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Bolous Y, Trpkov K, Siadat F, El Hallani S, Merrimen J, Wang C. Sarcomatoid Urothelial Carcinoma Arising in Autosomal Dominant Polycystic Kidney Disease: A Case Report and Literature Review. Int J Surg Pathol 2024:10668969241286055. [PMID: 39380364 DOI: 10.1177/10668969241286055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2024]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) may be associated with various epithelial malignancies. The most reported ones are papillary renal cell carcinoma (RCC) and clear cell RCC. Only one noninvasive urothelial carcinoma arising in the renal pelvis has been previously reported in the setting of ADPKD in the English literature. A 52-year-old patient with ADPKD and a history of renal transplant presented with a poorly differentiated sarcomatoid neoplasm in his native left polycystic kidney. A recognizable urothelial or renal cell carcinoma differentiation was not identified in the resected neoplasm microscopically. The initial diagnosis for this specimen was challenging on morphology and immunohistochemistry, but targeted next-generation sequencing provided molecular evidence in support of urothelial origin, indicating a hotspot mutation -124 C > T in the TERT promoter (C228 T) and loss of heterozygosity on chromosomes 9p and 8p. This tumor is unique because, to our knowledge, this is the first report of upper tract sarcomatoid urothelial carcinoma in a patient with ADPKD.
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Affiliation(s)
- Yousef Bolous
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Kiril Trpkov
- Rockyview General Hospital, Alberta Precision Labs, University of Calgary, Calgary, AB, Canada
| | - Farshid Siadat
- Rockyview General Hospital, Alberta Precision Labs, University of Calgary, Calgary, AB, Canada
| | - Soufiane El Hallani
- Alberta Precision Labs Walter C. Mackenzie Health Sciences Centre, Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Jennifer Merrimen
- Division of Anatomical Pathology, Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, NS, Canada
| | - Cheng Wang
- Division of Anatomical Pathology, Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, NS, Canada
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2
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Shin MH, Choi NK. Incidental renal cell carcinoma post bilateral nephrectomy in autosomal dominant polycystic kidney disease. World J Clin Cases 2024; 12:6187-6194. [PMID: 39371564 PMCID: PMC11362899 DOI: 10.12998/wjcc.v12.i28.6187] [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: 05/24/2024] [Revised: 07/01/2024] [Accepted: 07/15/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND Renal cell carcinoma (RCC) is more common in patients with autosomal dominant polycystic kidney disease (ADPKD) than in the general population. Diagnosing RCC in ADPKD is challenging due to the presence of multiple renal cysts, often leading to delays and difficulties in distinguishing RCC from cyst infection or hemorrhage. AIM To analyze the prevalence and characterize the clinical features of RCC in patients with ADPKD undergoing simultaneous bilateral native nephrectomy. METHODS Between May 2017 and April 2024, 19 ADPKD patients undergoing hemodialysis and awaiting kidney transplantation due to end-stage renal disease (ESRD) underwent bilateral nephrectomies in a single center. Parameters such as patient characteristics, intraoperative blood loss, blood transfusion volume, length of hospital stay, and postoperative complications were documented. Pathological findings for RCC were reviewed. RESULTS A total of 38 kidneys were excised from 19 patients, with a mean age of 56.8 years and an average hemodialysis duration of 84.2 months. Eight patients underwent open nephrectomies, and 11 underwent hand-assisted laparoscopic nephrectomies. RCC was detected in 15.8% of kidneys, affecting 21.1% of patients. Two patients had multifocal RCC in both kidneys. All RCC cases were pT1 stage, with the largest lesion averaging 16.5 mm in diameter. The average operative duration was 120 minutes, with intraoperative blood loss averaging 184.2 mL. Five patients required blood transfusions. Postoperative complications occurred in five patients, with a mean hospital stay of 17.1 days. The mean follow-up period was 28.1 months. CONCLUSION The prevalence of RCC is higher in patients with ADPKD with ESRD than in those with ESRD alone. Thus, clinicians should be cautious and implement surveillance programs to monitor the development of RCC in patients with ADPKD, particularly those on dialysis.
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Affiliation(s)
- Min-Ho Shin
- Division of General Surgery, Department of Hepato-Bilio-Pancreatic Surgery and Transplantation Surgery, Chosun University College of Medicine, Gwangju 61453, South Korea
| | - Nam-Kyu Choi
- Division of General Surgery, Department of Hepato-Bilio-Pancreatic Surgery and Transplantation Surgery, Chosun University College of Medicine, Gwangju 61453, South Korea
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3
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Fleming AM, Gehle DB, Perrino MR, Graetz DE, Bissler JJ, McCarville B, Krasin MJ, Brennan RC, Zhang J, Yang W, Sapkota Y, Hudson MM, Davidoff AM, Green DM, Murphy AJ. Concomitant Wilms tumor and autosomal dominant polycystic kidney disease. Pediatr Blood Cancer 2024; 71:e31230. [PMID: 39085996 PMCID: PMC11369902 DOI: 10.1002/pbc.31230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/01/2024] [Accepted: 07/16/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Concomitant Wilms tumor (WT) and autosomal dominant polycystic kidney disease (ADPKD) is exceedingly rare, presenting a diagnostic and technical challenge to pediatric surgical oncologists. The simultaneous workup and management of these disease processes are incompletely described. PROCEDURE We performed a retrospective analysis of patients treated at our institution with concomitant diagnoses of WT and ADPKD. We also review the literature on the underlying biology and management principles of these conditions. RESULTS We present three diverse cases of concomitant unilateral WT and ADPKD who underwent nephrectomy. One patient had preoperative imaging consistent with ADPKD with confirmatory testing postoperatively, one was found to have contralateral renal cysts intraoperatively with confirmatory imaging post nephrectomy, and one was diagnosed in childhood post nephrectomy. All patients are alive at last follow-up, and the patient with longest follow-up has progressed to end-stage kidney failure requiring transplantation and dialysis in adulthood. All patients underwent germline testing and were found to have no cancer predisposition syndrome or pathogenic or likely pathogenic variants for WT. CONCLUSION Concomitant inheritance of ADPKD and development of WT are extremely rare, and manifestations of ADPKD may not present until late childhood or adulthood. ADPKD is not a known predisposing condition for WT. When ADPKD diagnosis is made by family history, imaging, and/or genetic testing before WT diagnosis and treatment, the need for extensive preoperative characterization of cystic kidney lesions in children and increased risk of post-nephrectomy kidney failure warrant further discussion of surgical approach and perioperative management strategies.
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Affiliation(s)
- Andrew M. Fleming
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, TN 38105
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38163
| | - Daniel B. Gehle
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, TN 38105
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38163
| | - Melissa R. Perrino
- Department of Oncology, Division of Cancer Predisposition, St. Jude Children’s Research Hospital, Memphis, TN 38105
| | - Dylan E. Graetz
- Department of Oncology, Solid Tumor Division, St. Jude Children’s Research Hospital, Memphis, TN 38105
| | - John J. Bissler
- Department of Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN 38105
- Department of Pediatrics, Division of Pediatric Nephrology, University of Tennessee Health Science Center, TN 38163
| | - Beth McCarville
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN 38105
| | - Matthew J. Krasin
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105
| | - Rachel C. Brennan
- Department of Pediatric Hematology & Oncology, Logan Health, Kalispell, MT 59901
| | - Jinghui Zhang
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN 38105
| | - Wentao Yang
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN 38105
| | - Yadav Sapkota
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105
- Department of Oncology, Division of Cancer Survivorship, St. Jude Children’s Research Hospital, Memphis, TN 38105
| | - Andrew M. Davidoff
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, TN 38105
| | - Daniel M. Green
- Department of Oncology, Division of Cancer Survivorship, St. Jude Children’s Research Hospital, Memphis, TN 38105
| | - Andrew J. Murphy
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, TN 38105
- Department of Surgery, Division of Pediatric Surgery, University of Tennessee Health Science Center, Memphis, TN 38163
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4
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Hirasawa H, Taketomi-Takahashi A, Katsumata N, Higuchi T, Sekine Y, Suzuki K, Kaneko Y, Hiromura K, Fukushima Y, Tsushima Y. Efficacy of 18F-Fluorodeoxyglucose positron emission tomography/computed tomography for detecting renal cell carcinoma in patients with end-stage renal disease. Jpn J Radiol 2024; 42:1178-1186. [PMID: 38795287 PMCID: PMC11442643 DOI: 10.1007/s11604-024-01593-5] [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: 01/23/2024] [Accepted: 05/11/2024] [Indexed: 05/27/2024]
Abstract
PURPOSE Dialysis patients are at an increased risk of developing renal cell carcinoma (RCC); however, differentiating between RCC and benign cysts can sometimes be difficult using modalities, such as computed tomography (CT) and ultrasonography. 18F-Fluorodeoxyglucose positron emission tomography (FDG-PET)/CT efficiently detects malignant tumors; however, physiological accumulation of FDG in the kidney limits its efficacy in detecting renal tumors. However, in patients with severely impaired renal function, the renal accumulation of FDG is decreased, possibly improving the detection of renal malignancies in this patient population. This study evaluated the usefulness of FDG-PET/CT as a screening tool for detecting RCC in patients with end-stage renal disease. MATERIALS AND METHODS This prospective study recruited 150 participants from 2012 to 2016 who were on dialysis or underwent renal transplantation and were on dialysis until transplantation. FDG-PET/CT was performed to screen for RCC. Three radiologists independently evaluated the images. No protocol was defined for the additional management of positive examinations, leaving decisions to the discretion of each participant. Negative examinations were observed until the end of 2019. RESULTS In total, 150 participants (mean age, 58 ± 13 years; 105 men) underwent FDG-PET/CT. Twenty patients (13.4%) were diagnosed as positive. Fifteen patients underwent additional examinations and/or procedures, and RCC was found in seven patients. Of the four patients who underwent surgical resection, the pathological results were clear cell RCC in one, papillary RCC in one, and acquired cystic disease-associated RCC in two. Two participants were diagnosed with RCC on bone biopsy, and one was diagnosed on dynamic CT but opted for observation. The sensitivity, specificity, and negative predictive value were 100%, 93.9%, and 100%, respectively. CONCLUSION FDG-PET/CT was useful for detecting RCC in patients with end-stage renal disease. Our findings show the potential use of FDG-PET/CT as a screening tool for RCC in this patient population.
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Affiliation(s)
- Hiromi Hirasawa
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan.
| | - Ayako Taketomi-Takahashi
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Natsumi Katsumata
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Tetsuya Higuchi
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Yoshitaka Sekine
- Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kazuhiro Suzuki
- Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yoriaki Kaneko
- Department of Nephrology and Rheumatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Keiju Hiromura
- Department of Nephrology and Rheumatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yasuhiro Fukushima
- Department of Applied Medical Imaging, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
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Coppola A, Tessitore L, Fontana F, Piacentino F, Recaldini C, Minenna M, Capogrosso P, Minici R, Laganà D, Ierardi AM, Carrafiello G, D’Angelo F, Carcano G, Cacioppa LM, Dehò F, Venturini M. Dual-Energy Computed Tomography in Urological Diseases: A Narrative Review. J Clin Med 2024; 13:4069. [PMID: 39064110 PMCID: PMC11277677 DOI: 10.3390/jcm13144069] [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: 06/12/2024] [Revised: 07/01/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Dual-Energy computed tomography (DECT) with its various advanced techniques, including Virtual Non-Contrast (VNC), effective atomic number (Z-eff) calculation, Z-maps, Iodine Density Index (IDI), and so on, holds great promise in the diagnosis and management of urogenital tumours. In this narrative review, we analyze the current status of knowledge of this technology to provide better lesion characterization, improve the staging accuracy, and give more precise treatment response assessments in relation to urological tumours.
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Affiliation(s)
- Andrea Coppola
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy
| | - Luigi Tessitore
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy
| | - Federico Fontana
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy
| | - Chiara Recaldini
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy
| | - Manuela Minenna
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy
| | - Paolo Capogrosso
- Urology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
| | - Roberto Minici
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
| | - Domenico Laganà
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Anna Maria Ierardi
- Radiology Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Via Sforza 35, 20122 Milan, Italy
| | - Gianpaolo Carrafiello
- Radiology Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Via Sforza 35, 20122 Milan, Italy
| | - Fabio D’Angelo
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
- Orthopedic Surgery Unit, ASST Sette Laghi, 21100 Varese, Italy
| | - Giulio Carcano
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy
- Emergency and Transplant Surgery Department, ASST Sette Laghi, 21100 Varese, Italy
| | - Laura Maria Cacioppa
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy
- Division of Interventional Radiology, Department of Radiological Sciences, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, 60126 Ancona, Italy
| | - Federico Dehò
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy
- Urology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy
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Chen PL, Chen CF, Lin HYH, Riley DJ, Chen Y. The Link between Autosomal Dominant Polycystic Kidney Disease and Chromosomal Instability: Exploring the Relationship. Int J Mol Sci 2024; 25:2936. [PMID: 38474184 PMCID: PMC10932443 DOI: 10.3390/ijms25052936] [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: 01/29/2024] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024] Open
Abstract
In autosomal dominant polycystic kidney disease (ADPKD) with germline mutations in a PKD1 or PKD2 gene, innumerable cysts develop from tubules, and renal function deteriorates. Second-hit somatic mutations and renal tubular epithelial (RTE) cell death are crucial features of cyst initiation and disease progression. Here, we use established RTE lines and primary ADPKD cells with disease-associated PKD1 mutations to investigate genomic instability and DNA damage responses. We found that ADPKD cells suffer severe chromosome breakage, aneuploidy, heightened susceptibility to DNA damage, and delayed checkpoint activation. Immunohistochemical analyses of human kidneys corroborated observations in cultured cells. DNA damage sensors (ATM/ATR) were activated but did not localize at nuclear sites of damaged DNA and did not properly activate downstream transducers (CHK1/CHK2). ADPKD cells also had the ability to transform, as they achieved high saturation density and formed colonies in soft agar. Our studies indicate that defective DNA damage repair pathways and the somatic mutagenesis they cause contribute fundamentally to the pathogenesis of ADPKD. Acquired mutations may alternatively confer proliferative advantages to the clonally expanded cell populations or lead to apoptosis. Further understanding of the molecular details of aberrant DNA damage responses in ADPKD is ongoing and holds promise for targeted therapies.
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Affiliation(s)
- Phang-Lang Chen
- Department of Biological Chemistry, University of California, Irvine, CA 92697, USA; (P.-L.C.); (C.-F.C.)
| | - Chi-Fen Chen
- Department of Biological Chemistry, University of California, Irvine, CA 92697, USA; (P.-L.C.); (C.-F.C.)
| | - Hugo Y.-H. Lin
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Daniel J. Riley
- Department of Medicine, Division of Nephrology, University of Texas Health, San Antonio, TX 78245, USA;
| | - Yumay Chen
- Department of Medicine, Division of Endocrinology, University of California, Irvine, CA 92697, USA
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Rumrill WM, Ballard DH. Metastatic Renal Cell Carcinoma in a Patient With Autosomal Dominant Polycystic Kidney Disease. Clin Nucl Med 2024; 49:e131-e133. [PMID: 38271253 DOI: 10.1097/rlu.0000000000005059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
ABSTRACT Autosomal dominant polycystic kidney disease (ADPKD) manifests as multiple cysts in the kidneys and liver but can also present with musculoskeletal and cardiovascular abnormalities. ADPKD patients are at increased risk for renal cell carcinoma development. We show the FDG PET/CT findings in a patient with renal cell carcinoma secondary to ADPKD and complicated by worsening pulmonary metastasis. The primary renal tumor shows intense FDG uptake despite no suspicious features with contrast CT.
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Affiliation(s)
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
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Drake AM, Paynter JA, Yim A, Tempo JA, Manning TG, Brennan J, Qin KR. Prevalence of Renal Neoplasia in Autosomal Dominant Polycystic Kidney Disease: Systematic Review and Meta-Analysis. Nephron Clin Pract 2024; 148:457-467. [PMID: 38301614 PMCID: PMC11216357 DOI: 10.1159/000536245] [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: 11/01/2023] [Accepted: 01/08/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) is a common inherited condition; however, its relationship with renal cell carcinoma (RCC) remains unclear. This paper aims to establish the prevalence of RCC and its subtypes amongst ADPKD patients. METHODS A database search was conducted to retrieve studies reporting RCC occurrence within ADPKD patients until July 2023. Key outcomes included number and subtype of RCC cases, and number of RCCs presenting incidentally. A random-effects meta-analysis was performed. RESULTS Our search yielded 569 articles, 16 met the inclusion criteria. Nephrectomy specimens from 1,147 ADPKD patients were identified. Of studies reporting per-kidney results (n = 13), 73 RCCs were detected amongst 1,493 kidneys, equating to a per-kidney prevalence of 4.3% (95% CI, 3.1-5.7, I2 = 15.7%). 75 ADPKD patients were found to have RCC (75/1,147), resulting in a per-person prevalence of 5.7% (95% CI, 3.7-7.9, I2 = 40.3%) (n = 16). As 7 patients had bilateral disease, 82 RCCs were detected in total. Of these, 39 were clear cell RCC, 35 were papillary and 8 were other. As such, papillary RCCs made up 41.1% (95% CI, 25.9-56.9, I2 = 18.1%) of detected cancers. The majority of RCCs were detected incidentally (72.5% [95% CI, 43.7-95.1, I2 = 66.9%]). CONCLUSION ADPKD appears to be associated with the papillary RCC subtype. The clinical implications of these findings are unclear, however, may become apparent as outcomes and life expectancy amongst APDKD patients improve.
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Affiliation(s)
- Anna M. Drake
- School of Rural Health, Monash University, Bendigo, VIC, Australia
| | - Jessica A. Paynter
- School of Rural Health, Monash University, Bendigo, VIC, Australia
- Department of Urology, Bendigo Health, Bendigo, VICAustralia
| | - Arthur Yim
- Department of Urology, Austin Health, Melbourne, VIC, Australia
| | - Jake A. Tempo
- Department of Urology, Austin Health, Melbourne, VIC, Australia
| | - Todd G. Manning
- School of Rural Health, Monash University, Bendigo, VIC, Australia
| | - Janelle Brennan
- School of Rural Health, Monash University, Bendigo, VIC, Australia
- Department of Urology, Bendigo Health, Bendigo, VICAustralia
| | - Kirby R. Qin
- School of Rural Health, Monash University, Bendigo, VIC, Australia
- Department of Urology, Bendigo Health, Bendigo, VICAustralia
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia
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9
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Rooseno G, Yatindra IBGTY, Djatisoesanto W, Djojodimedjo T. Renal cell carcinoma in autosomal dominant polycystic kidney disease: A case report. Radiol Case Rep 2023; 18:4370-4373. [PMID: 37840887 PMCID: PMC10568278 DOI: 10.1016/j.radcr.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 08/28/2023] [Accepted: 09/01/2023] [Indexed: 10/17/2023] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is one of the congenital cystic renal diseases with the highest incidence. ADPKD was suspected of being a risk factor for the emergence of RCC. A 65-year-old male complained of numbness in both knees for a week. The patient came to a neurosurgeon and was advised to perform a lumbosacral MRI. The patient had no complaints. The patient had a history of hypertension but was never treated. Computed tomography intravenous pyelogram (CT-IVP) revealed a heterogeneous lobulated mass in the upper to the middle of the right kidney to the right renal hilus. It also revealed multiple cysts, in both kidneys. The patient underwent an open radical nephrectomy in the right kidney with minimal bleeding. Three years revealed no pain at the surgery site or hematuria. Abdominal MRI revealed no recidive mass. This case report comprehensively described an autosomal dominant polycystic kidney disease that coexists with RCC. malignant lesions were found in ADPKD cases without any clinical symptoms of malignancy. M malignant lesions could be discovered by chance in nephrectomy specimens. Autosomal dominant polycystic kidney disease with renal cell carcinoma is a unique presentation. Despite the rarity of the situation, the patient was successfully treated.
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Affiliation(s)
- Gullyawan Rooseno
- Department of Urology, Faculty of Medicine, Airlangga University, Surabaya, East Java, Indonesia
- Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia
| | - Ida Bagus Gde Tirta Yoga Yatindra
- Department of Urology, Faculty of Medicine, Airlangga University, Surabaya, East Java, Indonesia
- Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia
| | - Wahjoe Djatisoesanto
- Department of Urology, Faculty of Medicine, Airlangga University, Surabaya, East Java, Indonesia
- Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia
| | - Tarmono Djojodimedjo
- Department of Urology, Faculty of Medicine, Airlangga University, Surabaya, East Java, Indonesia
- Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia
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10
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Carotenuto P, Gradilone SA, Franco B. Cilia and Cancer: From Molecular Genetics to Therapeutic Strategies. Genes (Basel) 2023; 14:1428. [PMID: 37510333 PMCID: PMC10379587 DOI: 10.3390/genes14071428] [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: 06/07/2023] [Revised: 07/07/2023] [Accepted: 07/09/2023] [Indexed: 07/30/2023] Open
Abstract
Cilia are microtubule-based organelles that project from the cell surface with motility or sensory functions. Primary cilia work as antennae to sense and transduce extracellular signals. Cilia critically control proliferation by mediating cell-extrinsic signals and by regulating cell cycle entry. Recent studies have shown that primary cilia and their associated proteins also function in autophagy and genome stability, which are important players in oncogenesis. Abnormal functions of primary cilia may contribute to oncogenesis. Indeed, defective cilia can either promote or suppress cancers, depending on the cancer-initiating mutation, and the presence or absence of primary cilia is associated with specific cancer types. Together, these findings suggest that primary cilia play important, but distinct roles in different cancer types, opening up a completely new avenue of research to understand the biology and treatment of cancers. In this review, we discuss the roles of primary cilia in promoting or inhibiting oncogenesis based on the known or predicted functions of cilia and cilia-associated proteins in several key processes and related clinical implications.
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Affiliation(s)
- Pietro Carotenuto
- Medical Genetics, Department of Translational Medical Science, University of Naples “Federico II”, 80131 Naples, Italy
- TIGEM, Telethon Institute of Genetics and Medicine, 80078 Naples, Italy
| | - Sergio A. Gradilone
- The Hormel Institute, University of Minnesota, Austin, MN 55912, USA;
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
| | - Brunella Franco
- Medical Genetics, Department of Translational Medical Science, University of Naples “Federico II”, 80131 Naples, Italy
- TIGEM, Telethon Institute of Genetics and Medicine, 80078 Naples, Italy
- School of Advanced Studies, Genomic and Experimental medicine Program (Scuola Superiore Meridionale), 80138 Naples, Italy
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11
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Reprint of: lessons from histopathologic examination of nephrectomy specimens in patients with tuberous sclerosis complex: cysts, angiomyolipomas & renal cell carcinoma. Hum Pathol 2023; 133:136-152. [PMID: 36894367 DOI: 10.1016/j.humpath.2023.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 09/08/2022] [Indexed: 03/09/2023]
Abstract
Renal manifestations in patients with tuberous sclerosis complex (TSC) include cysts, angiomyolipoma, and renal cell carcinoma. Unlike many hereditary predisposition syndromes, the spectrum of renal tumors in TSC patients (including both angiomyolipoma and renal cell carcinoma) is broad, with significant morphologic heterogeneity. An improved understanding of histopathologic findings in TSC patients and associated clinicopathologic correlates has significant implications not just in establishing a diagnosis of TSC, but also in the recognition of sporadic tumors occurring secondary to somatic alterations of TSC1/TSC2/MTOR pathway genes and accurate prognostication. In this review, we have discussed issues relevant to clinical management based on histopathologic findings in nephrectomy specimens from patients with TSC. This includes discussions related to screening for TSC, diagnosis of PKD1/TSC2 contiguous gene deletion syndrome, the morphologic spectrum of angiomyolipoma and renal epithelium-derived neoplasia, including the risk of disease progression.
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12
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Odedra D, Sabongui S, Khalili K, Schieda N, Pei Y, Krishna S. Autosomal Dominant Polycystic Kidney Disease: Role of Imaging in Diagnosis and Management. Radiographics 2023; 43:e220126. [DOI: 10.1148/rg.220126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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13
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Gupta S, Stanton ML, Reynolds JP, Whaley RD, Herrera-Hernandez L, Jimenez RE, Cheville JC. Lessons from histopathologic examination of nephrectomy specimens in patients with tuberous sclerosis complex: cysts, angiomyolipomas, and renal cell carcinoma. Hum Pathol 2022; 129:123-139. [PMID: 36115585 DOI: 10.1016/j.humpath.2022.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 09/08/2022] [Indexed: 02/07/2023]
Abstract
Renal manifestations in patients with tuberous sclerosis complex (TSC) include cysts, angiomyolipoma, and renal cell carcinoma. Unlike many hereditary predisposition syndromes, the spectrum of renal tumors in TSC patients (including both angiomyolipoma and renal cell carcinoma) is broad, with significant morphologic heterogeneity. An improved understanding of histopathologic findings in TSC patients and associated clinicopathologic correlates has significant implications not just in establishing a diagnosis of TSC, but also in the recognition of sporadic tumors occurring secondary to somatic alterations of TSC1/TSC2/MTOR pathway genes and accurate prognostication. In this review, we have discussed issues relevant to clinical management based on histopathologic findings in nephrectomy specimens from patients with TSC. This includes discussions related to screening for TSC, diagnosis of PKD1/TSC2 contiguous gene deletion syndrome, the morphologic spectrum of angiomyolipoma and renal epithelium-derived neoplasia, including the risk of disease progression.
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Affiliation(s)
- Sounak Gupta
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Melissa L Stanton
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ, 85054, USA.
| | - Jordan P Reynolds
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, 32224, USA.
| | - Rumeal D Whaley
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
| | | | - Rafael E Jimenez
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
| | - John C Cheville
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
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Bilan tomodensitométrique thoracique et abdomino-pelvien chez les patients insuffisants rénaux candidats à une transplantation rénale : intérêts et indications. Nephrol Ther 2022; 18:518-525. [DOI: 10.1016/j.nephro.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/29/2022] [Accepted: 05/31/2022] [Indexed: 11/21/2022]
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15
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Darius T, Bertoni S, De Meyer M, Buemi A, Devresse A, Kanaan N, Goffin E, Mourad M. Simultaneous nephrectomy during kidney transplantation for polycystic kidney disease does not detrimentally impact comorbidity and graft survival. World J Transplant 2022; 12:100-111. [PMID: 35663541 PMCID: PMC9136716 DOI: 10.5500/wjt.v12.i5.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/11/2021] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The lack of space, as an indication for a native unilateral nephrectomy for positioning a future kidney graft in the absence of other autosomal dominant polycystic kidney disease-related symptoms, remains controversial.
AIM To evaluate the surgical comorbidity and the impact on graft survival of an associated ipsilateral native nephrectomy during isolated kidney transplantation in patients with autosomal dominant polycystic kidney disease.
METHODS One hundred and fifty-four kidney transplantations performed between January 2007 and January 2019 of which 77 without (kidney transplant alone (KTA) group) and 77 with associated ipsilateral nephrectomy (KTIN group), were retrospectively reviewed. Demographics and surgical variables were analyzed and their respective impact on surgical comorbidity and graft survival.
RESULTS Creation of space for future graft positioning was the main reason (n = 74, 96.1%) for associated ipsilateral nephrectomy. No significant difference in surgical comorbidity (lymphocele, wound infection, incisional hernia, wound hematoma, urinary infection, need for blood transfusion, hospitalization stay, Dindo Clavien classification and readmission rate) was observed between the two study groups. The incidence of primary nonfunction and delayed graft function was comparable in both groups [0% and 2.6% (P = 0.497) and 9.1% and 16.9% (P = 0.230), respectively, in the KTA and KTIN group]. The 1- and 5-year graft survival were 94.8% and 90.3%, and 100% and 93.8%, respectively, in the KTA and KTIN group (P = 0.774). The 1- and 5-year patient survival were 96.1% and 92.9%, and 100% and 100%, respectively, in the KTA and KTIN group (P = 0.168).
CONCLUSION Simultaneous ipsilateral native nephrectomy to create space for graft positioning during kidney transplantation in patients with autosomal dominant polycystic kidney disease does not negatively impact surgical comorbidity and short- and long-term graft survival.
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Affiliation(s)
- Tom Darius
- Surgical and Abdominal Transplantation Unit, University Clinics Saint Luc, Brussels 1200, Belgium
| | - Sébastien Bertoni
- Surgical and Abdominal Transplantation Unit, University Clinics Saint Luc, Brussels 1200, Belgium
| | - Martine De Meyer
- Surgical and Abdominal Transplantation Unit, University Clinics Saint Luc, Brussels 1200, Belgium
| | - Antoine Buemi
- Surgical and Abdominal Transplantation Unit, University Clinics Saint Luc, Brussels 1200, Belgium
| | - Arnaud Devresse
- Division of Nephrology, University Clinics Saint Luc, Brussels 1200, Belgium
| | - Nada Kanaan
- Division of Nephrology, University Clinics Saint Luc, Brussels 1200, Belgium
| | - Eric Goffin
- Division of Nephrology, University Clinics Saint Luc, Brussels 1200, Belgium
| | - Michel Mourad
- Surgical and Abdominal Transplantation Unit, University Clinics Saint Luc, Brussels 1200, Belgium
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Tagliaferri AR, Costanzo C. Delayed Metastasis of Clear Cell Renal Carcinoma to the Colon in the Setting of Benign Kidney Disease. Cureus 2022; 14:e22659. [PMID: 35371644 PMCID: PMC8963926 DOI: 10.7759/cureus.22659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 11/05/2022] Open
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Gupta S, Lohse CM, Rowsey R, McCarthy MR, Shen W, Herrera-Hernandez L, Boorjian SA, Houston Thompson R, Jimenez RE, Leibovich BC, Cheville JC. Renal Neoplasia in Polycystic Kidney Disease: An Assessment of Tuberous Sclerosis Complex-associated Renal Neoplasia and PKD1/TSC2 Contiguous Gene Deletion Syndrome. Eur Urol 2021; 81:229-233. [PMID: 34876325 DOI: 10.1016/j.eururo.2021.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/15/2021] [Accepted: 11/12/2021] [Indexed: 11/04/2022]
Abstract
To determine the incidence of renal neoplasia among patients undergoing nephrectomy for polycystic kidney disease (PKD), we queried our institutional nephrectomy registry (years 2000-2020). Approximately 4% (231 of 5757) of patients who underwent nephrectomy had PKD, and 26 of these 231 patients (11.3%) had renal neoplasia. Tumors from an additional two patients with PKD were also evaluated. Patients with PKD who had tuberous sclerosis complex (TSC)-associated renal neoplasia were screened for PKD1/TSC2 contiguous gene deletion syndrome (CGS) using single nucleotide polymorphism arrays. The median age of patients with PKD and renal neoplasia at nephrectomy was 54 yr. The median tumor size was 2.0 cm and the tumors were predominantly of low grade and stage. The tumors consisted of 23 renal cell carcinomas (RCCs), one epithelioid angiomyolipoma, and four angiomyolipomas. The median follow-up was 59.5 mo (n = 26) and only one patient with clear cell RCC developed metastases. Two patients with angiomyolipomas had PKD1/TSC2 CGS. Our results support screening of patients with PKD and TSC-associated renal neoplasia as well as TSC patients with cystic renal disease for CGS, as identification of patients with CGS can better define the manifestation and prognosis of CGS and guide counseling regarding patterns of inheritance. PATIENT SUMMARY: We identified patients with abnormal kidney cell growth (called renal neoplasia) among those undergoing removal of kidney tissue for polycystic kidney disease (PKD) and patients with a syndrome involving deletions in two genes, called PKD1/TSC2 contiguous gene deletion syndrome (CGS) at our institution. Of 231 PKD patients with removal of kidney tissue, 11.3% had renal neoplasia, and two patients with angiomyolipoma tumors had PKD1/TSC2 CGS. Detection of renal neoplasia associated with a condition called tuberous sclerosis complex in PKD may increase the identification of patients with PKD1/TSC2 CGS and guide patient counseling regarding outcomes and patterns of inheritance.
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Affiliation(s)
- Sounak Gupta
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Christine M Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Ross Rowsey
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Michael R McCarthy
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Wei Shen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Rafael E Jimenez
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - John C Cheville
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Abbas M, Pätzel M, Thurn A, Brinkmann OA, Bettendorf O. Incidental occurrence of papillary renal cell carcinoma in the native kidney with autosomal dominant polycystic kidney disease after renal transplantation: A case report. Mol Clin Oncol 2021; 15:223. [PMID: 34548922 PMCID: PMC8447179 DOI: 10.3892/mco.2021.2386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 07/13/2021] [Indexed: 11/05/2022] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is one of the best-known genetic diseases. Almost half of the patients with ADPKD will develop end-stage renal disease, and the majority of patients are treated with renal transplantation. The current study presents a case that developed papillary renal cell carcinoma (PRCC) in the native right kidney 10 years after renal transplantation. PRCC is a not common malignant tumour entity (18.5% of all cases of renal cell carcinoma) compared with common clear cell renal carcinoma (65-70% of all cases of RCC).
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Affiliation(s)
- Mahmoud Abbas
- Institute of Pathology and Cytology, D-48465 Schüttorf, Germany
| | - Melanie Pätzel
- Urology Department, Bonifatius Hospital, D-49808 Lingen, Germany
| | - Angelika Thurn
- Institute of Pathology and Cytology, D-48465 Schüttorf, Germany
| | | | - Olaf Bettendorf
- Institute of Pathology and Cytology, D-48465 Schüttorf, Germany
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19
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Renal cell carcinoma in native nephrectomy specimens of autosomal dominant polycystic kidney disease (ADPKD) patients with end-stage renal disease: Findings from an Australian transplant center. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211010653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: The aim of this study was to present a contemporary review of renal cell carcinoma (RCC) in native nephrectomy (NN) specimens of patients with autosomal dominant polycystic kidney disease (ADPKD) and end-stage renal disease (ESRD). Materials (patients) and methods: A retrospective review of all ADPKD patients who underwent NN from 1 October 2010 to 31 July 2019 was performed. Data was collected on demographics, length of time on renal replacement therapy, indications for surgery, perioperative details, and histology. Results: In total, 32 NNs were performed in our study period with 12.5% ( n=4) histologically diagnosed with RCC, consisting of 75% ( n=3) Type 1 papillary RCC (p RCC) and 25% ( n=1) clear cell RCC. Average age of ADPKD patients with ESRD diagnosed with RCC was 67±5.9 years. Average time on dialysis for RCC and non-RCC patients was 35.75±46.28 and 22.04±24.33 months, respectively. We did not find a significant correlation between the diagnosis of RCC and time on dialysis. Conclusion: Our contemporary series shows a significant proportion of ADPKD patients with ESRD undergoing NN have RCC. Compared to previously published datasets, our patients are older, and selective to those with very large kidneys and lesions suspicious for RCC. While there may be a role in imaging native kidneys with ADPKD to rule out suspicious lesions, it must be balanced against the cost, radiation exposure, and potential harm from an increased rate of nephrectomy that may ensue for suspicious lesions found on screening. Level of evidence: Not applicable for this multicentre audit.
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20
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Lubennikov AE, Petrovskii NV, Krupinov GE, Shilov EM, Trushkin RN, Kotenko ON, Glybochko PV. Bilateral Nephrectomy in Patients with Autosomal Dominant Polycystic Kidney Disease and End-Stage Chronic Renal Failure. Nephron Clin Pract 2021; 145:164-170. [PMID: 33550285 DOI: 10.1159/000513168] [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: 07/06/2020] [Accepted: 11/16/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In patients with autosomal dominant polycystic kidney disease (ADPKD) and end-stage kidney disease, bilateral nephrectomy (BN) is currently performed predominantly via the laparoscopic approach. We analysed the results of BN depending on the approach and preoperative and perioperative factors. PATIENTS AND METHODS This was a single-centre retrospective study carried out from April 2010 to March 2020, including a total of 142 patients presenting with ADPKD who were treated by BN. Of these, 108 patients meeting the inclusion criteria were selected to analyse the results. We compared therapeutic outcomes depending on the surgical approach (laparotomy or laparoscopy) and the type of the operation (emergent or elective). RESULTS Of the 108 eligible patients, 36 (group I) underwent laparoscopic BN and the remaining 72 patients (group II) were subjected to midline laparotomy. Sixty-nine patients underwent elective surgery and 39 endured emergent operations. The most frequent indications (87 patients, 80.6%) for surgical treatment were urinary tract infection and infected cysts. The median length of hospital stay for group I and group II patients amounted to 8 days (IQR: 7.5-9) and 12.5 days (IQR: 9-16.5), respectively (p < 0.001). However, comparing the patients operated on electively, the actual difference in the length of hospital stay was inconsiderable: median 8 days (IQR: 7-9) in group I and 9 days (IQR: 9-11.5) in group II. The median duration of the operation was significantly (p < 0.001) longer in group I amounting to 217.5 min (IQR: 197.5-305) than in group II equalling 115 min (IQR: 107.5-145). The frequency of postoperative complications, lethal outcomes, and blood loss volume did not statistically significantly differ depending on the surgical approach. Only patients operated on emergency underwent releparotomy due to intraoperative large bowel injury. Lethal outcomes (n = 18, 16.7%) after surgery were observed only in emergent patients. Sepsis prior to surgery, systemic inflammation response syndrome (SIRS) with the CRP level above 173 mg/mL, prolonged preoperative antibacterial therapy, and undiagnosed large bowel injury were associated with a lethal outcome after BN. CONCLUSION The results of open and laparoscopic BN in elective surgery were comparable. Emergency operations for infected renal cysts and SIRS were associated with increased incidence of large bowel injury and lethal outcomes.
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Affiliation(s)
- Alexander E Lubennikov
- Municipal Clinical Hospital No. 52 of the Moscow Department of Healthcare, Moscow, Russian Federation
| | - Nicolay V Petrovskii
- Institute of Urology and Human Reproductive Health, First Moscow State Medical University (Sechenov University), Moscow, Russian Federation,
| | - German E Krupinov
- Institute of Urology and Human Reproductive Health, First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Evgeniy M Shilov
- Clinic of Rheumatology, Nephrology and Occupational Pathology named after E.M. Tareev, First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Roman N Trushkin
- Municipal Clinical Hospital No. 52 of the Moscow Department of Healthcare, Moscow, Russian Federation
| | - Oleg N Kotenko
- Municipal Clinical Hospital No. 52 of the Moscow Department of Healthcare, Moscow, Russian Federation
| | - Petr V Glybochko
- Institute of Urology and Human Reproductive Health, First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
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21
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Li F, Li B, Zhang W, Huang Y, Zhao X, Hu L, Xi Q, Liu Q, Miao Z, Hou J, Pu J. Resection of adult polycystic kidney with retroperitoneal laparoscopic technique assisted by arterial embolization. Transl Androl Urol 2020; 9:2705-2712. [PMID: 33457242 PMCID: PMC7807379 DOI: 10.21037/tau-20-1281] [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] [Indexed: 11/19/2022] Open
Abstract
Background Traditional surgical methods have high complication rate and large injury in the resection of adult polycystic kidney. We investigated the effect of retroperitoneal laparoscopic resection of adult polycystic kidney assisted by arterial embolization. Methods The data of adult polycystic kidney patients who underwent laparoscopic surgery assisted by arterial embolization from November 2015 to November 2018 in our hospital were retrospectively analyzed, and the data of patients who underwent open surgery during the same period were collected. The basic data, surgical conditions, postoperative recover situation, and complications of the two groups were compared. Results There was no significant difference in the basic situation between the laparoscopic operation group and open operation (control) group. The bleeding volume, hospitalization time, and the length of incision in the laparoscopic operation group were significantly better than those in the open operation (control) group, but the operation time was significantly longer than that in the open operation group. There was no significant difference in drainage tube extraction time, bed rest time and blood transfusion rate between the two groups. There was no significant difference in the complication rate between the two groups. Conclusions Arterial interventional embolization-assisted retroperitoneal laparoscopy is an effective method for the resection of polycystic kidney.
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Affiliation(s)
- Feng Li
- Department of Urinary Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Bo Li
- Department of Intervention Therapy Department, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Weijie Zhang
- Department of Urinary Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuhua Huang
- Department of Urinary Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaojun Zhao
- Department of Urinary Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Linkun Hu
- Department of Urinary Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qilin Xi
- Department of Urinary Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qiuchen Liu
- Department of Urinary Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhijun Miao
- Department of Urinary Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jianquan Hou
- Department of Urinary Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jinxian Pu
- Department of Urinary Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
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Sarcomatoid renal cell carcinoma with autosomal dominant polycystic kidney disease: a case report and literature review. CEN Case Rep 2020; 10:199-207. [PMID: 33064294 DOI: 10.1007/s13730-020-00544-z] [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: 02/08/2020] [Accepted: 10/04/2020] [Indexed: 10/23/2022] Open
Abstract
Diagnosis of renal cell carcinoma (RCC) in patients with autosomal dominant polycystic kidney disease (ADPKD) is challenging and often delayed due to accompanying multiple renal cysts. Sometimes, it is difficult to distinguish RCC from cyst infection or hemorrhage. We herein present the case of a patient with ADPKD undergoing long-term hemodialysis whose sarcomatoid RCC was difficult to diagnose and was confirmed via nephrectomy. A 53-year-old male, undergoing hemodialysis since 20 years for end-stage renal disease secondary to ADPKD, was admitted to our hospital with a 3-week history of fever at > 38 °C and right flank pain. Clinical manifestations were compatible with cyst infection. Magnetic resonance images of the lesion identified in the lower right kidney, revealing slightly high signal intensity on T1-weighted images, low signal intensity on T2 weighted images, and restricted diffusion on diffusion-weighted images, were also consistent with those of cyst infection. Therefore, antibiotic therapy with ciprofloxacin, doripenem, and vancomycin was initiated. However, the patient's symptoms did not improve. Consequently, right nephrectomy was performed for both diagnosis and treatment, which revealed a sarcomatoid RCC with metastasis to the regional lymph node. The patient gradually developed cachexia and died on day 106 post-admission. The present case illustrates the difficulty of diagnosing RCC in patients with ADPKD, particularly sarcomatoid RCC, which is a rare and aggressive variant of RCC, even with the use of various types of imaging modalities. An early decision of nephrectomy may be necessary in such cases.
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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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24
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Timing of Nephrectomy and Renal Transplantation in Patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD) in the Era of Living Kidney Donation. TRANSPLANTOLOGY 2020. [DOI: 10.3390/transplantology1010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common hereditary disorders. Once progressed to end-stage renal disease, kidney transplantation may be needed. Whether and when to perform a (bilateral) native nephrectomy in case of end-stage renal failure are issues under debate. At our institution, with a growing number of living kidney donations, the general trend is to perform a native nephrectomy prior to transplantation. Our aim was to compare the outcomes of this approach to a nephrectomy during or after transplantation and to compare our findings to results reported in the literature. Data were prospectively collected from all ADPKD patients undergoing native nephrectomy and kidney transplantation at the Leiden University Medical Center between 2000–2017. A literature search was performed in the PubMed and Scopus databases. The clinical results were retrospectively reviewed and were stratified according to the timing of the nephrectomy. From the literature review, the most practiced approach was a combined unilateral nephrectomy and kidney transplantation. However, in our series, the favored approach was to perform a scheduled bilateral nephrectomy prior to kidney transplantation. A total of 114 patients underwent a native nephrectomy prior to (group 1, n = 85), during (group 2, n = 5), or after (group 3, n = 24) kidney transplantation. There were no statistically significant differences in postoperative morbidity after nephrectomy nor differences in kidney transplant outcome. Bilateral nephrectomy prior to kidney transplantation is a safe, controlled approach carrying minimal complication and mortality rates and facilitating a subsequent transplant procedure without mechanical or hemodynamic limitations for the graft.
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25
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Pierre M, Moreau K, Braconnier A, Kanagaratnam L, Lessore De Sainte Foy C, Sigogne M, Béchade C, Petrache A, Verger C, Frimat L, Duval-Sabatier A, Caillard S, Halin P, Touam M, Issad B, Vrtovsnik F, Petitpierre F, Lobbedez T, Touré F. Unilateral nephrectomy versus renal arterial embolization and technique survival in peritoneal dialysis patients with autosomal dominant polycystic kidney disease. Nephrol Dial Transplant 2020; 35:320-327. [PMID: 31747008 DOI: 10.1093/ndt/gfz200] [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] [Received: 06/15/2019] [Accepted: 08/21/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) is a common genetic disorder associated with progressive enlargement of the kidneys and liver. ADPKD patients may require renal volume reduction, especially before renal transplantation. The standard treatment is unilateral nephrectomy. However, surgery incurs a risk of blood transfusion and alloimmunization. Furthermore, when patients are treated with peritoneal dialysis (PD), surgery is associated with an increased risk of temporary or definitive switch to haemodialysis (HD). Unilateral renal arterial embolization can be used as an alternative approach to nephrectomy. METHODS We performed a multicentre retrospective study to compare the technique of survival of PD after transcatheter renal artery embolization with that of nephrectomy in an ADPKD population. We included ADPKD patients treated with PD submitted to renal volume reduction by either surgery or arterial embolization. Secondary objectives were to compare the frequency and duration of a temporary switch to HD in both groups and the impact of the procedure on PD adequacy parameters. RESULTS More than 700 patient files from 12 centres were screened. Only 37 patients met the inclusion criteria (i.e. treated with PD at the time of renal volume reduction) and were included in the study (21 embolized and 16 nephrectomized). Permanent switch to HD was observed in 6 embolized patients (28.6%) versus 11 nephrectomized patients (68.8%) (P = 0.0001). Renal artery embolization was associated with better technique survival: subdistribution hazard ratio (SHR) 0.29 [95% confidence interval (CI) 0.12-0.75; P = 0.01]. By multivariate analysis, renal volume reduction by embolization and male gender were associated with a decreased risk of switching to HD. After embolization, a decrease in PD adequacy parameters was observed but no embolized patients required temporary HD; the duration of hospitalization was significantly lower [5 days [interquartile range (IQR) 4.0-6.0] in the embolization group versus 8.5 days (IQR 6.0-11.0) in the surgery group. CONCLUSIONS Transcatheter renal artery embolization yields better technique survival of PD in ADPKD patients requiring renal volume reduction.
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Affiliation(s)
| | - Karine Moreau
- Department of Nephrology, CHU Bordeaux, Bordeaux, France
| | | | | | | | | | | | | | - Christian Verger
- Registre de dialyse peritoneale de langue française, Pontoise, France
| | - Luc Frimat
- Department of Nephrology, CHU Nancy, Vandœuvre-lès-Nancy, France
| | | | - Sophie Caillard
- Department of Nephrology, CHU Strasbourg, Strasbourg, France
| | - Pascale Halin
- Department of Nephrology, CH Charleville-Mézières, Charleville-Mézières, France
| | - Malick Touam
- Department of Nephrology, CHU Necker-enfants-malades, Paris, France
| | - Belkacem Issad
- Department of Nephrology, CHU Pitié-Salpêtrière, Paris, France
| | | | | | | | - Fatouma Touré
- Department of Nephrology, CHU Reims, Reims, France.,Department of Nephrology, CHU Limoges, Limoges, France
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Abstract
PURPOSE OF REVIEW In recent years, there has been renewed interest in the use of contrast-enhanced ultrasound (CEUS) in abdominal imaging and intervention. The goal of this article is to review the practical applications of CEUS in the kidney, including renal mass characterization, treatment monitoring during and after percutaneous ablation, and biopsy guidance. RECENT FINDINGS Current evidence suggests that CEUS allows accurate differentiation of solid and cystic renal masses and is an acceptable alternative to either computed tomography (CT) or magnetic resonance imaging (MRI) for characterization of indeterminate renal masses. CEUS is sensitive and specific for diagnosing residual or recurrent renal cell carcinoma (RCC) following percutaneous ablation. Furthermore, given its excellent spatial and temporal resolution, CEUS is well suited to demonstrate tumoral microvascularity associated with malignant renal masses and is an effective complement to conventional grayscale ultrasound (US) for percutaneous biopsy guidance. Currently underutilized, CEUS is an important problem-solving tool in renal imaging and intervention whose role will continue to expand in coming years.
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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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Higgins M, Obaidi I, McMorrow T. Primary cilia and their role in cancer. Oncol Lett 2019; 17:3041-3047. [PMID: 30867732 PMCID: PMC6396132 DOI: 10.3892/ol.2019.9942] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/24/2018] [Indexed: 01/25/2023] Open
Abstract
Primary cilia are microtubule-based organelles that are expressed on almost all mammalian cells. It has become apparent that these structures are important signaling hubs that serve crucial roles in Wnt, hedgehog, extracellular signal-regulated kinase (ERK)/mitogen-activated protein kinase (MAPK) and Notch signaling pathways. A number of diseases have been found to involve dysfunctional primary cilia; collectively these diseases are called ciliopathies. In recent years, there has been more focus on the association between primary cilia and cancer, including renal, pancreatic and breast cancer. Numerous studies have demonstrated that various types of cancer cells fail to express cilia. Notably, it has also been indicated that a number of renal carcinogens induce a significant loss of cilia in renal epithelial cells. The present review focuses on the existing literature regarding primary cilia and their involvement with cancer signaling pathways, providing a brief overview of the structural features and functions of primary cilia, then discussing the evidence associating primary cilia with cancer, and presenting the available information on the ERK/MAPK, hedgehog and Wnt signaling pathways, and their involvement in primary cilia in association with cancer.
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Affiliation(s)
- Michael Higgins
- School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Belfield, Dublin 4, Ireland
| | - Ismael Obaidi
- School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Belfield, Dublin 4, Ireland
| | - Tara McMorrow
- School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Belfield, Dublin 4, Ireland
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Zhang W, Blumenfeld JD, Prince MR. MRI in autosomal dominant polycystic kidney disease. J Magn Reson Imaging 2019; 50:41-51. [PMID: 30637853 DOI: 10.1002/jmri.26627] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/05/2018] [Accepted: 12/08/2018] [Indexed: 12/15/2022] Open
Affiliation(s)
- Weiguo Zhang
- Department of Radiology, Weill Cornell Medicine New York New York USA
| | - Jon D. Blumenfeld
- Rogosin Institute, and Department of MedicineWeill Cornell Medicine New York New York USA
| | - Martin R. Prince
- Department of Radiology, Weill Cornell Medicine New York New York USA
- Columbia College of Physicians and Surgeons New York New York USA
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Dual energy CT for evaluation of polycystic kidneys: a multi reader study of interpretation time and diagnostic confidence. Abdom Radiol (NY) 2018; 43:3418-3424. [PMID: 29926138 DOI: 10.1007/s00261-018-1674-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE To compare dual-energy CT (DECT) iodine overlay images with renal mass protocol CT in the evaluation of polycystic kidneys with respect to reading time, diagnostic confidence, and detection of renal lesions that are not definitively benign. METHODS Following IRB approval, portal venous phase dual-source DECT scans performed between September 2013 and February 2016 from 55 patients (mean age 67 ± 15 years, 31 male, 24 female) with polycystic kidneys (4 or more cysts) were included. For each patient, two image sets were created: (1) DECT post-processed iodine overlay images and (2) simulated renal mass protocol CT images (virtual noncontrast and mixed images). Two radiologists independently retrospectively reviewed both sets at separate time points, evaluating for the presence of lesions that were not definitively benign (enhancing lesions or Bosniak IIF cysts), as well as reading times and Likert scale diagnostic confidence ratings (scaled 1-5) for the presence of non-benign lesions. Reading times were compared with a t test, diagnostic confidence with a McNemar test, and lesion number detection with Cohen's kappa test. RESULTS Iodine overlay images were read faster (mean 55 ± 26 s) than renal mass protocol (mean 105 ± 51 s) (p < 0.001). Readers assigned the highest diagnostic confidence rating in 64% using iodine overlay series, compared to 17% using renal mass protocol (p < 0.0001). The proportion of patients with recorded lesions was not significantly different between methods (p = 0.62). CONCLUSIONS DECT improves lesion assessment in polycystic kidneys by decreasing reading times and increasing diagnostic confidence, without affecting lesion detection rates.
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The association between autosomal dominant polycystic kidney disease and cancer. Int Urol Nephrol 2018; 51:93-100. [DOI: 10.1007/s11255-018-1951-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 08/07/2018] [Indexed: 12/19/2022]
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Chen K, Tan YG, Tan D, Pek G, Huang HH, Sim SPA. Predictors and outcomes of laparoscopic nephrectomy in autosomal dominant polycystic kidney disease. Investig Clin Urol 2018; 59:238-245. [PMID: 29984338 PMCID: PMC6028464 DOI: 10.4111/icu.2018.59.4.238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/24/2018] [Indexed: 11/25/2022] Open
Abstract
Purpose Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease, and 20% of patients eventually require nephrectomies due to compressive symptoms or renal-related complications. Traditionally, nephrectomies were performed via the open approach in view of space constraints. We evaluate our institution's outcomes for laparoscopic nephrectomy (LN) for ADPKD. Materials and Methods We retrospectively reviewed 33 patients with ADPKD who underwent nephrectomies from November 2005 to December 2016 at a tertiary institution. Preoperative kidney volume was calculated via the ellipsoid method by using computed tomography scan. Results The median age was 51.0 years (interquartile range [IQR], 44.5–56.0 years). Sixteen patients (48.5%) underwent open nephrectomy (ON), 15 patients (45.5%) had LNs, and 2 patients (6.1%) had laparoscopic converted to ON due to dense adhesions. Thirteen patients had bilateral while 18 patients had unilateral nephrectomies. Median kidney volume in the open group was 1,042 cm3 (IQR, 753–2,365 cm3) versus 899 cm3 (IQR, 482–1,914 cm3) in the laparoscopy group and did not differ significantly. The operative time was comparable between both groups. Patients who underwent LN had lesser blood loss (350 mL vs. 650 mL; 95% confidence interval [CI], 1.822–3.533; p=0.016) and shorter length of hospital stay (4.0 days vs. 6.5 days; 95% CI, 1.445–5.755; p=0.001) compared to patients who underwent ON. Both groups had similar low morbidity rate and no mortality. Conclusions LN for ADPKD is a safe and effective alternative to ON independent of kidney size with comparable outcomes and benefits of minimally invasive surgery.
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Affiliation(s)
- Kenneth Chen
- Department of Urology, Singapore General Hospital, Singapore
| | - Yu Guang Tan
- Department of Urology, Singapore General Hospital, Singapore
| | - Darren Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gregory Pek
- University College Dublin, Dublin, Republic of Ireland
| | - Hong Hong Huang
- Department of Urology, Singapore General Hospital, Singapore
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Adams DJ, Demchur JA, Aronson LR. Renal cell carcinoma in a cat with polycystic kidney disease undergoing renal transplantation. JFMS Open Rep 2018; 4:2055116918766152. [PMID: 29780607 PMCID: PMC5954322 DOI: 10.1177/2055116918766152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Case summary A 10-year-old spayed female American Shorthair cat underwent renal
transplantation due to worsening chronic kidney disease secondary to
polycystic kidney disease. During transplantation, the right kidney grossly
appeared to be more diseased than the left and was firmly adhered to the
surrounding tissues. An intraoperative fine-needle aspirate of the right
native kidney revealed inflammatory cells but no evidence of neoplasia. To
create space for the allograft, a right nephrectomy was performed. Following
nephrectomy, the right native kidney was submitted for biopsy. Biopsy
results revealed a renal cell carcinoma. Although the cat initially
recovered well from surgery, delayed graft function was a concern in the
early postoperative period. Significant azotemia persisted and the cat began
to have diarrhea. Erythematous skin lesions developed in the perineal and
inguinal regions, which were suspected to be secondary to thromboembolic
disease based on histopathology. The cat’s clinical status continued to
decline with development of signs of sepsis, followed by marked obtundation
with uncontrollable seizures. Given the postoperative diagnosis of renal
cell carcinoma and the cat’s progressively declining clinical status, humane
euthanasia was elected. Relevance and novel information This case is the first to document renal cell carcinoma in a cat with
polycystic kidney disease. An association of the two diseases has been
reported in the human literature, but such a link has yet to be described in
veterinary medicine. Given the association reported in the human literature,
a plausible relationship between polycystic kidney disease and renal cell
carcinoma in cats merits further investigation.
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Affiliation(s)
- Daniel J Adams
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jolie A Demchur
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lillian R Aronson
- Section of Surgery, Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Kamboj M, Zeng X, Koratala A. Renal cyst infection: a diagnostic dilemma. Clin Case Rep 2018; 6:762-763. [PMID: 29636958 PMCID: PMC5889223 DOI: 10.1002/ccr3.1441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 01/28/2018] [Accepted: 01/31/2018] [Indexed: 11/23/2022] Open
Abstract
Cyst infection is a common complication of autosomal dominant polycystic kidney disease. It presents with vague clinical features and imaging findings which make the diagnosis challenging. Imaging findings can be misinterpreted as renal cell carcinoma, and biopsy of the lesion is often required for definitive diagnosis.
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Affiliation(s)
- Mayanka Kamboj
- Division of Nephrology, Hypertension and Renal Transplantation University of Florida Gainesville Florida
| | - Xu Zeng
- Division of Pathology, Immunology and Laboratory Medicine University of Florida Gainesville Florida
| | - Abhilash Koratala
- Division of Nephrology, Hypertension and Renal Transplantation University of Florida Gainesville Florida
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35
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Lee Y, Hung S, Wang H, Lin C, Wang H, Chang M, Sung J, Chiou Y, Lin S. Is there different risk of cancer among end-stage renal disease patients undergoing hemodialysis and peritoneal dialysis? Cancer Med 2018; 7:485-498. [PMID: 29356425 PMCID: PMC5806101 DOI: 10.1002/cam4.1289] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 01/02/2023] Open
Abstract
Cancer is a global issue in recent decade. Despite this alarming increase in the incidence of cancer, to date, whether the risk of developing cancer differs among peritoneal dialysis (PD) and hemodialysis (HD) patients is still uncertain. In this retrospective cohort study, data were obtained from the National Health Insurance Research Database of Taiwan, which provides coverage to almost 99% of the nation's population. After matching, a total of 4491 (or 3369) incident PD patients and 8982 (or 6738) incident HD patients between 2000 and 2009 were enrolled from the database. In addition, 22,455 (or 16,845) nondialysis patients were selected as a control group. The patients were monitored for the occurrence of cancer until 2010, and their data were analyzed using several different models. In general, the results showed that the risks of hepatocellular, kidney, bladder, extra kidney/bladder urinary tract, and thyroid cancers were higher in dialysis patients. We also compared the risk of cancer between two dialysis groups by using the HD patients as the reference group. The result showed that there is no significant different for each cancer risk between two dialysis groups. In conclusion, dialysis patients had a higher risk of certain types of cancer than those in the nonuremia group. However, there was no significant difference in the cancer risk between the two dialysis groups when compared directly.
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Affiliation(s)
- Yi‐Che Lee
- Division of NephrologyDepartment of Internal MedicineE‐DA Dachang Hospital/ I‐Shou UniversityKaohsiungTaiwan
| | - Shih‐Yuan Hung
- Division of NephrologyDepartment of Internal MedicineE‐DA Dachang Hospital/ I‐Shou UniversityKaohsiungTaiwan
- School of Medicine for International StudentsE‐DA Hospital/ I‐Shou UniversityKaohsiungTaiwan
| | - Hao‐Kuang Wang
- School of Medicine for International StudentsE‐DA Hospital/ I‐Shou UniversityKaohsiungTaiwan
- Department of NeurosurgeryE‐DA Hospital/ I‐Shou UniversityKaohsiungTaiwan
| | - Chi‐Wei Lin
- School of Medicine for International StudentsE‐DA Hospital/ I‐Shou UniversityKaohsiungTaiwan
- Department of Medical EducationE‐DA Hospital/ I‐Shou UniversityKaohsiungTaiwan
| | - Hsi‐Hao Wang
- Division of NephrologyDepartment of Internal MedicineE‐DA Dachang Hospital/ I‐Shou UniversityKaohsiungTaiwan
| | - Min‐Yu Chang
- Division of NephrologyDepartment of Internal MedicineE‐DA Dachang Hospital/ I‐Shou UniversityKaohsiungTaiwan
| | - Junne‐Ming Sung
- Division of NephrologyDepartment of Internal MedicineNational Cheng Kung University HospitalTainanTaiwan
| | - Yuan‐Yow Chiou
- Department of PediatricsNational Cheng Kung University HospitalTainanTaiwan
- Institute of Clinical MedicineCollege of MedicineNational Cheng Kung UniversityTainanTaiwan
| | - Sheng‐Hsiang Lin
- Institute of Clinical MedicineCollege of MedicineNational Cheng Kung UniversityTainanTaiwan
- Biostatistics Consulting CenterNational Cheng Kung University HospitalTainanTaiwan
- Department of Public HealthCollege of MedicineNational Cheng‐Kung UniversityTainanTaiwan
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36
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Hickman LA, Sawinski D, Guzzo T, Locke JE. Urologic malignancies in kidney transplantation. Am J Transplant 2018; 18:13-22. [PMID: 28985026 DOI: 10.1111/ajt.14533] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 09/22/2017] [Accepted: 09/26/2017] [Indexed: 01/25/2023]
Abstract
With advances in immunosuppression, graft and patient outcomes after kidney transplantation have improved considerably. As a result, long-term complications of transplantation, such as urologic malignancies, have become increasingly important. Kidney transplant recipients, for example, have a 7-fold risk of renal cell carcinoma (RCC) and 3-fold risk of urothelial carcinoma (UC) compared with the general population. While extrapolation of data from the general population suggest that routine cancer screening in transplant recipients would allow for earlier diagnosis and management of these potentially lethal malignancies, currently there is no consensus for posttransplantation RCC or UC screening as supporting data are limited. Further understanding of risk factors, presentation, optimal management of, and screening for urologic malignancies in kidney transplant patients is warranted, and as such, this review will focus on the incidence, surveillance, and treatment of urologic malignancies in kidney transplant recipients.
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Affiliation(s)
- Laura A Hickman
- Department of Surgery, Division of Transplantation, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Deirdre Sawinski
- Department of Medicine, Renal Electrolyte and Hypertension Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Thomas Guzzo
- Department of Urology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jayme E Locke
- Department of Surgery, Division of Transplantation, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
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An Evaluation of the Safety and Efficacy of Simultaneous Bilateral Nephrectomy and Renal Transplantation for Polycystic Kidney Disease: A 20-Year Experience. Transplantation 2017; 101:2774-2779. [PMID: 29064957 DOI: 10.1097/tp.0000000000001779] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Many strategies regarding timing of native nephrectomies exist for patients with symptomatic polycystic kidney disease (PCKD). METHODS This is a single-center, retrospective study of 594 adults with PCKD who had renal transplants from 1994 to 2014. Three groups were analyzed: renal transplant-only recipients (tx alone), recipients of simultaneous bilateral nephrectomies and transplant (simultaneous), and recipients with pretransplant bilateral nephrectomies (pre). The primary outcome was graft survival. Secondary outcomes included postoperative complications. RESULTS Five hundred sixty-five adults with PCKD received kidney transplants (303 tx alone, 161 simultaneous, 27 pre). Ten-year posttransplant graft survival was 68.5%, 63.6%, and 65.7% for tx alone, simultaneous, and precohorts (P = 0.86). No statistically significant differences were observed in rates of postoperative ileus, deep vein thrombosis, small bowel obstruction, urinary stricture, urine leak, hernia formation, and delayed graft function. More wound complications were seen in prepatients (25.9% vs 11.1% tx alone, 5.1% simultaneous; P = 0.03), whereas simultaneous patients had a lower incidence of lymphocele (1.3% vs 11.1% pre, 10.2% tx-alone; P = 0.002). Importantly, simultaneous patients had more renal vascular thromboses (4.4% vs 1.3% tx alone, 0% pre; P = 0.04). 16.3% of renal transplant alone patients required nephrectomy at 10 years follow-up. Twenty-nine patients were referred for transplant having had nephrectomies and were ultimately not transplanted. In 4 of these patients who had data available for analysis, the mean panel-reactive antibody significantly increased after nephrectomy was performed. CONCLUSIONS Simultaneous bilateral nephrectomy can be safely performed at the time of renal transplantation, however, carries a significantly increased risk of renal vascular thrombosis.
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Huh H, Jo HA, Yi Y, Kim SH, Moon KC, Ahn C, Park HC. Xp11.2 translocation renal cell carcinoma in the autosomal dominant polycystic kidney disease patient with preserved renal function. Korean J Intern Med 2017; 32:1108-1111. [PMID: 29032669 PMCID: PMC5668382 DOI: 10.3904/kjim.2014.133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 06/25/2014] [Accepted: 07/08/2014] [Indexed: 11/27/2022] Open
Affiliation(s)
- Hyuk Huh
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyung Ah Jo
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - YongJin Yi
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seung Hyup Kim
- Division of Nephrology, Department of Internal Medicine, Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Kyung Chul Moon
- Division of Nephrology, Department of Internal Medicine, Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Curie Ahn
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hayne Cho Park
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Correspondence to Hayne Cho Park, M.D. Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-2072-2228 Fax: +82-2-762-9662 E-mail:
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Dimala CA, Bechem NN, Kadia BM, Feteh VF, Choukem SP. Diagnostic and therapeutic challenges of an ambiguous cystic kidney disease in a resource limited setting: a case report. BMC Res Notes 2017; 10:114. [PMID: 28249589 PMCID: PMC5333378 DOI: 10.1186/s13104-017-2437-8] [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: 09/13/2016] [Accepted: 02/24/2017] [Indexed: 12/03/2022] Open
Abstract
Background Unilateral renal cystic disease is a rare condition that shares morphological similarities with multicystic dysplastic kidney, the former often distinguished from the latter on some clinical and histopathological grounds. However serious diagnostic and therapeutic dilemmas set in when there is a considerable overlap in the distinguishing features between these entities. Case presentation A 19-year-old African female presented with a chronic severe debilitating right lower quadrant abdominal pain refractory to analgesics. Biochemical investigations and imaging studies revealed a non-functional polycystic right kidney and no identifiable pelvicalyceal system or ureter but with preserved renal function. The marked overlap in clinical presentation between unilateral renal cystic disease and multicystic dysplastic kidney in this patient necessitated further investigation to pose an appropriate diagnosis. A right nephrectomy was performed and histopathological analysis of the resected kidney done, the results of which were more consistent with unilateral renal cystic disease. The post-operative course was favorable. Conclusion Unilateral renal cystic disease with an ipsilateral non-functional kidney and an atretic pelvicalyceal system is a very rare condition that needs to be distinguished from multicystic dysplastic kidney in order to guide management and set prognosis. A suspicion of either of these diseases therefore warrants a thorough clinical evaluation and the appropriate combination of biochemical and imaging investigations.
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Affiliation(s)
- Christian Akem Dimala
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. .,Orthopaedics Department, Southend University Hospital, Essex, UK. .,Health and Human Development (2HD) Research Group, Douala, Cameroon.
| | | | | | - Vitalis Fambombi Feteh
- Health and Human Development (2HD) Research Group, Douala, Cameroon.,Mboppi Baptist Hospital, Douala, Cameroon
| | - Simeon Pierre Choukem
- Health and Human Development (2HD) Research Group, Douala, Cameroon.,Faculty of Health Sciences, University of Buea, Buea, Cameroon.,Douala General Hospital, Douala, Cameroon
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Lai J, Modi L, Ramai D, Tortora M. Tuberous sclerosis complex and polycystic kidney disease contiguous gene syndrome with Moyamoya disease. Pathol Res Pract 2017; 213:410-415. [PMID: 28237043 DOI: 10.1016/j.prp.2016.12.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 12/30/2016] [Accepted: 12/31/2016] [Indexed: 10/20/2022]
Abstract
Tuberous sclerosis complex (TSC) and autosomal dominant polycystic kidney disease (ADPKD) are two diseases sharing close genetic loci on chromosome 16. Due to contiguous gene syndrome, also known as contiguous gene deletion syndrome, the proximity of TSC2 and PKD1 genes increases the risk of co-deletion resulting in a shared clinical presentation. Furthermore, Moyamoya disease (MMD) is a rare vaso-occlusive disease in the circle of Willis. We present the first case of TSC2/PKD1 contiguous gene syndrome in a patient with MMD along with detailed histopathologic, radiologic, and cytogenetic analyses. We also highlight the clinical presentation and surgical complications in this case.
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Affiliation(s)
- Jonathan Lai
- Department of Pathology, St. Barnabas Medical Center, 94 Old Short Hills Rd, Livingston, NJ 07039, United States
| | - Lopa Modi
- Department of Pathology, St. Barnabas Medical Center, 94 Old Short Hills Rd, Livingston, NJ 07039, United States
| | - Daryl Ramai
- Department of Pathology, St. Barnabas Medical Center, 94 Old Short Hills Rd, Livingston, NJ 07039, United States.
| | - Matthew Tortora
- Department of Pathology, St. Barnabas Medical Center, 94 Old Short Hills Rd, Livingston, NJ 07039, United States
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41
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Risk of cancer in patients with polycystic kidney disease: a propensity-score matched analysis of a nationwide, population-based cohort study. Lancet Oncol 2016; 17:1419-1425. [DOI: 10.1016/s1470-2045(16)30250-9] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/06/2016] [Accepted: 06/15/2016] [Indexed: 12/29/2022]
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Xu L, Rong Y, Wang W, Lian H, Gan W, Yan X, Li X, Guo H. Percutaneous radiofrequency ablation with contrast-enhanced ultrasonography for solitary and sporadic renal cell carcinoma in patients with autosomal dominant polycystic kidney disease. World J Surg Oncol 2016; 14:193. [PMID: 27460786 PMCID: PMC4962510 DOI: 10.1186/s12957-016-0916-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 06/15/2016] [Indexed: 11/11/2022] Open
Abstract
Background The aim of this study was to assess the functional and oncologic outcomes of percutaneous radiofrequency ablation (RFA) with contrast-enhanced ultrasonography (CEUS) for renal cell carcinoma in patient with autosomal dominant polycystic kidney. Methods We performed a retrospective review of five patients with renal cell carcinoma (RCC) in autosomal dominant polycystic kidney disease (ADPKD) from January 2009 to December 2014 with a media follow-up of 33 months. The tumors were ablated with Cool-tip RFA system under the guidance of CEUS. Routine follow-up included contrast-enhanced computed tomography/magnetic resonance imaging (CT/MRI) and renal function tests. Results Media diameter of the treated renal tumors was 3.1 cm (range 1.7–5.2 cm). Initial ablation success rate was 4/5. After over 6 months contrast-enhanced CT/MRI follow-up after RFA, no patients experienced local tumor recurrence. No patients required dialysis in the periprocedural period. Minor complications only developed in two cases. There was no significant difference in estimated glomerular filtration rate (eGFR) between pre- and post-RFA. Conclusions Our initial experience of this technique for RCC in ADPKD was favorable with good renal function preservation and oncologic outcomes. It may be a good choice for RCC in ADPKD.
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Affiliation(s)
- Linfeng Xu
- School of Medicine, The Affiliated Drum Tower Hospital of Nanjing University, 321 Zhongshan Road, Nanjing, Jiangsu, People's Republic of China
| | - Yang Rong
- School of Medicine, The Affiliated Drum Tower Hospital of Nanjing University, 321 Zhongshan Road, Nanjing, Jiangsu, People's Republic of China
| | - Wei Wang
- School of Medicine, The Affiliated Drum Tower Hospital of Nanjing University, 321 Zhongshan Road, Nanjing, Jiangsu, People's Republic of China
| | - Huibo Lian
- School of Medicine, The Affiliated Drum Tower Hospital of Nanjing University, 321 Zhongshan Road, Nanjing, Jiangsu, People's Republic of China
| | - Weidong Gan
- School of Medicine, The Affiliated Drum Tower Hospital of Nanjing University, 321 Zhongshan Road, Nanjing, Jiangsu, People's Republic of China
| | - Xiang Yan
- School of Medicine, The Affiliated Drum Tower Hospital of Nanjing University, 321 Zhongshan Road, Nanjing, Jiangsu, People's Republic of China
| | - Xiaogong Li
- School of Medicine, The Affiliated Drum Tower Hospital of Nanjing University, 321 Zhongshan Road, Nanjing, Jiangsu, People's Republic of China.
| | - Hongqian Guo
- School of Medicine, The Affiliated Drum Tower Hospital of Nanjing University, 321 Zhongshan Road, Nanjing, Jiangsu, People's Republic of China.
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Lee VW, Tunnicliffe DJ, Rangan GK. KHA-CARI Autosomal Dominant Polycystic Kidney Disease Guideline: Management of End-Stage Kidney Disease. Semin Nephrol 2016; 35:595-602.e12. [PMID: 26718164 DOI: 10.1016/j.semnephrol.2015.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Vincent W Lee
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia; Centre for Transplant and Renal Research, Westmead Institute for Medical Research, University of Sydney, Westmead, Sydney, Australia.
| | - David J Tunnicliffe
- KHA-CARI Guidelines, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia; Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Gopala K Rangan
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia; Centre for Transplant and Renal Research, Westmead Millennium Institute for Medical Research, University of Sydney, Westmead, Sydney, Australia
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Seeger-Nukpezah T, Geynisman DM, Nikonova AS, Benzing T, Golemis EA. The hallmarks of cancer: relevance to the pathogenesis of polycystic kidney disease. Nat Rev Nephrol 2015; 11:515-34. [PMID: 25870008 PMCID: PMC5902186 DOI: 10.1038/nrneph.2015.46] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is a progressive inherited disorder in which renal tissue is gradually replaced with fluid-filled cysts, giving rise to chronic kidney disease (CKD) and progressive loss of renal function. ADPKD is also associated with liver ductal cysts, hypertension, chronic pain and extra-renal problems such as cerebral aneurysms. Intriguingly, improved understanding of the signalling and pathological derangements characteristic of ADPKD has revealed marked similarities to those of solid tumours, even though the gross presentation of tumours and the greater morbidity and mortality associated with tumour invasion and metastasis would initially suggest entirely different disease processes. The commonalities between ADPKD and cancer are provocative, particularly in the context of recent preclinical and clinical studies of ADPKD that have shown promise with drugs that were originally developed for cancer. The potential therapeutic benefit of such repurposing has led us to review in detail the pathological features of ADPKD through the lens of the defined, classic hallmarks of cancer. In addition, we have evaluated features typical of ADPKD, and determined whether evidence supports the presence of such features in cancer cells. This analysis, which places pathological processes in the context of defined signalling pathways and approved signalling inhibitors, highlights potential avenues for further research and therapeutic exploitation in both diseases.
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Affiliation(s)
- Tamina Seeger-Nukpezah
- Department I of Internal Medicine and Centre for Integrated Oncology, University of Cologne, Kerpenerstrasse 62, D-50937 Cologne, Germany
| | - Daniel M Geynisman
- Department of Medical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA
| | - Anna S Nikonova
- Department of Developmental Therapeutics, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA
| | - Thomas Benzing
- Department II of Internal Medicine and Centre for Molecular Medicine Cologne, University of Cologne, Kerpenerstrasse 62, D-50937 Cologne, Germany
| | - Erica A Golemis
- Department of Developmental Therapeutics, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA
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Abstract
Renal cancer occurs more frequently in renal transplanted patients than in the general population, affecting native kidneys in 90% of cases and the graft in 10 %. In addition to general risk factors, malignancy susceptibility may be influenced by immunosuppressive therapy, the use of calcineurin inhibitors (CNI) as compared with mammalian target of rapamycin inhibitors, and the length of dialysis treatment. Acquired cystic kidney disease may increase the risk for renal cancer after transplantation, while autosomal dominant polycystic kidney disease does not seem to predispose to cancer development. Annual ultrasound evaluation seems appropriate in patients with congenital or acquired cystic disease or even a single cyst in native kidneys, and every 2 years in patients older than 60 years if they were on dialysis for more than 5 years before transplantation. Immunosuppression should be lowered in patients who develop renal cancer, by reduction or withdrawal of CNI. Although more evidence is still needed, it seems reasonable to shift patients from CNI to everolimus or sirolimus if not already treated with one of these drugs, with due caution in subjects with chronic allograft nephropathy.
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Chapman AB, Devuyst O, Eckardt KU, Gansevoort RT, Harris T, Horie S, Kasiske BL, Odland D, Pei YP, Perrone RD, Pirson Y, Schrier RW, Torra R, Torres VE, Watnick T, Wheeler DC. Autosomal-dominant polycystic kidney disease (ADPKD): executive summary from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2015; 88:17-27. [PMID: 25786098 PMCID: PMC4913350 DOI: 10.1038/ki.2015.59] [Citation(s) in RCA: 352] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 01/23/2015] [Accepted: 01/28/2015] [Indexed: 02/06/2023]
Abstract
Autosomal-dominant polycystic kidney disease (ADPKD) affects up to 12 million individuals and is the fourth most common cause for renal replacement therapy worldwide. There have been many recent advances in the understanding of its molecular genetics and biology, and in the diagnosis and management of its manifestations. Yet, diagnosis, evaluation, prevention, and treatment vary widely and there are no broadly accepted practice guidelines. Barriers to translation of basic science breakthroughs to clinical care exist, with considerable heterogeneity across countries. The Kidney Disease: Improving Global Outcomes Controversies Conference on ADPKD brought together a panel of multidisciplinary clinical expertise and engaged patients to identify areas of consensus, gaps in knowledge, and research and health-care priorities related to diagnosis; monitoring of kidney disease progression; management of hypertension, renal function decline and complications; end-stage renal disease; extrarenal complications; and practical integrated patient support. These are summarized in this review.
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Affiliation(s)
| | | | | | | | | | - Shigeo Horie
- Juntendo University Graduate School of Medicine, Bunkyou, Tokyo Japan
| | | | | | - York P. Pei
- University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Ronald D. Perrone
- Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Yves Pirson
- Université Catholique de Louvain, Brussels, Belgium
| | | | - Roser Torra
- Fundació Puigvert, REDinREN, Universitat Autónoma de Barcelona, Barcelona, Spain
| | | | - Terry Watnick
- University of Maryland School of Medicine, Baltimore, Maryland, USA
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EXP CLIN TRANSPLANTExp Clin Transplant 2015; 13. [DOI: 10.6002/ect.2015.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Antignac C, Calvet JP, Germino GG, Grantham JJ, Guay-Woodford LM, Harris PC, Hildebrandt F, Peters DJM, Somlo S, Torres VE, Walz G, Zhou J, Yu ASL. The Future of Polycystic Kidney Disease Research--As Seen By the 12 Kaplan Awardees. J Am Soc Nephrol 2015; 26:2081-95. [PMID: 25952256 DOI: 10.1681/asn.2014121192] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Polycystic kidney disease (PKD) is one of the most common life-threatening genetic diseases. Jared J. Grantham, M.D., has done more than any other individual to promote PKD research around the world. However, despite decades of investigation there is still no approved therapy for PKD in the United States. In May 2014, the University of Kansas Medical Center hosted a symposium in Kansas City honoring the occasion of Dr. Grantham's retirement and invited all the awardees of the Lillian Jean Kaplan International Prize for Advancement in the Understanding of Polycystic Kidney Disease to participate in a forward-thinking and interactive forum focused on future directions and innovations in PKD research. This article summarizes the contributions of the 12 Kaplan awardees and their vision for the future of PKD research.
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Affiliation(s)
- Corinne Antignac
- National Institute of Health and Medical Research, Laboratory of Inherited Kidney Diseases, Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, and The Department of Genetics, Necker Hospital, Paris, France
| | - James P Calvet
- The Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas;
| | - Gregory G Germino
- Kidney Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Jared J Grantham
- The Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas
| | - Lisa M Guay-Woodford
- Center for Translational Science, Children's National Health System, Washington, DC
| | - Peter C Harris
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Friedhelm Hildebrandt
- Howard Hughes Medical Institute and Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dorien J M Peters
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Stefan Somlo
- Departments of Internal Medicine and Genetics, Yale University School of Medicine, New Haven, Connecticut
| | - Vicente E Torres
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Gerd Walz
- Renal Division, Department of Medicine, University Medical Center Freiburg, Freiburg, Germany; and
| | - Jing Zhou
- Harvard Center for Polycystic Kidney Disease Research, Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alan S L Yu
- The Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas;
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Chai MH, Park H, Kim Y, Kim JS, Kim SH, Eom M, Yang JW, Han BG, Choi SO. Papillary Adenoma Identified in Removed Polycystic Kidneys during Kidney Transplantation in Autosomal Dominant Polycystic Kidney Disease Patient. KOREAN JOURNAL OF TRANSPLANTATION 2014. [DOI: 10.4285/jkstn.2014.28.4.246] [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)
- Moon Hee Chai
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hyeoncheol Park
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Youngsub Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jae Seok Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sung Hoon Kim
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Minseob Eom
- Department of Pathology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jae Won Yang
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Byoung Geun Han
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seung Ok Choi
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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