polycystic renal disease and for whom transplantation, for ergonomic reasons was temporarily advised against. MATERIAL AND METHODS Between November 2014 and March 2017, as part of pre-transplantory procedure 15 patients, including 11 men and 4 women benfited from renal embolization (RAE) in a context of preparation for transplant in Lille University Hospital. All of the patients were suffering from autosomal dominant polycystic renal disease (ADPKD) at a severe or terminal stage of renal disease. RESULTS The original mean total kidney volume (TKV) was 2550.6 cm3±1771 (1102 cm3; 7310 cm3), the average TKV at 3 months was 1684 cm3±1539 (648 cm3; 6930 cm3) with an average decrease of 33% in the volume (5.2%; 83.9%) (95% confidence interval [0.229-0.436]) (P<0.01) and 1632±1743 (599 cm3; 6758 cm3) at 6 months with an average decrease of 40.7% (7.6%; 64.1%) (IC95% 0.306-0.508) (P<0.01). Among the 15 patients, 13 had their contraindication removed and to date 7 have had successful transplants. One failure due to a very high initial volume (7310cm3) required a secondary nephrectomy. No post-embolization syndrome has been noticed, 2 minor complications occurred (13%) involving a difficult resumption of transit and there was one case of hematuria. CONCLUSION ERA procedures must have a place in the ergonomic transplant strategy of patients with ADPKD with a low complication rate and a high efficiency. Nephrectomy indications before transplantation must therefore be reconsidered due to a major postoperative risk. Our results are in line with larger scale studies. Nevertheless, these results need to be confirmed by a large-scale randomized prospective study. LEVEL OF EVIDENCE 4.
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17
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Yamagami T, Kajiwara K, Yamanishi T, Minamiguchi H, Yoshimatsu R. Use of a micro-balloon catheter in transcatheter arterial embolization of the renal artery for recurrence of symptoms of autosomal dominant polycystic kidney disease. Acta Radiol Open 2018; 7:2058460118818849. [PMID: 30559978 PMCID: PMC6291887 DOI: 10.1177/2058460118818849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 11/20/2018] [Indexed: 11/16/2022] Open
Abstract
We report a 63-year-old woman who had recurrent symptoms such as remarkable abdominal distension caused by autosomal dominant polycystic kidney disease in spite of previous bilateral renal arterial embolization with microcoils. Renal arterial embolization with trisacryl gelatin microspheres was performed. The embolic agent was infused while the micro-balloon catheter that was coaxially inserted from a 4-F catheter was inflated without any complications. The size of the polycystic kidneys decreased and the symptoms were satisfactorily relieved.
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Affiliation(s)
- Takuji Yamagami
- Department of Radiology, Kochi University, Kochi Medical School Kohasu, Oko-cho, Nankoku, Kochi, Japan
| | - Kenji Kajiwara
- Department of Radiology, Kochi University, Kochi Medical School Kohasu, Oko-cho, Nankoku, Kochi, Japan
| | - Tomoaki Yamanishi
- Department of Radiology, Kochi University, Kochi Medical School Kohasu, Oko-cho, Nankoku, Kochi, Japan
| | - Hiroki Minamiguchi
- Department of Radiology, Kochi University, Kochi Medical School Kohasu, Oko-cho, Nankoku, Kochi, Japan
| | - Rika Yoshimatsu
- Department of Radiology, Kochi University, Kochi Medical School Kohasu, Oko-cho, Nankoku, Kochi, Japan
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18
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Tolvaptan in Japanese patients with later-stage autosomal dominant polycystic kidney disease. J Nephrol 2018; 31:961-966. [PMID: 30357715 DOI: 10.1007/s40620-018-0545-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 09/17/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND A recent study demonstrated that tolvaptan slowed estimated glomerular filtration rate (eGFR) decline in later-stage autosomal dominant polycystic kidney disease (ADPKD) patients. However, Japanese patients were not included in that trial, therefore tolvaptan's efficacy in Japanese patients with advanced chronic kidney disease (CKD) has remained unknown. METHODS In this prospective cohort study, 54 patients with ADPKD who had eGFR ≥ 15 ml/min/1.73 m2 and total kidney volume (TKV) ≥ 750 ml were treated with tolvaptan. The primary endpoint was the change in height-adjusted total kidney volume (htTKV) and eGFR after 1-year treatment with tolvaptan. Then, we compared the primary endpoint between later CKD stage (baseline eGFR < 45 ml/min/1.73 m2) and earlier CKD stage (baseline eGFR ≥ 45 ml/min/1.73 m2). RESULTS The rate of kidney growth during the 1-year treatment did not differ significantly between earlier and later CKD stages. The median and interquartile range of relative change in htTKV in later CKD stage was 8.2%/year [4.4, 26.6], as compared with 5.7%/year [1.6, 16.4] in earlier CKD stage (p = 0.17). Nor did the rate of eGFR decline between earlier and later CKD stages. The relative annual change in eGFR in later CKD stage was - 9.7%/year [- 15.9, - 2.1], as compared with - 6.8%/year [- 11.1, 0.1] in earlier CKD stage (p = 0.18). CONCLUSION This analysis indicates that the efficacy of tolvaptan for Japanese patients with later stage ADPKD was not significantly different from that of Japanese patients with earlier stage ADPKD.
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19
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Lozano-Vilardell P, Lara-Hernández R, Benabarre-Castany N, García-García D. Abdominal Aortic Aneurysm Associated with Polycystic Kidney Disease: Endovascular Aortic Repair and Renal Embolization. Ann Vasc Surg 2018; 56:351.e13-351.e15. [PMID: 30342219 DOI: 10.1016/j.avsg.2018.07.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 07/17/2018] [Indexed: 02/02/2023]
Abstract
A 79-year old patient with an asymptomatic 63-mm infrarenal abdominal aortic aneurysm, confirmed on computed tomography, was admitted in our unit. The patient had undergone kidney transplantation years before, due to renal failure secondary to polycystic kidney disease. Renal function at admission was normal. The aneurysm had a very short neck, and a standard endovascular aortic repair procedure was not feasible. Therefore, the 2 renal arteries were embolized with coils and endovascular repair of the aneurysm, covering the ostia of the renal arteries, was achieved placing the endoprosthesis up to the level of the superior mesenteric artery. The course of the patient was uneventful and was discharged without complications. Endovascular repair in patients without infrarenal aortic necks and nonfunctional kidneys secondary to polycystic kidney disease can be achieved with safety embolizing and covering the ostia of the renal arteries.
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Affiliation(s)
| | - Raúl Lara-Hernández
- Angiology and Vascular Surgery Department, Hospital Universitari Son Espases, Palma, Spain
| | - Noé Benabarre-Castany
- Angiology and Vascular Surgery Department, Hospital Universitari Son Espases, Palma, Spain
| | - David García-García
- Angiology and Vascular Surgery Department, Hospital Universitari Son Espases, Palma, Spain
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20
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Toriu N, Mizuno H, Sawa N, Sumida K, Suwabe T, Hayami N, Sekine A, Yamanouchi M, Hoshino J, Takaichi K, Yanagita M, Fujimaru T, Mori T, Sohara E, Uchida S, Ubara Y. Everolimus Reduces the Size of Tuberous Sclerosis Complex-Related Huge Renal Angiomyolipomas Exceeding 20 cm in the Longest Diameter. Case Rep Oncol 2018; 11:258-267. [PMID: 29867433 PMCID: PMC5981599 DOI: 10.1159/000488704] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 03/22/2018] [Indexed: 12/18/2022] Open
Abstract
We evaluated the efficacy of everolimus in 3 patients who had huge renal angiomyolipomas associated with tuberous sclerosis complex. Two patients with large lipid-rich angiomyolipomas had a history of renal transarterial embolization for renal bleeding, but the effect had only been temporary and the embolized kidneys had continued to enlarge. In case 1, case 2, and case 3, total renal volume was respectively 3,891, 4,035, and 1,179 cm3 before administration of everolimus, decreasing to 3,016 (77%), 3,043 (75%), and 1,051 (89%) cm3 after 1 year of everolimus therapy and to 2,832 (73%), 3,209 (80%), and 1,102 (93%) cm3 after 3 years. New renal bleeding did not occur, but elevation of serum creatinine and urinary protein were noted in 2 patients. While previous reports have largely assessed the effect of everolimus for angiomyolipomas of < 10 cm in the longest diameter, our findings suggest that this drug might also be effective for huge lesions of > 20 cm in diameter. However, total renal volume still exceeds 2,000 cm3 in 2 of our patients, suggesting limited size reduction of lipid-rich angiomyolipomas. In addition, occurrence of everolimus-related nephropathy needs to be monitored carefully.
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Affiliation(s)
- Naoya Toriu
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
| | | | - Naoki Sawa
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
| | | | | | | | | | | | - Junichi Hoshino
- Nephrology Center, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Kenmei Takaichi
- Nephrology Center, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Motoko Yanagita
- Department of Nephrology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takuya Fujimaru
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takayasu Mori
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eisei Sohara
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinichi Uchida
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Tokyo, Japan
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21
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Toriu N, Hoshino J, Kobori S, Watanabe S, Oguro M, Oshima Y, Hiramatsu R, Mizuno H, Ikuma D, Sekine A, Hayami N, Sumida K, Yamanouchi M, Hasegawa E, Sawa N, Takaichi K, Yanagita M, Fujimaru T, Sohara E, Uchida S, Ubara Y. Transcatheter Arterial Embolization Therapy for Huge Renal Cysts: Two Case Reports. Case Rep Nephrol Dial 2018; 8:82-89. [PMID: 29850462 PMCID: PMC5968287 DOI: 10.1159/000489088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 04/09/2018] [Indexed: 11/22/2022] Open
Abstract
We encountered 2 patients with symptomatic huge simple renal cysts. In case 1, 4,000 mL of cyst fluid was drained via a catheter, but intracystic bleeding occurred immediately afterwards. Transcatheter arterial embolization (TAE) was performed, after which the bleeding stopped, and cyst drainage was repeated successfully. After 2 years, the total cyst volume was reduced from 11,775 mL to 75.4 mL. In case 2, TAE was performed prophylactically before drainage. Subsequently, 9,400 mL of fluid was removed from multiple cysts. After 1 year, the total cyst volume was reduced from 9,215 mL to 633 mL without bleeding. Based on these 2 cases, prophylactic TAE before drainage may be useful in patients with huge renal cysts.
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Affiliation(s)
- Naoya Toriu
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
| | | | - Saeko Kobori
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
| | - Sun Watanabe
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
| | | | | | | | | | | | | | | | | | | | | | - Naoki Sawa
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
| | - Kenmei Takaichi
- Nephrology Center, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Motoko Yanagita
- Department of Nephrology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takuya Fujimaru
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eisei Sohara
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinichi Uchida
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Tokyo, Japan
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22
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Suwabe T, Ubara Y, Sekine A, Ueno T, Yamanouchi M, Hayami N, Hoshino J, Kawada M, Hiramatsu R, Hasegawa E, Sawa N, Takaichi K. Effect of renal transcatheter arterial embolization on quality of life in patients with autosomal dominant polycystic kidney disease. Nephrol Dial Transplant 2018; 32:1176-1183. [PMID: 28873973 DOI: 10.1093/ndt/gfx186] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 04/11/2017] [Indexed: 02/03/2023] Open
Abstract
Background Currently, there are few strategies for improving the quality of life (QOL) in patients with autosomal dominant polycystic kidney disease (ADPKD) and massive kidneys. Renal transcatheter arterial embolization (TAE) reduces kidney volume, but its impact on QOL in ADPKD patients on hemodialysis is unknown. This study investigated the influence of renal TAE on QOL in ADPKD patients with massive kidneys receiving hemodialysis. Methods This prospective observational study enrolled 188 ADPKD patients on hemodialysis (92 men and 96 women; mean age 56.7 ± 9.1 years) who underwent renal TAE at Toranomon Hospital between August 2010 and July 2014. The 36-item Short Form Health Survey (SF-36) and our original 15-item questionnaire were used to evaluate QOL. Results Using a linear mixed model, the least squares mean values of the SF-36 physical component summary (PCS), mental component summary (MCS) and role/social component summary (RCS) before renal TAE were calculated as 38.21 [95% confidence interval (CI) 36.50-39.91], 48.45 (47.05-49.86) and 43.04 (40.70-45.37), respectively. These values improved to 42.0 (40.22-43.77; P < 0.001 versus before TAE), 51.25 (49.78-52.71; P = 0.001) and 49.67 (47.22-52.12; P < 0.001), respectively, 1 year after renal TAE. Scores for abdominal fullness, poor appetite and heartburn showed marked improvement after renal TAE, while scores for fever, bodily pain and sleep disorder also improved slightly, but significantly. Scores for constipation and use of analgesics/sleeping medications/laxatives did not improve significantly. All of the SF-36 scores and the scores for specific symptoms (except bodily pain, snoring and constipation) were significantly correlated with the sequential decrease of the height-adjusted total kidney volume. Conclusions In ADPKD patients on hemodialysis, renal TAE was effective in improving abdominal fullness, appetite, heartburn and SF-36 scores (MCS and RCS scores), but not for sleep disturbance, constipation and physical strength (PCS score).
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Affiliation(s)
- Tatsuya Suwabe
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | - Yoshifumi Ubara
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Akinari Sekine
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | - Toshiharu Ueno
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | | | - Noriko Hayami
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | | | | | | | - Eiko Hasegawa
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | - Naoki Sawa
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | - Kenmei Takaichi
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
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Volume Reduction in Enlarged Kidneys in Autosomal Dominant Polycystic Kidney Disease (ADPKD) Prior to Renal Transplant with Transcatheter Arterial Embolization (TAE): A Systematic Review and Meta-Analysis. Cardiovasc Intervent Radiol 2018; 41:828-834. [PMID: 29388019 DOI: 10.1007/s00270-018-1890-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/22/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE Symptomatically enlarged kidneys observed in autosomal dominant polycystic kidney disease (ADPKD) patients can lead to compression symptoms and contraindications to renal transplantation. Surgical nephrectomy can be utilized to increase space in the abdomen prior to renal transplantation; however, not all individuals are appropriate candidates for this procedure. Transcatheter arterial embolization (TAE) of the renal arteries can provide a noninvasive way to reduce renal volume in ADPKD. MATERIALS AND METHODS We performed a systematic literature review on the usage of TAE to reduce renal volume prior to kidney transplantation and to relief compression symptoms in ADPKD. PubMed, Web of Science, and Cochrane Library were searched for articles focused on the usage of TAE to reduce renal volume in symptomatic enlarged kidneys. Renal volume data were compiled, and meta-analysis was performed with three or more studies. RESULTS Six papers satisfied the inclusion and exclusion criteria. Significant renal volume reduction was observed by 12 months in all studies. Success of TAE was measured with three clinical outcomes: removal of contraindication for renal transplant, relief of compression symptoms, and pulmonary function test. Proportionality meta-analysis of three studies measuring relief of compression symptoms showed no significant differences in heterogeneity (p = 0.4543). CONCLUSION Current studies conclude that TAE is an effective and minimally invasive option for reduction in renal volume in order to optimize patient outcome for renal transplantation and for relief of compression symptoms. Further prospective studies involving increased sample size and multiple centers should be pursued to establish evidence-based guidelines.
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Versteeg IB, Casteleijn NF, Gansevoort RT. Transcatheter arterial embolization: an underappreciated alternative to nephrectomy in autosomal dominant polycystic kidney disease? Nephrol Dial Transplant 2017; 32:1075-1078. [PMID: 28460119 DOI: 10.1093/ndt/gfx056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 02/12/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Niek F Casteleijn
- Department of Urology, Expertise Center for Polycystic Kidney Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Tillou X, Timsit MO, Sallusto F, Culty T, Verhoest G, Doerfler A, Thuret R, Kleinclauss F. [Polycystic kidney disease and kidney transplantation]. Prog Urol 2016; 26:993-1000. [PMID: 27665410 DOI: 10.1016/j.purol.2016.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 08/22/2016] [Accepted: 08/22/2016] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To perform a state of the art about autosomal dominant polykystic kidney disease (ADPKD), management of its urological complications and end stage renal disease treatment modalities. MATERIAL AND METHODS An exhaustive systematic review of the scientific literature was performed in the Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of the following keywords (MESH): "autosomal dominant polykystic kidney disease", "complications", "native nephrectomy", "kidney transplantation". Publications obtained were selected based on methodology, language, date of publication (last 10 years) and relevance. Prospective and retrospective studies, in English or French, review articles; meta-analysis and guidelines were selected and analyzed. This search found 3779 articles. After reading titles and abstracts, 52 were included in the text, based on their relevance. RESULTS ADPKD is the most inherited renal disease, leading to end stage renal disease requiring dialysis or renal transplantation in about 50% of the patients. Many urological complications (gross hematuria, cysts infection, renal pain, lithiasis) of ADPKD required urological management. The pretransplant evaluation will ask the challenging question of native nephrectomy only in case of recurrent kidney complications or large kidney not allowing graft implantation. The optimum timing for native nephrectomy will depend on many factors (dialysis or preemptive transplantation, complication severity, anuria, easy access to transplantation, potential living donor). CONCLUSION Pretransplant management of ADPKD is challenging. A conservative strategy should be promoted to avoid anuria (and its metabolic complications) and to preserve a functioning low urinary tract and quality of life. When native nephrectomy should be performed, surgery remains the gold standard but renal arterial embolization may be a safe option due to its low morbidity.
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Affiliation(s)
- X Tillou
- Service d'urologie et transplantation, CHU Côte de Nacre, 14000 Caen, France
| | - M-O Timsit
- Service d'urologie, hôpital européen Georges-Pompidou, 75015 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - F Sallusto
- Département d'urologie et transplantation, CHU de Toulouse, 31400 Toulouse, France
| | - T Culty
- Service d'urologie, CHU d'Angers, 49100 Angers, France
| | - G Verhoest
- Service d'urologie, CHU de Rennes, 35000 Rennes, France
| | - A Doerfler
- Service d'urologie et transplantation, CHU Côte de Nacre, 14000 Caen, France
| | - R Thuret
- Service d'urologie, CHU Lapeyronie, 34000 Montpellier, France; Université de Montpellier, 34000 Montpellier, France
| | - F Kleinclauss
- Service d'urologie et transplantation, CHRU de Besançon, 3, boulevard A.-Fleming, 25000 Besançon, France; Université de Franche-Comté, 25000 Besançon, France; Inserm UMR 1098, 25000 Besançon, France.
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26
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Abstract
Recent developments in endovascular radiological techniques and devices make embolization as a major therapeutic option in many renal vascular or neoplastic diseases, before surgery. These techniques show a very good efficacy with a low morbidity and a better renal tolerance. Indications of embolization in nephrology are post-biopsy arteriovenous fistulas, renal graft intolerance, functional exclusion and polycystic kidney disease before transplantation. Others are at the interface between nephrology and urology as angiomyolipomas (mostly in tuberous sclerosis context), arterial aneurysms and arteriovenous malformations.
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Affiliation(s)
- Nicolas Grenier
- Service d'imagerie diagnostique et interventionnelle de l'adulte, groupe hospitalier Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
| | - François Petitpierre
- Service d'imagerie diagnostique et interventionnelle de l'adulte, groupe hospitalier Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - Yann Le Bras
- Service d'imagerie diagnostique et interventionnelle de l'adulte, groupe hospitalier Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - Anne-Sophie Lasserre
- Service d'imagerie diagnostique et interventionnelle de l'adulte, groupe hospitalier Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - François Cornelis
- Service d'imagerie diagnostique et interventionnelle de l'adulte, groupe hospitalier Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
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27
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Suwabe T, Ubara Y, Mise K, Ueno T, Sumida K, Yamanouchi M, Hayami N, Hoshino J, Kawada M, Imafuku A, Hiramatsu R, Hasegawa E, Sawa N, Takaichi K. Suitability of Patients with Autosomal Dominant Polycystic Kidney Disease for Renal Transcatheter Arterial Embolization. J Am Soc Nephrol 2015; 27:2177-87. [PMID: 26620095 DOI: 10.1681/asn.2015010067] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 10/13/2015] [Indexed: 01/18/2023] Open
Abstract
In patients with autosomal dominant polycystic kidney disease (ADPKD), massive renal enlargement is a serious problem. Renal transcatheter arterial embolization (TAE) can reduce renal volume (RV), but effectiveness varies widely, and the reasons remain unclear. We investigated factors affecting renal volume reduction rate (RVRR) after renal TAE in all 449 patients with ADPKD who received renal TAE at Toranomon Hospital from January of 2006 to July of 2013, including 228 men and 221 women (mean age =57.0±9.1 years old). One year after renal TAE, the RVRR ranged from 3.9% to 84.8%, and the least squares mean RVRR calculated using a linear mixed model was 45.5% (95% confidence interval [95% CI], 44.2% to 46.8%). Multivariate analysis using the linear mixed model revealed that RVRR was affected by the presence of large cysts with wall thickening (regression coefficient [RC], -6.10; 95% CI, -9.04 to -3.16; P<0.001), age (RC, -0.82; 95% CI, -1.03 to -0.60; P<0.001), dialysis duration (RC, -0.10; 95% CI, -0.18 to -0.03; P<0.01), systolic BP (RC, 0.39; 95% CI, 0.19 to 0.59; P<0.001), and the number of microcoils used for renal TAE (RC, 1.35; 95% CI, 0.83 to 1.86; P<0.001). Significantly more microcoils were needed to achieve renal TAE in patients with younger age and shorter dialysis duration. In conclusion, cyst wall thickening had an important effect on cyst volume reduction. Renal TAE was more effective in patients who were younger, had shorter dialysis duration, or had hypertension, parameters that might associate with cyst wall stiffness and renal artery blood flow.
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Affiliation(s)
- Tatsuya Suwabe
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | | | - Koki Mise
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | - Toshiharu Ueno
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | - Keiichi Sumida
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | | | - Noriko Hayami
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | | | | | - Aya Imafuku
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | | | - Eiko Hasegawa
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | - Naoki Sawa
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
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28
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Sumida K, Hoshino J, Suwabe T, Kasai T, Hayami N, Mise K, Kawada M, Imafuku A, Hiramatsu R, Hasegawa E, Yamanouchi M, Sawa N, Narui K, Takaichi K, Ubara Y. Sleep-Disordered Breathing in Patients with Polycystic Liver and Kidney Disease Referred for Transcatheter Arterial Embolization. Clin J Am Soc Nephrol 2015; 10:949-956. [PMID: 25825485 PMCID: PMC4455207 DOI: 10.2215/cjn.06930714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 02/10/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Sleep-disordered breathing (SDB) is prevalent among patients with CKD, but its prevalence among patients with symptomatic autosomal dominant polycystic kidney disease (ADPKD) and its association with total liver and kidney volume remain unclear. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This study examined the association between height-adjusted total liver and kidney volume (htTLKV) and SDB in a cross-sectional study of 304 adult patients with symptomatic ADPKD who were hospitalized at Toranomon Hospital for transcatheter arterial embolization and who underwent pulse oximetry between April 2008 and November 2013. SDB was defined as having a 3% oxygen desaturation index of ≥15 events per hour of sleep. Logistic regression was performed with sex-specific quartiles of htTLKV as the main predictor, using patient data and comorbidities as covariates. RESULTS Overall (54.6% women, mean age 56.2±9.4 years, 83.5% on hemodialysis), 177 of 304 patients (58.2%) had SDB. SDB was strongly associated with htTLKV quartiles, demonstrating that odds ratios (ORs) and 95% confidence intervals (95% CIs) for SDB were 1.63 (0.76 to 3.48), 2.35 (1.09 to 5.06), and 4.61 (1.98 to 10.7) for htTLKV quartiles 2-4 (P for trend, P=0.003), respectively. Older age (OR, 1.81 per 10 years; 95% CI, 1.29 to 2.55), male sex (OR, 3.87; 95% CI, 1.96 to 7.66), receiving hemodialysis (OR, 3.46; 95% CI, 1.62 to 12.1), and higher body mass index (≥25 kg/m(2)) (OR, 3.03; 95% CI, 1.08 to 8.52) were also associated with SDB. CONCLUSIONS In this highly selected population of patients with symptomatic ADPKD referred for transcatheter arterial embolization, SDB was highly prevalent and independently associated with higher htTLKV.
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Affiliation(s)
- Keiichi Sumida
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan; Nephrology Center and
| | - Junichi Hoshino
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan; Nephrology Center and
| | - Tatsuya Suwabe
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan; Nephrology Center and
| | - Takatoshi Kasai
- Sleep Center, Toranomon Hospital, Tokyo, Japan; and Departments of Cardiology and Cardio-Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Noriko Hayami
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan; Nephrology Center and
| | - Koki Mise
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | | | | | | | | | | | | | - Koji Narui
- Sleep Center, Toranomon Hospital, Tokyo, Japan; and
| | - Kenmei Takaichi
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan; Nephrology Center and
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan; Nephrology Center and
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29
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Petitpierre F, Cornelis F, Couzi L, Lasserre AS, Tricaud E, Le Bras Y, Merville P, Combe C, Ferriere JM, Grenier N. Embolization of renal arteries before transplantation in patients with polycystic kidney disease: a single institution long-term experience. Eur Radiol 2015; 25:3263-71. [PMID: 25981217 DOI: 10.1007/s00330-015-3730-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/17/2015] [Accepted: 03/20/2015] [Indexed: 01/23/2023]
Abstract
PURPOSE We aimed to retrospectively assess the long-term safety and efficacy of embolization of renal arteries (ERA) in patients with polycystic kidney disease (PKD) before renal transplantation. MATERIAL AND METHODS Between January 2008 and November 2013, 82 ERA procedures were performed on 76 kidneys in 73 patients (mean age 53 years, range: 34-72). All patients had terminal-stage PKD and were under dialysis and on the renal transplant waiting list with a temporary contraindication due to excessive renal volume. RESULTS ERA was considered successful in 89.5% (68/76) of embolized kidneys, meaning that the temporary contraindication for transplantation could be withdrawn for 65 patients (on average 5.6 months, range: 2.8-24.3, after ERA). Mean volume reduction was 40 (range: 2-69) at 3 months and 59% (35-86) thereafter (both p < 0.001). Post-embolization syndrome occurred after 15 of 82 procedures (18.3%). The severe complication rate was 4.9%. Forty-three (67.7%) transplantations were successfully conducted after ERA, with a mean follow-up of 26.2 months (range: 1.8-59.5), and the estimated 5-year graft survival rate was 95.3% [95% CI: 82.7-98.8]. CONCLUSIONS ERA is a safe and effective alternative to nephrectomy before renal transplantation in patients with PKD. KEY POINTS • Embolization of non-functioning polycystic kidneys allowed transplantation in 89.5% of cases. • Technical failure rate was 7.9% after embolization, irrespective of the technique used. • Post-embolization syndrome occurred after 18.3% of the procedures. • A low rate of severe complications (4.9%) was observed after renal embolization.
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Affiliation(s)
- F Petitpierre
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - F Cornelis
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France.
| | - L Couzi
- Department of Nephrology, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - A S Lasserre
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - E Tricaud
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Y Le Bras
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - P Merville
- Department of Nephrology, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - C Combe
- Department of Urology, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - J M Ferriere
- Department of Urology, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - N Grenier
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France
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30
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Sakuhara Y, Nishio S, Morita K, Abo D, Hasegawa Y, Yuasa N, Mochizuki T, Soyama T, Oba K, Shirato H, Kudo K. Transcatheter Arterial Embolization with Ethanol Injection in Symptomatic Patients with Enlarged Polycystic Kidneys. Radiology 2015; 277:277-85. [PMID: 25923222 DOI: 10.1148/radiol.2015141637] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the safety and effectiveness of transcatheter arterial embolization (TAE) with ethanol in symptomatic patients with enlarged polycystic kidney disease. MATERIALS AND METHODS This prospective study was institutional review board approved and was planned for patients with symptoms related to enlarged polycystic kidney disease, such as a markedly distended abdomen, gastroesophageal reflux, and abdominal pain. At the time of TAE, all patients were undergoing dialysis therapy for chronic renal failure, and their urinary volume had decreased to less than 500 mL per day. Bilateral renal TAE with absolute ethanol was performed, and changes in kidney volume, clinical symptoms, laboratory data, and complications were evaluated after TAE. The differences in patients' kidney volumes, clinical symptoms, abdominal circumference, and dry weights before and after TAE were analyzed with a mixed effect model. RESULTS Fifteen patients (seven men and eight women; mean age, 57.7 years ± 5.3 [standard deviation]) were treated. Among the 15 patients, the follow-up period was 24 months in 13 patients, 6 months in one patient, and 3 months in one patient. The mean kidney volume was 3380 mL before renal TAE, and at 3, 12, and 24 months after TAE, it significantly decreased to 60.9%, 39.8%, and 32.1% of the pretherapeutic value, respectively (P < .001). All patients reported improved clinical symptoms within 3 months after TAE (P < .001). Abdominal circumferences were significantly decreased after TAE (P < .001). The dry weights also continued to significantly decreased until 6 months after TAE (P < .001), at which point they began to slightly increase until 24 months after TAE. Abdominal pain, nausea, and inflammatory response developed in all patients after TAE, but these symptoms improved with conservative treatment. Abscess formation was found in one kidney, and drainage catheter placement was performed. No major complications related to TAE occurred in the remaining patients. CONCLUSION Renal contraction therapy by TAE with ethanol injection appears to be a safe and effective treatment in patients with symptomatic enlarged polycystic kidney disease.
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Affiliation(s)
- Yusuke Sakuhara
- From the Department of Diagnostic and Interventional Radiology (Y.S., D.A., T.S., K.K.), Department of Medicine II (S.N.), Department of Urology (K.M.), and Translational Research and Clinical Trial Center (K.O.), Hokkaido University Hospital, N-14, W-5, Kita-ku, Sapporo, Hokkaido 060-0848, Japan; Department of Diagnostic Radiology, Sapporo City General Hospital, Sapporo, Japan (Y.H.); Department of Radiology, Steel Memorial Muroran Hospital, Murofan, Japan (N.Y.); Department of Medicine IV, Tokyo Women's Medical University, Tokyo, Japan (T.M.); and Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan (H.S.)
| | - Saori Nishio
- From the Department of Diagnostic and Interventional Radiology (Y.S., D.A., T.S., K.K.), Department of Medicine II (S.N.), Department of Urology (K.M.), and Translational Research and Clinical Trial Center (K.O.), Hokkaido University Hospital, N-14, W-5, Kita-ku, Sapporo, Hokkaido 060-0848, Japan; Department of Diagnostic Radiology, Sapporo City General Hospital, Sapporo, Japan (Y.H.); Department of Radiology, Steel Memorial Muroran Hospital, Murofan, Japan (N.Y.); Department of Medicine IV, Tokyo Women's Medical University, Tokyo, Japan (T.M.); and Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan (H.S.)
| | - Ken Morita
- From the Department of Diagnostic and Interventional Radiology (Y.S., D.A., T.S., K.K.), Department of Medicine II (S.N.), Department of Urology (K.M.), and Translational Research and Clinical Trial Center (K.O.), Hokkaido University Hospital, N-14, W-5, Kita-ku, Sapporo, Hokkaido 060-0848, Japan; Department of Diagnostic Radiology, Sapporo City General Hospital, Sapporo, Japan (Y.H.); Department of Radiology, Steel Memorial Muroran Hospital, Murofan, Japan (N.Y.); Department of Medicine IV, Tokyo Women's Medical University, Tokyo, Japan (T.M.); and Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan (H.S.)
| | - Daisuke Abo
- From the Department of Diagnostic and Interventional Radiology (Y.S., D.A., T.S., K.K.), Department of Medicine II (S.N.), Department of Urology (K.M.), and Translational Research and Clinical Trial Center (K.O.), Hokkaido University Hospital, N-14, W-5, Kita-ku, Sapporo, Hokkaido 060-0848, Japan; Department of Diagnostic Radiology, Sapporo City General Hospital, Sapporo, Japan (Y.H.); Department of Radiology, Steel Memorial Muroran Hospital, Murofan, Japan (N.Y.); Department of Medicine IV, Tokyo Women's Medical University, Tokyo, Japan (T.M.); and Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan (H.S.)
| | - Yu Hasegawa
- From the Department of Diagnostic and Interventional Radiology (Y.S., D.A., T.S., K.K.), Department of Medicine II (S.N.), Department of Urology (K.M.), and Translational Research and Clinical Trial Center (K.O.), Hokkaido University Hospital, N-14, W-5, Kita-ku, Sapporo, Hokkaido 060-0848, Japan; Department of Diagnostic Radiology, Sapporo City General Hospital, Sapporo, Japan (Y.H.); Department of Radiology, Steel Memorial Muroran Hospital, Murofan, Japan (N.Y.); Department of Medicine IV, Tokyo Women's Medical University, Tokyo, Japan (T.M.); and Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan (H.S.)
| | - Noriaki Yuasa
- From the Department of Diagnostic and Interventional Radiology (Y.S., D.A., T.S., K.K.), Department of Medicine II (S.N.), Department of Urology (K.M.), and Translational Research and Clinical Trial Center (K.O.), Hokkaido University Hospital, N-14, W-5, Kita-ku, Sapporo, Hokkaido 060-0848, Japan; Department of Diagnostic Radiology, Sapporo City General Hospital, Sapporo, Japan (Y.H.); Department of Radiology, Steel Memorial Muroran Hospital, Murofan, Japan (N.Y.); Department of Medicine IV, Tokyo Women's Medical University, Tokyo, Japan (T.M.); and Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan (H.S.)
| | - Toshio Mochizuki
- From the Department of Diagnostic and Interventional Radiology (Y.S., D.A., T.S., K.K.), Department of Medicine II (S.N.), Department of Urology (K.M.), and Translational Research and Clinical Trial Center (K.O.), Hokkaido University Hospital, N-14, W-5, Kita-ku, Sapporo, Hokkaido 060-0848, Japan; Department of Diagnostic Radiology, Sapporo City General Hospital, Sapporo, Japan (Y.H.); Department of Radiology, Steel Memorial Muroran Hospital, Murofan, Japan (N.Y.); Department of Medicine IV, Tokyo Women's Medical University, Tokyo, Japan (T.M.); and Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan (H.S.)
| | - Takeshi Soyama
- From the Department of Diagnostic and Interventional Radiology (Y.S., D.A., T.S., K.K.), Department of Medicine II (S.N.), Department of Urology (K.M.), and Translational Research and Clinical Trial Center (K.O.), Hokkaido University Hospital, N-14, W-5, Kita-ku, Sapporo, Hokkaido 060-0848, Japan; Department of Diagnostic Radiology, Sapporo City General Hospital, Sapporo, Japan (Y.H.); Department of Radiology, Steel Memorial Muroran Hospital, Murofan, Japan (N.Y.); Department of Medicine IV, Tokyo Women's Medical University, Tokyo, Japan (T.M.); and Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan (H.S.)
| | - Koji Oba
- From the Department of Diagnostic and Interventional Radiology (Y.S., D.A., T.S., K.K.), Department of Medicine II (S.N.), Department of Urology (K.M.), and Translational Research and Clinical Trial Center (K.O.), Hokkaido University Hospital, N-14, W-5, Kita-ku, Sapporo, Hokkaido 060-0848, Japan; Department of Diagnostic Radiology, Sapporo City General Hospital, Sapporo, Japan (Y.H.); Department of Radiology, Steel Memorial Muroran Hospital, Murofan, Japan (N.Y.); Department of Medicine IV, Tokyo Women's Medical University, Tokyo, Japan (T.M.); and Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan (H.S.)
| | - Hiroki Shirato
- From the Department of Diagnostic and Interventional Radiology (Y.S., D.A., T.S., K.K.), Department of Medicine II (S.N.), Department of Urology (K.M.), and Translational Research and Clinical Trial Center (K.O.), Hokkaido University Hospital, N-14, W-5, Kita-ku, Sapporo, Hokkaido 060-0848, Japan; Department of Diagnostic Radiology, Sapporo City General Hospital, Sapporo, Japan (Y.H.); Department of Radiology, Steel Memorial Muroran Hospital, Murofan, Japan (N.Y.); Department of Medicine IV, Tokyo Women's Medical University, Tokyo, Japan (T.M.); and Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan (H.S.)
| | - Kohsuke Kudo
- From the Department of Diagnostic and Interventional Radiology (Y.S., D.A., T.S., K.K.), Department of Medicine II (S.N.), Department of Urology (K.M.), and Translational Research and Clinical Trial Center (K.O.), Hokkaido University Hospital, N-14, W-5, Kita-ku, Sapporo, Hokkaido 060-0848, Japan; Department of Diagnostic Radiology, Sapporo City General Hospital, Sapporo, Japan (Y.H.); Department of Radiology, Steel Memorial Muroran Hospital, Murofan, Japan (N.Y.); Department of Medicine IV, Tokyo Women's Medical University, Tokyo, Japan (T.M.); and Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan (H.S.)
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Hamanoue S, Hoshino J, Suwabe T, Marui Y, Ueno T, Kikuchi K, Hazue R, Mise K, Kawada M, Imafuku A, Hayami N, Sumida K, Hiramatsu R, Hasegawa E, Sawa N, Takaichi K, Ubara Y. Peritoneal Dialysis is Limited by Kidney and Liver Volume in Autosomal Dominant Polycystic Kidney Disease. Ther Apher Dial 2015; 19:207-11. [DOI: 10.1111/1744-9987.12272] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | | | | | - Yuji Marui
- Nephrology Center; Toranomon Hospital; Tokyo Japan
| | | | | | - Ryo Hazue
- Nephrology Center; Toranomon Hospital; Tokyo Japan
| | - Koki Mise
- Nephrology Center; Toranomon Hospital; Tokyo Japan
| | | | - Aya Imafuku
- Nephrology Center; Toranomon Hospital; Tokyo Japan
| | | | | | | | | | - Naoki Sawa
- Nephrology Center; Toranomon Hospital; Tokyo Japan
| | - Kennmei Takaichi
- Nephrology Center; Toranomon Hospital; Tokyo Japan
- Okinaka Memorial Institute for Medical Research; Toranomon Hospital; Tokyo Japan
| | - Yoshifumi Ubara
- Nephrology Center; Toranomon Hospital; Tokyo Japan
- Okinaka Memorial Institute for Medical Research; Toranomon Hospital; Tokyo Japan
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Abstract
Owing to improvements in catheters and embolic agents, renal artery embolization (RAE) is increasingly used to treat nephrological and urological disease. RAE has become a useful adjunct to medical resuscitation in severe penetrating, iatrogenic or blunt renal traumatisms with active bleeding, and might avoid surgical intervention, particularly among patients that are haemodynamically stable. The role of RAE in pre-operative or palliative management of advanced malignant renal tumours remains debated; however, RAE is recommended as a first-line therapy for bleeding angiomyolipomas and can be used as a preventative treatment for angiomyolipomas at risk of bleeding. RAE represents an alternative to nephrectomy in various medical conditions, including severe uncontrolled hypertension among patients with end-stage renal disease, renal graft intolerance syndrome or autosomal dominant polycystic kidney disease. RAE is increasingly used to treat renal artery aneurysms or symptomatic renal arteriovenous malformations, with a low complication rate as compared with surgical alternatives. This Review highlights the potential use of RAE as an adjunct in the management of renal disease. We first compare and contrast the technical approaches of RAE associated with the various available embolization agents and then discuss the complications associated with RAE and alternative procedures.
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Hoshino J, Suwabe T, Hayami N, Sumida K, Mise K, Kawada M, Imafuku A, Hiramatsu R, Yamanouchi M, Hasegawa E, Sawa N, Takei R, Takaichi K, Ubara Y. Survival after arterial embolization therapy in patients with polycystic kidney and liver disease. J Nephrol 2014; 28:369-77. [PMID: 25230989 DOI: 10.1007/s40620-014-0138-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 09/01/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Transcatheter arterial embolization (TAE) has become a therapeutic option for symptomatic polycystic kidney disease (PKD) and polycystic liver disease (PLD). However, factors affecting survival with renal TAE remain unknown. METHODS All symptomatic patients with severe PKD and/or PLD who received renal and/or hepatic TAE at our center from October 1996 through March 2013 (n = 1,028) were followed until death. Their survival was compared with that of the general PKD population on dialysis in Japan. Factors affecting survival were analyzed using the Cox hazard model. RESULTS After renal TAE, 5- and 10-year survival was, respectively, 0.78 (95% confidence interval, 0.74-0.82) and 0.56 (0.49-0.63); with hepatic TAE, 0.69 (0.58-0.77) and 0.41 (0.22-0.60); and with dual TAE (renal and hepatic), 0.82 (0.72-0.88) and 0.45 (0.31-0.59). Survival after dialysis initiation was better among patients with renal TAE than among general PKD patients. Factors affecting survival after renal TAE were age [hazard ratio (HR) 3.02 (1.44-6.33) for every 10 years] and albumin [HR 0.70 (0.55-0.89) per 0.1 g/dl]. Kidney volume was not associated with patient death after TAE. The main causes of death among patients after renal TAE were similar to those of the general PKD population on dialysis whereas, after hepatic TAE, the main cause was cyst infection with liver failure (12.5% with PLD and 5.9% with PKD, p < 0.01). CONCLUSION Survival after renal TAE with severe PKD was better than for the general PKD population on dialysis, suggesting that renal TAE could overcome the disadvantage due to huge organ size.
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Affiliation(s)
- Junichi Hoshino
- Nephrology Center, Toranomon Hospital, 1-3-1, Kajigaya, Takatsu-ku, Kawasaki, Kanagawa, 213-8587, Japan,
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Casteleijn NF, Visser FW, Drenth JP, Gevers TJ, Groen GJ, Hogan MC, Gansevoort RT. A stepwise approach for effective management of chronic pain in autosomal-dominant polycystic kidney disease. Nephrol Dial Transplant 2014; 29 Suppl 4:iv142-iv153. [PMID: 25165181 PMCID: PMC4217572 DOI: 10.1093/ndt/gfu073] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 03/12/2014] [Indexed: 12/12/2022] Open
Abstract
Chronic pain, defined as pain existing for >4-6 weeks, affects >60% of patients with autosomal-dominant polycystic disease (ADPKD). It can have various causes, indirectly or directly related to the increase in kidney and liver volume in these patients. Chronic pain in ADPKD patients is often severe, impacting physical activity and social relationships, and frequently difficult to manage. This review provides an overview of pathophysiological mechanisms that can lead to pain and discusses the sensory innervation of the kidneys and the upper abdominal organs, including the liver. In addition, the results of a systematic literature search of ADPKD-specific treatment options are presented. Based on pathophysiological knowledge and evidence derived from the literature an argumentative stepwise approach for effective management of chronic pain in ADPKD is proposed.
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Affiliation(s)
- Niek F. Casteleijn
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Folkert W. Visser
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joost P.H. Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Tom J.G. Gevers
- Department of Gastroenterology and Hepatology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Gerbrand J. Groen
- Pain Centre, Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marie C. Hogan
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ron T. Gansevoort
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - on behalf of the DIPAK Consortium
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Gastroenterology and Hepatology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
- Pain Centre, Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Hoshino J, Ubara Y, Suwabe T, Sumida K, Hayami N, Mise K, Hiramatsu R, Hasegawa E, Yamanouchi M, Sawa N, Takei R, Takaichi K. Intravascular embolization therapy in patients with enlarged polycystic liver. Am J Kidney Dis 2014; 63:937-44. [PMID: 24602778 DOI: 10.1053/j.ajkd.2014.01.422] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 01/16/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hepatic transcatheter arterial embolization (TAE) has become an accepted treatment option for patients with symptomatic autosomal dominant polycystic kidney disease (ADPKD) who also have polycystic liver disease and who are not good candidates for surgery. However, indications for TAE and long-term outcome with it are still unclear. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS Symptomatic patients with ADPKD with polycystic liver disease who underwent hepatic TAE, June 2001 to December 2012, at Toranomon Hospital and whose liver volume data were available were studied (N=244; 56% on dialysis therapy, none with kidney transplants). Mean age was 55 ± 9 (SD) years, and mean liver volumes were 8,353 ± 2,807 and 6,626 ± 2,485 cm(3) in men and women, respectively. Target arteries were embolized from the periphery using platinum microcoils. PREDICTORS Sex-specific quartiles (6,433, 8,142, and 9,574 cm(3) in men and 4,638, 6,078, and 8,181 cm(3) in women) of total liver volume pretreatment. OUTCOMES All causes of mortality were obtained from medical records, followed up until July 31, 2013. MEASUREMENTS Laboratory values were measured before TAE and 1, 3, 6, and 12 months after. Organ volumes were measured pretreatment, then 6 and 12 months after, by summing the products of the organ areas traced in each computed tomographic image. RESULTS Liver/cyst volume decreased to 94.7% (95% CI, 93.5%-95.8%) at 6 months and 90.8% (95% CI, 88.7%-92.9%) at 12 months of pretreatment volumes. Serum protein and hematocrit values improved significantly without liver damage. Survival was significantly better for patients with liver volume ≤ 9,574 cm(3) (men) and ≤ 8,181 cm(3) (women) than for those with larger livers (5-year survival, 69% and 48%; P=0.02). Infection and liver failure caused most deaths, especially in patients with larger livers. LIMITATIONS Referral bias and lack of control group. CONCLUSIONS Hepatic TAE appears to be a safe and less invasive option for patients with symptomatic polycystic liver, especially those contraindicated for surgical treatment (eg, with malnutrition or on dialysis therapy), improving both hepatic volume and nutrition.
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Affiliation(s)
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital, Tokyo, Japan; Okinaka Memorial Institute, Tokyo, Japan
| | | | | | | | - Koki Mise
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
| | | | | | | | - Naoki Sawa
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
| | - Ryoji Takei
- Department of Radiology, Touzan Hospital, Tokyo, Japan
| | - Kenmei Takaichi
- Nephrology Center, Toranomon Hospital, Tokyo, Japan; Okinaka Memorial Institute, Tokyo, Japan
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Hattori Y, Hoshino J, Suwabe T, Sumida K, Mise K, Hayami N, Sawa N, Takaichi K, Ubara Y. Umbilical hernia in autosomal dominant polycystic kidney disease. Clin Exp Nephrol 2014; 19:154-6. [PMID: 24408221 PMCID: PMC4335090 DOI: 10.1007/s10157-013-0927-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 12/11/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Yoshinari Hattori
- Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato, Tokyo, 105-8470, Japan
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Suwabe T, Ubara Y, Mise K, Kawada M, Hamanoue S, Sumida K, Hayami N, Hoshino J, Hiramatsu R, Yamanouchi M, Hasegawa E, Sawa N, Takaichi K. Quality of life of patients with ADPKD-Toranomon PKD QOL study: cross-sectional study. BMC Nephrol 2013; 14:179. [PMID: 23978051 PMCID: PMC3765978 DOI: 10.1186/1471-2369-14-179] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 08/23/2013] [Indexed: 11/23/2022] Open
Abstract
Background The quality of life (QOL) of patients with autosomal dominant polycystic kidney disease (ADPKD) has not been investigated well. This study was performed to clarify the QOL of patients with ADPKD and to identify factors that affected their QOL. Methods The present cross-sectional study is part of a prospective observational study on the QOL of ADPKD patients. Patients with ADPKD who were referred to Toranomon Hospital between March 2010 and November 2012 were enrolled. The short form-36 (SF-36) questionnaire and our original 12-item questionnaire were used to evaluate QOL. We analyzed the results of the questionnaire survey and then investigated correlations between QOL and clinical features. Results A total of 219 patients (93 men and 126 women) were enrolled and their mean age was 55.1±10.8 years. There were 108 patients on dialysis. The SF-36 scores (PCS, MCS, and RCS) of all patients were significantly lower than the mean scores for the Japanese population. Stepwise multiple regression analysis demonstrated that Hb, serum Alb, ascites, and cerebrovascular disease all had a significant influence on the PCS, while mental disease had a significant influence on the MCS and serum Alb significantly influenced the RCS. The total liver and kidney volume (TLKV) and the dialysis status were not significantly associated with any of the SF-36 scores by multiple regression analysis, but TLKV was closely correlated with abdominal distention and distention had an important influence on QOL. Pain, sleep disturbance, heartburn, fever, gross hematuria, and anorexia also affected QOL, but these variables were not correlated with TLKV. Conclusions Several factors influence QOL, so improving symptoms unrelated to TLKV as well as reducing abdominal distention can improve the QOL of ADPKD patients.
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Affiliation(s)
- Tatsuya Suwabe
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan.
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Perrone RD, Coons SJ, Cavanaugh K, Finkelstein F, Meyer KB. Patient-reported outcomes in clinical trials of CKD-related therapies: report of a symposium sponsored by the national kidney foundation and the U.S. Food and Drug Administration. Am J Kidney Dis 2013; 62:1046-57. [PMID: 23988757 DOI: 10.1053/j.ajkd.2013.07.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 07/22/2013] [Indexed: 11/11/2022]
Abstract
The National Kidney Foundation and the U.S. Food and Drug Administration (FDA) convened a symposium in September 2010, bringing together more than 70 experts, including representatives from the FDA, the National Institutes of Health, the Critical Path Institute, nephrologists, patients, and the pharmaceutical industry to discuss the feasibility and process of developing patient-reported outcome (PRO) measures to access how patients feel or function to be used in clinical trials for regulatory review of treatment benefit. Three disease areas were evaluated for development of end point models in which PRO measures may be useful: anemia secondary to chronic kidney disease, autosomal dominant polycystic kidney disease (ADPKD), and nephrotic syndrome. The participants thought it valuable to use observational data to generate hypotheses regarding patient baseline characteristics that are likely to predict clinically important changes in PROs in response to anemia treatment and to design adequately powered blinded randomized controlled trials of anemia treatment using PROs as primary rather than secondary end points. Validated PRO instruments that reflect the patient experience in ADPKD and nephrotic syndrome are essential to incorporate into clinical trials of new therapeutic interventions because glomerular filtration rate decline may occur late in the disease course, at which point therapeutic benefit is less likely. Conference attendees addressed how PRO measures could be used to evaluate, monitor, provide care, and facilitate the introduction of treatments for patients with these challenging conditions.
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Fraser N, Lyon PC, Williams AR, Christian MT, Shenoy MU. Native nephrectomy in pediatric transplantation--less is more! J Pediatr Urol 2013; 9:84-9. [PMID: 22227459 DOI: 10.1016/j.jpurol.2011.12.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Accepted: 12/16/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Indications for pre-transplantation native nephrectomy (PTNN) include chronic renal parenchymal infection, proteinuria, intractable hypertension, polycystic kidneys and malignancy. Our aim was to establish the frequency and reasons for PTNN in children undergoing renal transplant at our center. MATERIALS AND METHODS Children listed for renal transplant between 1998 and 2010 who underwent PTNN were analyzed. Etiology of established renal failure, indication for nephrectomy, stage of chronic kidney disease, laterality, complications, and timing of subsequent transplant were determined. Outcome of children, and that of preserved native kidneys following transplant, was reviewed. RESULTS 21/203 children listed for transplant (10.3%) underwent PTNN (32 nephrectomies). Indications were drug-resistant proteinuria (6 children), recurrent upper tract urosepsis (6), refractory hypertension (4), malignancy/malignant predisposition (4), concomitant procedure during ureterocystoplasty (1). Median age at nephrectomy was 3.3 years; 86% had impaired renal function at time of (first) nephrectomy. Median time until transplantation following bilateral nephrectomy was 1.7 years. 19/21 children have been transplanted; 17 reached stable graft function. Only 2 children who did not undergo PTNN required nephrectomy post-transplant. CONCLUSION When malignancies were excluded, PTNN was performed in a minority (8.4%) of children, mainly for proteinuria. This adds great advantage by reducing morbidity. Resulting graft function seems favorable.
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Affiliation(s)
- Nia Fraser
- Department of Paediatric Urology, Kidney Transplant Unit, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Queens Medical Centre, Derby Rd, Nottingham NG7 2UH, UK.
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Tsuchiya Y, Ubara Y, Suwabe T, Nomura K, Sumida K, Hiramatsu R, Hoshino J, Hasegawa E, Yamanouchi M, Hayami N, Sawa N, Takaichi K, Oohashi K. AA-amyloidosis in autosomal dominant polycystic kidney disease caused by chronic cyst infections lasting for 30 years. Intern Med 2013; 52:791-4. [PMID: 23545677 DOI: 10.2169/internalmedicine.52.9277] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report the case of a 66-year-old Japanese woman who was admitted to our hospital due to diarrhea and malaise. She had been diagnosed with autosomal dominant polycystic kidney disease (ADPKD) at 35 years of age and had suffered from recurrent cyst infections since that time. Antibiotic therapy combined with hepatic cyst drainage and cyst sclerosing therapy led to transient improvements each time. At 66 years of age, watery diarrhea occurred. The patient's serum albumin level declined to 1.8 g/dL, and her C-reactive protein level was 4.5 mg/dL. An endoscopic biopsy of the descending colon revealed amorphous deposits in the small arteries and tissues of the submucosal layer. The deposits were positive for Congo Red staining and amyloid A staining. Therefore, AA-amyloidosis was diagnosed. An endoscopic biopsy of the stomach and duodenum also showed AA-amyloid deposits. If an ADPKD patient with a long history of cyst infection develops diarrhea and malaise, AA-amyloidosis should be considered as a possible complication.
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Ozbek O, Acar K, Koc O, Saritas K, Toy H, Solak Y, Ozbek S, Kucukapan A, Guler I, Gaipov A, Turk S, Haznedaroglu IC. Short-Term Effects of Ankaferd Hemostat for Renal Artery Embolization: An Experimental Study. Cardiovasc Intervent Radiol 2012; 36:498-504. [DOI: 10.1007/s00270-012-0419-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 04/29/2012] [Indexed: 11/24/2022]
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Yamakoshi S, Ubara Y, Suwabe T, Hiramatsu R, Yamanouchi M, Hayami N, Sumida K, Hasegawa E, Hoshino J, Sawa N, Takaichi K, Kawabata M. Transcatheter renal artery embolization improves lung function in patients with autosomal dominant polycystic kidney disease on hemodialysis. Clin Exp Nephrol 2012; 16:773-8. [PMID: 22526485 DOI: 10.1007/s10157-012-0619-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Accepted: 02/23/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND Since 1996, transcatheter renal artery embolization (renal TAE) has been performed to reduce the volume of the kidneys in patients with autosomal dominant polycystic kidney disease (ADPKD) and complications of nephromegaly at our hospital. Respiratory dysfunction is often a serious problem in these patients before TAE. PATIENTS AND METHODS Between January 2006 and October 2008, renal TAE was performed and lung function testing [percent vital capacity (%VC) and percent forced expiratory volume in 1 s (%FEV(1.0))] was done by spirometry in 28 patients on maintenance hemodialysis who had respiratory symptoms. RESULTS Renal volume was 6,330.5 ± 3,126.5 cm(3) (range 1,771-12,761 cm(3)) before TAE, and decreased significantly to 2,892.2 ± 1,841.7 cm(3) (range 622-6,961 cm(3)) by 12 months after TAE (p = 0.0001). The percent decrease of renal volume at 12 months after TAE versus baseline was 45.6 ± 14.6% (range 6.6-67.3%). %VC showed a significant increase from 95.9 ± 14.8% (range 63-127%) before renal TAE to 100.1 ± 11.7% (range 78-120%) at 12 months after TAE (p < 0.01). %FEV(1.0) was also significantly increased from 87.9 ± 15.0% (range 55-110%) before renal TAE to 92.5 ± 14.4% (range 58.0-115.0%) at 12 months after TAE (p < 0.01). The changes of VC (ΔVC%) and FEV(1.0) (ΔFEV(1.0)%) both showed a significant positive correlation with the reduction of renal volume (Δ renal volume) (p = 0.001 and p = 0.004, respectively). CONCLUSION Since TAE not only led to a significant decrease of renal volume in ADPKD patients with nephromegaly, but also improved lung function (both %VC and %FEV(1.0)), pulmonary dysfunction should be recognized as one of the extrarenal complications of ADPKD.
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Affiliation(s)
- Shiho Yamakoshi
- Department of Pulmonary and Critical Care Medicine, Toranomon Hospital, Kajigaya, Kanagawa, Japan
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Emphysematous cyst infection in autosomal dominant polycystic kidney disease. Clin Exp Nephrol 2012; 16:505-6. [PMID: 22450907 DOI: 10.1007/s10157-012-0622-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 03/06/2012] [Indexed: 10/28/2022]
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Morishita H, Yamagami T, Takeuchi Y, Matsumoto T, Asai S, Nakanouchi T, Sato O, Nishimura T. Use of N-butyl-2-cyanoacrylate for transcatheter arterial embolization of renal arteries in patients with polycystic kidney disease. J Vasc Interv Radiol 2012; 22:1631-3. [PMID: 22024120 DOI: 10.1016/j.jvir.2011.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 07/10/2011] [Accepted: 07/11/2011] [Indexed: 11/19/2022] Open
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Hiramatsu R, Ubara Y, Suwabe T, Sumida K, Hayami N, Yamanouchi M, Mise K, Hasegawa E, Hoshino J, Sawa N, Takaichi K. Osteomalacia and insufficiency fracture in a hemodialysis patient with autosomal dominant polycystic kidney disease. Intern Med 2012. [PMID: 23207124 DOI: 10.2169/internalmedicine.51.8109] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 61-year-old Japanese woman on hemodialysis with autosomal dominant polycystic kidney disease (ADPKD) was admitted to the hospital with gluteal pain. Radiographs demonstrated a fracture of the left pubis. The serum 1,25(OH)(2)-vitamin D and 25(OH)-vitamin D levels were low. A biopsy of the right iliac crest disclosed osteomalacia. Active vitamin D sterol was administered in conjunction with dietary modification. Her gluteal pain was resolved three years later, and healing of the fracture was confirmed by radiology. This case emphasizes that vitamin D deficiency and malnutrition can cause osteomalacia in dialysis patients, even if calcium (Ca) and phosphate (P) levels are controlled by calcium carbonate.
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Toyohara T, Hayami N, Ubara Y. Successful Peritoneal Dialysis After Renal Transcatheter Arterial Embolization in Autosomal Dominant Polycystic Kidney Disease. Am J Kidney Dis 2011; 58:860-1. [DOI: 10.1053/j.ajkd.2011.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 07/27/2011] [Indexed: 11/11/2022]
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Park UJ, Kim HT, Kim MY, Hwang EA, Han SY, Park SB, Kim HC, Kim YH, Cho WH. Successful Renal Transplantation in Patients with Polycystic Kidneys after Renal Contraction by Renal Artery Embolization - Report on 2 Cases. KOREAN JOURNAL OF TRANSPLANTATION 2011. [DOI: 10.4285/jkstn.2011.25.3.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ui Jun Park
- Department of Transplant & Vascular Surgery, Dongsan Medical Center, Keimyung University, Daegu, Korea
| | - Hyoung Tae Kim
- Department of Transplant & Vascular Surgery, Dongsan Medical Center, Keimyung University, Daegu, Korea
| | - Min Young Kim
- Department of Transplant & Vascular Surgery, Dongsan Medical Center, Keimyung University, Daegu, Korea
| | - Eun Ah Hwang
- Department of Internal Medicine, Dongsan Medical Center, Keimyung University, Daegu, Korea
| | - Seung Yeup Han
- Department of Internal Medicine, Dongsan Medical Center, Keimyung University, Daegu, Korea
| | - Sung Bae Park
- Department of Internal Medicine, Dongsan Medical Center, Keimyung University, Daegu, Korea
| | - Hyun Chul Kim
- Department of Internal Medicine, Dongsan Medical Center, Keimyung University, Daegu, Korea
| | - Young Hwan Kim
- Department of Interventional Radiology, Dongsan Medical Center, Keimyung University, Daegu, Korea
| | - Won Hyun Cho
- Department of Transplant & Vascular Surgery, Dongsan Medical Center, Keimyung University, Daegu, Korea
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Ishikawa I, Hayama S, Morita K, Nakazawa T, Yokoyama H, Honda R, Satoh K, Kakuma T. Long-term natural history of acquired cystic disease of the kidney. Ther Apher Dial 2010; 14:409-16. [PMID: 20649762 DOI: 10.1111/j.1744-9987.2010.00819.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Patients with acquired cystic disease of the kidney (ACDK) were followed longitudinally over an average of 21.7 +/- 5.4 years to determine the natural history of the disease; that is, how big the kidneys become, when the kidney size reaches a plateau, and when the size regresses. Twenty-seven male and 20 female patients with chronic glomerulonephritis treated at our hospital were investigated. CT scans were performed once a year and kidney volume was measured. Two different quadratic curves with a node of 5.2 years for males and 2.5 years for females after the start of hemodialysis were fitted to log-transformed kidney volume to the duration of hemodialysis using a linear mixed model. The maximum kidney volume in male patients was obtained 21.1 years after the start of hemodialysis using this model. Peak values of kidney volume were demonstrated in 19 of 26 cases during the observation period. The median peak value (interquartile range) of bilateral kidney volumes was 274 (165-849) mL/1.73 m(2) occurring 19.1 +/- 4.5 years after the start of dialysis. In one male patient who had undergone nephrectomy due to renal cell carcinoma and in two of the remaining 26 male patients, the maximum kidney volume of 782 (residual kidney), 1151, and 1129 mL regressed to 428, 616, and 847 mL (reduction rate: 45.3, 46.5, and 25.0%) at 20.6, 25.4, and 23.1 years after the start of hemodialysis, respectively. Kidney enlargement due to ACDK reached a plateau after 21.1 years of hemodialysis in the male patients. Partial regression of severe ACDK may occur naturally after long-term hemodialysis without renal transplantation.
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Affiliation(s)
- Isao Ishikawa
- Department of Internal Medicine, Division of Nephrology, Asanogawa General Hospital, Kanazawa, Japan.
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[Successful renal contraction therapy in polycystic kidney patient with renal transcatheter arterial embolization prior to ABO incompatible kidney transplantation]. Nihon Hinyokika Gakkai Zasshi 2010; 101:730-3. [PMID: 20954380 DOI: 10.5980/jpnjurol.101.730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
28-year-old female received dialysis treatment due to chronic renal failure caused by polycystic kidney disease. Later, she underwent a laparoscopic splenectomy and ABO incompatible living kidney transplantation successfully following bilateral renal contraction therapy with renal transcatheter arterial embolization (renal TAE). A unilateral or bilateral native nephrectomy of a massively enlarged kidney performed at the time of renal transplantation is a common treatment in polycystic kidney patients scheduled for transplantation. On the other hand, when treated with renal TAE, such patients can avoid a laparotomy, which provides several advantages when undergoing peritoneal dialysis in the future or a laparoscopic splenectomy prior to ABO incompatible kidney transplantation. Furthermore, we consider that bilateral renal TAE is necessary for polycystic kidney patients prior to renal transplantation for a variety of reasons, including problems associated with contrast nephropathy if renal TAE for left kidney is remained after renal transplantation.
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Cornelis F, Couzi L, Le Bras Y, Hubrecht R, Dodré E, Geneviève M, Pérot V, Wallerand H, Ferrière JM, Merville P, Grenier N. Embolization of polycystic kidneys as an alternative to nephrectomy before renal transplantation: a pilot study. Am J Transplant 2010; 10:2363-9. [PMID: 21143393 DOI: 10.1111/j.1600-6143.2010.03251.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In autosomal polycystic kidney disease, nephrectomy is required before transplantation if kidney volume is excessive. We evaluated the effectiveness of transcatheter arterial embolization (TAE) to obtain sufficient volume reduction for graft implantation. From March 2007 to December 2009, 25 patients with kidneys descending below the iliac crest had unilateral renal TAE associated with a postembolization syndrome protocol. Volume reduction was evaluated by CT before, 3, and 6 months after embolization. The strategy was considered a success if the temporary contraindication for renal transplantation could be withdrawn within 6 months after TAE. TAE was well tolerated and the objective was reached in 21 patients. The temporary contraindication for transplantation was withdrawn within 3 months after TAE in 9 patients and within 6 months in 12 additional patients. The mean reduction in volume was 42% at 3 months (p = 0.01) and 54% at 6 months (p = 0.001). One patient required a cyst sclerosis to reach the objective. The absence of sufficient volume reduction was due to an excessive basal renal volume, a missed accessory artery and/or renal artery revascularization. Embolization of enlarged polycystic kidneys appears to be an advantageous alternative to nephrectomy before renal transplantation.
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Affiliation(s)
- F Cornelis
- Department of Adult Diagnostic and Interventional Imaging, Bordeaux University Hospital, Place Amélie Raba Léon, Bordeaux, France
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