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He X, Hu Z, Dev H, Romano DJ, Sharbatdaran A, Raza SI, Wang SJ, Teichman K, Shih G, Chevalier JM, Shimonov D, Blumenfeld JD, Goel A, Sabuncu MR, Prince MR. Test Retest Reproducibility of Organ Volume Measurements in ADPKD Using 3D Multimodality Deep Learning. Acad Radiol 2024; 31:889-899. [PMID: 37798206 PMCID: PMC10957335 DOI: 10.1016/j.acra.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/28/2023] [Accepted: 09/05/2023] [Indexed: 10/07/2023]
Abstract
RATIONALE AND OBJECTIVES Following autosomal dominant polycystic kidney disease (ADPKD) progression by measuring organ volumes requires low measurement variability. The objective of this study is to reduce organ volume measurement variability on MRI of ADPKD patients by utilizing all pulse sequences to obtain multiple measurements which allows outlier analysis to find errors and averaging to reduce variability. MATERIALS AND METHODS In order to make measurements on multiple pulse sequences practical, a 3D multi-modality multi-class segmentation model based on nnU-net was trained/validated using T1, T2, SSFP, DWI and CT from 413 subjects. Reproducibility was assessed with test-re-test methodology on ADPKD subjects (n = 19) scanned twice within a 3-week interval correcting outliers and averaging the measurements across all sequences. Absolute percent differences in organ volumes were compared to paired students t-test. RESULTS Dice similarlity coefficient > 97%, Jaccard Index > 0.94, mean surface distance < 1 mm and mean Hausdorff Distance < 2 cm for all three organs and all five sequences were found on internal (n = 25), external (n = 37) and test-re-test reproducibility assessment (38 scans in 19 subjects). When averaging volumes measured from five MRI sequences, the model automatically segmented kidneys with test-re-test reproducibility (percent absolute difference between exam 1 and exam 2) of 1.3% which was better than all five expert observers. It reliably stratified ADPKD into Mayo Imaging Classification (area under the curve=100%) compared to radiologist. CONCLUSION 3D deep learning measures organ volumes on five MRI sequences leveraging the power of outlier analysis and averaging to achieve 1.3% total kidney test-re-test reproducibility.
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Affiliation(s)
- Xinzi He
- School of Electrical and Computer Engineering, Cornell University and Cornell Tech, New York, New York (X.H., R.S.); Department of Radiology, Weill Cornell Medicine, New York, New York (X.H., Z.H., H.D., D.J.R., A.S., S.I.R., S.J.W., K.T., G.S., A.G., R.S., M.R.P.)
| | - Zhongxiu Hu
- Department of Radiology, Weill Cornell Medicine, New York, New York (X.H., Z.H., H.D., D.J.R., A.S., S.I.R., S.J.W., K.T., G.S., A.G., R.S., M.R.P.)
| | - Hreedi Dev
- Department of Radiology, Weill Cornell Medicine, New York, New York (X.H., Z.H., H.D., D.J.R., A.S., S.I.R., S.J.W., K.T., G.S., A.G., R.S., M.R.P.)
| | - Dominick J Romano
- Department of Radiology, Weill Cornell Medicine, New York, New York (X.H., Z.H., H.D., D.J.R., A.S., S.I.R., S.J.W., K.T., G.S., A.G., R.S., M.R.P.)
| | - Arman Sharbatdaran
- Department of Radiology, Weill Cornell Medicine, New York, New York (X.H., Z.H., H.D., D.J.R., A.S., S.I.R., S.J.W., K.T., G.S., A.G., R.S., M.R.P.)
| | - Syed I Raza
- Department of Radiology, Weill Cornell Medicine, New York, New York (X.H., Z.H., H.D., D.J.R., A.S., S.I.R., S.J.W., K.T., G.S., A.G., R.S., M.R.P.)
| | - Sophie J Wang
- Department of Radiology, Weill Cornell Medicine, New York, New York (X.H., Z.H., H.D., D.J.R., A.S., S.I.R., S.J.W., K.T., G.S., A.G., R.S., M.R.P.)
| | - Kurt Teichman
- Department of Radiology, Weill Cornell Medicine, New York, New York (X.H., Z.H., H.D., D.J.R., A.S., S.I.R., S.J.W., K.T., G.S., A.G., R.S., M.R.P.)
| | - George Shih
- Department of Radiology, Weill Cornell Medicine, New York, New York (X.H., Z.H., H.D., D.J.R., A.S., S.I.R., S.J.W., K.T., G.S., A.G., R.S., M.R.P.)
| | - James M Chevalier
- Department of Medicine, Weill Cornell Medicine, New York, New York (J.M.C., D.S., J.D.B.); The Rogosin Institute, New York, New York (J.M.C., D.S., J.D.B.)
| | - Daniil Shimonov
- Department of Medicine, Weill Cornell Medicine, New York, New York (J.M.C., D.S., J.D.B.); The Rogosin Institute, New York, New York (J.M.C., D.S., J.D.B.)
| | - Jon D Blumenfeld
- Department of Medicine, Weill Cornell Medicine, New York, New York (J.M.C., D.S., J.D.B.); The Rogosin Institute, New York, New York (J.M.C., D.S., J.D.B.)
| | - Akshay Goel
- Department of Radiology, Weill Cornell Medicine, New York, New York (X.H., Z.H., H.D., D.J.R., A.S., S.I.R., S.J.W., K.T., G.S., A.G., R.S., M.R.P.)
| | - Mert R Sabuncu
- School of Electrical and Computer Engineering, Cornell University and Cornell Tech, New York, New York (X.H., R.S.); Department of Radiology, Weill Cornell Medicine, New York, New York (X.H., Z.H., H.D., D.J.R., A.S., S.I.R., S.J.W., K.T., G.S., A.G., R.S., M.R.P.)
| | - Martin R Prince
- Department of Radiology, Weill Cornell Medicine, New York, New York (X.H., Z.H., H.D., D.J.R., A.S., S.I.R., S.J.W., K.T., G.S., A.G., R.S., M.R.P.); Columbia University Vagelos College of Physicians and Surgeons, New York, New York (M.R.P.).
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Righini M, Mancini R, Busutti M, Buscaroli A. Autosomal Dominant Polycystic Kidney Disease: Extrarenal Involvement. Int J Mol Sci 2024; 25:2554. [PMID: 38473800 DOI: 10.3390/ijms25052554] [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: 01/03/2024] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disorder, but kidneys are not the only organs involved in this systemic disorder. Individuals with the condition may display additional manifestations beyond the renal system, involving the liver, pancreas, and brain in the context of cystic manifestations, while involving the vascular system, gastrointestinal tract, bones, and cardiac valves in the context of non-cystic manifestations. Despite kidney involvement remaining the main feature of the disease, thanks to longer survival, early diagnosis, and better management of kidney-related problems, a new wave of complications must be faced by clinicians who treated patients with ADPKD. Involvement of the liver represents the most prevalent extrarenal manifestation and has growing importance in the symptom burden and quality of life. Vascular abnormalities are a key factor for patients' life expectancy and there is still debate whether to screen or not to screen all patients. Arterial hypertension is often the earliest onset symptom among ADPKD patients, leading to frequent cardiovascular complications. Although cardiac valvular abnormalities are a frequent complication, they rarely lead to relevant problems in the clinical history of polycystic patients. One of the newest relevant aspects concerns bone disorders that can exert a considerable influence on the clinical course of these patients. This review aims to provide the "state of the art" among the extrarenal manifestation of ADPKD.
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Affiliation(s)
- Matteo Righini
- Nephrology and Dialysis Unit, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
- Nephrology, Dialysis and Transplantation Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Raul Mancini
- Nephrology, Dialysis and Transplantation Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Marco Busutti
- Nephrology, Dialysis and Transplantation Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Andrea Buscaroli
- Nephrology and Dialysis Unit, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
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3
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Schellekens P, Van Loon E, Coemans M, Meyts I, Vennekens R, Kuypers D, Mekahli D, Bammens B. Leukopenia in autosomal dominant polycystic kidney disease: a single-center cohort of kidney transplant candidates with post-transplantation follow-up. Clin Kidney J 2023; 16:2578-2586. [PMID: 38046014 PMCID: PMC10689124 DOI: 10.1093/ckj/sfad165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Indexed: 12/05/2023] Open
Abstract
Background Autosomal dominant polycystic kidney disease (ADPKD) has occasionally been associated with lower peripheral white blood cell (WBC) counts. This study aimed to investigate the peripheral blood cell counts in a large cohort of kidney transplant recipients before and after kidney transplantation and its potential impact on post-transplant outcomes. Methods This was a retrospective study with long-term follow-up data of 2090 patients who underwent a first kidney transplantation in the Leuven University Hospitals, of whom 392 had ADPKD. Results In total, 2090 patients who underwent a first kidney transplantation in the Leuven University Hospitals were included, of whom 392 had ADPKD. Both pre- and post-transplantation, ADPKD patients had significantly lower total WBC counts, and more specifically lower neutrophil, lymphocyte and eosinophil counts compared with the non-ADPKD patients. This observation was independent of potential confounders such as level of inflammation, smoking habit, vitamins and pre-transplant medication. Overall survival and kidney transplant survival were significantly better in ADPKD vs non-ADPKD transplant recipients and a longer time to first infection was observed. However, no association between blood cell counts and outcome differences was found. Conclusions In conclusion, this large single-center study reports a strong and independent association between ADPKD and lower peripheral WBC counts both before and after kidney transplantation. Considering the role of inflammation in disease progression, further investigation into the role of WBC in ADPKD is needed.
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Affiliation(s)
- Pieter Schellekens
- Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium
- Department of Cellular and Molecular Medicine, PKD Research Group, KU Leuven, Leuven, Belgium
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospitals of Leuven, Leuven, Belgium
| | - Elisabet Van Loon
- Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospitals of Leuven, Leuven, Belgium
| | - Maarten Coemans
- Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium
| | - Isabelle Meyts
- Department of Microbiology, Immunology and Transplantation, Laboratory of Inborn Errors of Immunity, KU Leuven, Leuven, Belgium
- Department of Pediatrics, Pediatric Immunology, University Hospitals of Leuven, Leuven, Belgium
| | - Rudi Vennekens
- Department of Cellular and Molecular Medicine, VIB Centre for Brain and Disease Research, Laboratory of Ion Channel Research, KU Leuven, Leuven, Belgium
| | - Dirk Kuypers
- Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospitals of Leuven, Leuven, Belgium
| | - Djalila Mekahli
- Department of Cellular and Molecular Medicine, PKD Research Group, KU Leuven, Leuven, Belgium
- Department of Pediatric Nephrology, University Hospitals of Leuven, Leuven, Belgium
| | - Bert Bammens
- Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospitals of Leuven, Leuven, Belgium
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Caroli A, Kline TL. Abdominal Imaging in ADPKD: Beyond Total Kidney Volume. J Clin Med 2023; 12:5133. [PMID: 37568535 PMCID: PMC10420262 DOI: 10.3390/jcm12155133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
In the context of autosomal dominant polycystic kidney disease (ADPKD), measurement of the total kidney volume (TKV) is crucial. It acts as a marker for tracking disease progression, and evaluating the effectiveness of treatment strategies. The TKV has also been recognized as an enrichment biomarker and a possible surrogate endpoint in clinical trials. Several imaging modalities and methods are available to calculate the TKV, and the choice depends on the purpose of use. Technological advancements have made it possible to accurately assess the cyst burden, which can be crucial to assessing the disease state and helping to identify rapid progressors. Moreover, the development of automated algorithms has increased the efficiency of total kidney and cyst volume measurements. Beyond these measurements, the quantification and characterization of non-cystic kidney tissue shows potential for stratifying ADPKD patients early on, monitoring disease progression, and possibly predicting renal function loss. A broad spectrum of radiological imaging techniques are available to characterize the kidney tissue, showing promise when it comes to non-invasively picking up the early signs of ADPKD progression. Radiomics have been used to extract textural features from ADPKD images, providing valuable information about the heterogeneity of the cystic and non-cystic components. This review provides an overview of ADPKD imaging biomarkers, focusing on the quantification methods, potential, and necessary steps toward a successful translation to clinical practice.
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Affiliation(s)
- Anna Caroli
- Bioengineering Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 24020 Ranica, BG, Italy
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5
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Szaraz D, Danek Z, Lipovy B, Krivanek J, Buchtova M, Moldovan Putnova B, Putnova I, Stembirek J, Andrasina T, Divacka P, Izakovicova Holla L, Borilova Linhartova P. Primary cilia and hypoxia-associated signaling in developmental odontogenic cysts in relation to autosomal dominant polycystic kidney disease - A novel insight. Heliyon 2023; 9:e17130. [PMID: 37389068 PMCID: PMC10300219 DOI: 10.1016/j.heliyon.2023.e17130] [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: 10/10/2022] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 07/01/2023] Open
Abstract
Developmental cysts are pathological epithelial-lined cavities arising in various organs as a result of systemic or hereditary diseases. Molecular mechanisms involved in the formation of developmental odontogenic cysts (OCs) are not fully understood yet; the cystogenesis of renal cysts originating from the autosomal dominant polycystic kidney disease (ADPKD) has been, however, explored in much greater detail. This narrative review aimed i) to summarize molecular and cellular processes involved in the formation and growth of developmental OCs, especially dentigerous cysts (DCs) and odontogenic keratocysts (OKCs), ii) to find if there are any similarities in their cystogenesis to ADPKD cysts, and, based on that, iii) to suggest potential factors, candidate molecules, and mechanisms that could be involved in the DC formation, thus proposing further research directions. Here we suggest a possible association of developmental OCs with primary cilia disruption and with hypoxia, which have been previously linked with cyst formation in ADPKD patients. This is illustrated on the imagery of tissues from an ADPKD patient (renal cyst) and from developmental OCs, supporting the similarities in cell proliferation, apoptosis, and primary cilia distribution in DC/OKC/ADPKD tissues. Based on all that, we propose a novel hypothesis of OCs formation suggesting a crucial role of mutations associated with the signaling pathways of primary cilia (in particular, Sonic Hedgehog). These can lead to excessive proliferation and formation of cell agglomerates, which is followed by hypoxia-driven apoptosis in the centers of such agglomerates (controlled by molecules such as Hypoxia-inducible factor-1 alpha), leading to cavity formation and, finally, the OCs development. Based on this, we propose future perspectives in the investigation of OC pathogenesis.
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Affiliation(s)
- David Szaraz
- Clinic of Maxillofacial Surgery, University Hospital Brno, Jihlavska 20, 62500 Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic
| | - Zdenek Danek
- Clinic of Maxillofacial Surgery, University Hospital Brno, Jihlavska 20, 62500 Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic
| | - Bretislav Lipovy
- Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic
- Department of Burns and Plastic Surgery, University Hospital Brno, Jihlavska 20, 62500 Brno, Czech Republic
| | - Jan Krivanek
- Department of Histology and Embryology, Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic
| | - Marcela Buchtova
- Laboratory of Molecular Morphogenesis, Institute of Animal Physiology and Genetics, Czech Academy of Sciences, Veveří 97, 602 00 Brno, Czech Republic
- Department of Experimental Biology, Faculty of Science, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic
| | - Barbora Moldovan Putnova
- Laboratory of Molecular Morphogenesis, Institute of Animal Physiology and Genetics, Czech Academy of Sciences, Veveří 97, 602 00 Brno, Czech Republic
- Department of Pathological Morphology and Parasitology, University of Veterinary Sciences, Palackého tř. 1946/1, 61242 Brno-Královo Pole, Czech Republic
| | - Iveta Putnova
- Laboratory of Molecular Morphogenesis, Institute of Animal Physiology and Genetics, Czech Academy of Sciences, Veveří 97, 602 00 Brno, Czech Republic
- Department of Anatomy, Histology and Embryology, University of Veterinary and Pharmaceutical Sciences, Palackého tř. 1946/1, 61242 Brno-Královo Pole, Czech Republic
| | - Jan Stembirek
- Laboratory of Molecular Morphogenesis, Institute of Animal Physiology and Genetics, Czech Academy of Sciences, Veveří 97, 602 00 Brno, Czech Republic
- Clinic of Maxillofacial Surgery, University Hospital Ostrava, 17. Listopadu 1790/5, 70800 Ostrava-Poruba, Czech Republic
| | - Tomas Andrasina
- Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic
- Department of Radiology and Nuclear Medicine, University Hospital Brno, Jihlavska 20, 62500 Brno, Czech Republic
| | - Petra Divacka
- Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic
- Department of Internal Medicine and Gastroenterology, University Hospital Brno, Jihlavska 20, 62500 Brno, Czech Republic
| | - Lydie Izakovicova Holla
- Clinic of Stomatology, Institution Shared with St. Anne’s University Hospital, Faculty of Medicine, Masaryk University, Pekarska 664/53, 60200 Brno, Czech Republic
| | - Petra Borilova Linhartova
- Clinic of Maxillofacial Surgery, University Hospital Brno, Jihlavska 20, 62500 Brno, Czech Republic
- Clinic of Stomatology, Institution Shared with St. Anne’s University Hospital, Faculty of Medicine, Masaryk University, Pekarska 664/53, 60200 Brno, Czech Republic
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic
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Sharbatdaran A, Romano D, Teichman K, Dev H, Raza SI, Goel A, Moghadam MC, Blumenfeld JD, Chevalier JM, Shimonov D, Shih G, Wang Y, Prince MR. Deep Learning Automation of Kidney, Liver, and Spleen Segmentation for Organ Volume Measurements in Autosomal Dominant Polycystic Kidney Disease. Tomography 2022; 8:1804-1819. [PMID: 35894017 PMCID: PMC9326744 DOI: 10.3390/tomography8040152] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/01/2022] [Accepted: 07/08/2022] [Indexed: 12/02/2022] Open
Abstract
Organ volume measurements are a key metric for managing ADPKD (the most common inherited renal disease). However, measuring organ volumes is tedious and involves manually contouring organ outlines on multiple cross-sectional MRI or CT images. The automation of kidney contouring using deep learning has been proposed, as it has small errors compared to manual contouring. Here, a deployed open-source deep learning ADPKD kidney segmentation pipeline is extended to also measure liver and spleen volumes, which are also important. This 2D U-net deep learning approach was developed with radiologist labeled T2-weighted images from 215 ADPKD subjects (70% training = 151, 30% validation = 64). Additional ADPKD subjects were utilized for prospective (n = 30) and external (n = 30) validations for a total of 275 subjects. Image cropping previously optimized for kidneys was included in training but removed for the validation and inference to accommodate the liver which is closer to the image border. An effective algorithm was developed to adjudicate overlap voxels that are labeled as more than one organ. Left kidney, right kidney, liver and spleen labels had average errors of 3%, 7%, 3%, and 1%, respectively, on external validation and 5%, 6%, 5%, and 1% on prospective validation. Dice scores also showed that the deep learning model was close to the radiologist contouring, measuring 0.98, 0.96, 0.97 and 0.96 on external validation and 0.96, 0.96, 0.96 and 0.95 on prospective validation for left kidney, right kidney, liver and spleen, respectively. The time required for manual correction of deep learning segmentation errors was only 19:17 min compared to 33:04 min for manual segmentations, a 42% time saving (p = 0.004). Standard deviation of model assisted segmentations was reduced to 7, 5, 11, 5 mL for right kidney, left kidney, liver and spleen respectively from 14, 10, 55 and 14 mL for manual segmentations. Thus, deep learning reduces the radiologist time required to perform multiorgan segmentations in ADPKD and reduces measurement variability.
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Affiliation(s)
- Arman Sharbatdaran
- Department of Radiology, Weill Cornell Medicine, Cornell University, New York, NY 10065, USA; (A.S.); (D.R.); (K.T.); (H.D.); (S.I.R.); (A.G.); (M.C.M.); (G.S.)
| | - Dominick Romano
- Department of Radiology, Weill Cornell Medicine, Cornell University, New York, NY 10065, USA; (A.S.); (D.R.); (K.T.); (H.D.); (S.I.R.); (A.G.); (M.C.M.); (G.S.)
| | - Kurt Teichman
- Department of Radiology, Weill Cornell Medicine, Cornell University, New York, NY 10065, USA; (A.S.); (D.R.); (K.T.); (H.D.); (S.I.R.); (A.G.); (M.C.M.); (G.S.)
| | - Hreedi Dev
- Department of Radiology, Weill Cornell Medicine, Cornell University, New York, NY 10065, USA; (A.S.); (D.R.); (K.T.); (H.D.); (S.I.R.); (A.G.); (M.C.M.); (G.S.)
| | - Syed I. Raza
- Department of Radiology, Weill Cornell Medicine, Cornell University, New York, NY 10065, USA; (A.S.); (D.R.); (K.T.); (H.D.); (S.I.R.); (A.G.); (M.C.M.); (G.S.)
| | - Akshay Goel
- Department of Radiology, Weill Cornell Medicine, Cornell University, New York, NY 10065, USA; (A.S.); (D.R.); (K.T.); (H.D.); (S.I.R.); (A.G.); (M.C.M.); (G.S.)
| | - Mina C. Moghadam
- Department of Radiology, Weill Cornell Medicine, Cornell University, New York, NY 10065, USA; (A.S.); (D.R.); (K.T.); (H.D.); (S.I.R.); (A.G.); (M.C.M.); (G.S.)
| | - Jon D. Blumenfeld
- The Rogosin Institute and Department of Medicine Weill Cornell Medicine, Cornell University, New York, NY 10065, USA; (J.D.B.); (J.M.C.); (D.S.)
| | - James M. Chevalier
- The Rogosin Institute and Department of Medicine Weill Cornell Medicine, Cornell University, New York, NY 10065, USA; (J.D.B.); (J.M.C.); (D.S.)
| | - Daniil Shimonov
- The Rogosin Institute and Department of Medicine Weill Cornell Medicine, Cornell University, New York, NY 10065, USA; (J.D.B.); (J.M.C.); (D.S.)
| | - George Shih
- Department of Radiology, Weill Cornell Medicine, Cornell University, New York, NY 10065, USA; (A.S.); (D.R.); (K.T.); (H.D.); (S.I.R.); (A.G.); (M.C.M.); (G.S.)
| | - Yi Wang
- Departments of Radiology at Weill Cornell Medicine and Biomedical Engineering, Cornell University, New York, NY 10065, USA;
| | - Martin R. Prince
- Department of Radiology, Weill Cornell Medicine, Cornell University, New York, NY 10065, USA; (A.S.); (D.R.); (K.T.); (H.D.); (S.I.R.); (A.G.); (M.C.M.); (G.S.)
- Columbia College of Physicians and Surgeons, Cornell University, New York, NY 10027, USA
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Cytopenia in autosomal dominant polycystic kidney disease (ADPKD): merely an association or a disease-related feature with prognostic implications? Pediatr Nephrol 2021; 36:3505-3514. [PMID: 33502599 DOI: 10.1007/s00467-021-04937-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/03/2020] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is associated with distinct cytopenias in observational studies; the most consistent and strongest association is seen with alternations in the lymphocytic lineages. Although the underlying mechanism of these associations is unclear, it has been hypothesized to be secondary to sequestration of white blood cells in cystic organs, or related to the uremic environment in chronic kidney disease (CKD). However, since mutations in PKD1 or -2 affect several immunomodulating pathways, cytopenia may well be an unrecognized extrarenal manifestation of ADPKD. Furthermore, many important questions on the clinical implications of this finding and the effect on the disease course in these patients are unanswered. In this review article, we provide an overview of the current evidence on cytopenia in ADPKD and explore the underlying mechanisms of this association and its potential prognostic implications. Based on the current literature, we hypothesize that polycystin deficiency can disturb immune cell homeostasis and that cytopenia is thus an intrinsic feature of ADPKD, related to genetic factors. Taken together, these findings warrant further investigation to establish the exact etiology and role of cytopenia in patients with ADPKD.
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Yin X, Blumenfeld JD, Riyahi S, Luo X, Rennert H, Barash I, Prince MR. Prevalence of Inferior Vena Cava Compression in ADPKD. Kidney Int Rep 2020; 6:168-178. [PMID: 33426396 PMCID: PMC7783582 DOI: 10.1016/j.ekir.2020.10.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/17/2020] [Accepted: 10/20/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Kidney and liver cysts in autosomal dominant polycystic kidney disease (ADPKD) can compress the inferior vena cava (IVC), but IVC compression prevalence and its risk factors are unknown. Methods Patients who have ADPKD (n = 216) with abdominal magnetic resonance imaging (MRI) studies and age-/sex-matched controls (n = 216) were evaluated for IVC compression as well as azygous vein diameter (a marker of collateral blood flow) and IVC aspect ratio (left-to-right dimension divided by anterior-to-posterior dimension with a value of 1 corresponding to a circular (high pressure) IVC caudal to compression. Results Severe IVC compression (≥70%) was observed in 33 (15%) ADPKD subjects and mild compression (≥50% to <70%) was observed in 33 (15%) subjects; whereas controls had no IVC compression (P < 0.001). Severe IVC compression was associated with larger azygous vein (4.0 ± 1.3 mm versus 2.3 ± 0.8 mm without IVC compression; P < 0.001) and a more circular IVC cross-section upstream (mean IVC aspect ratio: 1.16 ± 0.27 vs. 1.69 ± 0.67, P < 0.001), suggesting higher pressure upstream from the compression. IVC compression was associated with older age, lower estimated glomerular filtration rate (eGFR), greater height-adjusted total kidney volumes, greater height-adjusted liver volume (ht-LV), and greater liver and renal cyst fractions (P < 0.001). No subject younger than 30 years had IVC compression, but ADPKD subjects ≥40 years old had 12-fold higher risk of IVC compression (95% confidence interval [CI]: 4.2–42.4), with highest predicted probability for Mayo Clinic classes 1D (59%; 95% CI: 39%–76%) and 1E (74%; 95% CI: 49%–90%) after adjustment (P < 0.001). Women with ht-LV ≥ 2000 ml/m had 83% (95% CI: 59%–95%) prevalence of IVC compression. Complications of IVC compression included deep vein thrombosis (DVT) and symptomatic hypotension. Conclusions IVC compression is common in ADPKD patients >40 years old, with Mayo Clinic class 1D/E, and in females with ht-LV > 2000 ml/m.
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Affiliation(s)
- Xiaorui Yin
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA.,Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jon D Blumenfeld
- The Rogosin Institute, New York, New York, USA.,Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Sadjad Riyahi
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Xianfu Luo
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Hanna Rennert
- Department of Pathology, Weill Cornell Medicine, New York, New York, USA
| | - Irina Barash
- The Rogosin Institute, New York, New York, USA.,Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Martin R Prince
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA.,Department of Radiology, Columbia College of Physicians and Surgeons, New York, New York, USA
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Van Laecke S, Van Biesen W. Novel non-cystic features of polycystic kidney disease: having new eyes or seeking new landscapes. Clin Kidney J 2020; 14:746-755. [PMID: 33777359 PMCID: PMC7986322 DOI: 10.1093/ckj/sfaa138] [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: 03/21/2020] [Indexed: 01/08/2023] Open
Abstract
For decades, researchers have been trying to decipher the complex pathophysiology of autosomal dominant polycystic kidney disease (ADPKD). So far these efforts have led to clinical trials with different candidate treatments, with tolvaptan being the only molecule that has gained approval for this indication. As end-stage kidney disease due to ADPKD has a substantial impact on health expenditures worldwide, it is likely that new drugs targeting kidney function will be developed. On the other hand, recent clinical observations and experimental data, including PKD knockout models in various cell types, have revealed unexpected involvement of many other organs and cell systems of variable severity. These novel non-cystic features, some of which, such as lymphopenia and an increased risk to develop infections, should be validated or further explored and might open new avenues for better risk stratification and a more tailored approach. New insights into the aberrant pathways involved with abnormal expression of PKD gene products polycystin-1 and -2 could, for instance, lead to a more directed approach towards early-onset endothelial dysfunction and subsequent cardiovascular disease. Furthermore, a better understanding of cellular pathways in PKD that can explain the propensity to develop certain types of cancer can guide post-transplant immunosuppressive and prophylactic strategies. In the following review article we will systematically discuss recently discovered non-cystic features of PKD and not well-established characteristics. Overall, this knowledge could enable us to improve the outcome of PKD patients apart from ongoing efforts to slow down cyst growth and attenuate kidney function decline.
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Affiliation(s)
- Steven Van Laecke
- Renal Division, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Wim Van Biesen
- Renal Division, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
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