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Zhu C, He X, Blumenfeld JD, Hu Z, Dev H, Sattar U, Bazojoo V, Sharbatdaran A, Aspal M, Romano D, Teichman K, Ng He HY, Wang Y, Soto Figueroa A, Weiss E, Prince AG, Chevalier JM, Shimonov D, Moghadam MC, Sabuncu M, Prince MR. A Primer for Utilizing Deep Learning and Abdominal MRI Imaging Features to Monitor Autosomal Dominant Polycystic Kidney Disease Progression. Biomedicines 2024; 12:1133. [PMID: 38791095 PMCID: PMC11118119 DOI: 10.3390/biomedicines12051133] [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: 04/11/2024] [Revised: 05/06/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
Abdominal imaging of autosomal dominant polycystic kidney disease (ADPKD) has historically focused on detecting complications such as cyst rupture, cyst infection, obstructing renal calculi, and pyelonephritis; discriminating complex cysts from renal cell carcinoma; and identifying sources of abdominal pain. Many imaging features of ADPKD are incompletely evaluated or not deemed to be clinically significant, and because of this, treatment options are limited. However, total kidney volume (TKV) measurement has become important for assessing the risk of disease progression (i.e., Mayo Imaging Classification) and predicting tolvaptan treatment's efficacy. Deep learning for segmenting the kidneys has improved these measurements' speed, accuracy, and reproducibility. Deep learning models can also segment other organs and tissues, extracting additional biomarkers to characterize the extent to which extrarenal manifestations complicate ADPKD. In this concept paper, we demonstrate how deep learning may be applied to measure the TKV and how it can be extended to measure additional features of this disease.
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Affiliation(s)
- Chenglin Zhu
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
| | - Xinzi He
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14853, USA
- Cornell Tech, Cornell University, Ithaca, NY 10044, USA
| | - Jon D. Blumenfeld
- The Rogosin Institute, New York, NY 10021, USA; (J.D.B.); (J.M.C.); (D.S.)
- Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Zhongxiu Hu
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
| | - Hreedi Dev
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
| | - Usama Sattar
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
| | - Vahid Bazojoo
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
| | - Arman Sharbatdaran
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
| | - Mohit Aspal
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
| | - Dominick Romano
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
| | - Kurt Teichman
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
| | - Hui Yi Ng He
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
| | - Yin Wang
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
| | - Andrea Soto Figueroa
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
| | - Erin Weiss
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
| | - Anna G. Prince
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
| | - James M. Chevalier
- The Rogosin Institute, New York, NY 10021, USA; (J.D.B.); (J.M.C.); (D.S.)
- Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Daniil Shimonov
- The Rogosin Institute, New York, NY 10021, USA; (J.D.B.); (J.M.C.); (D.S.)
- Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Mina C. Moghadam
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
| | - Mert Sabuncu
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
- Cornell Tech, Cornell University, Ithaca, NY 10044, USA
- School of Electrical and Computer Engineering, Cornell University, Ithaca, NY 14853, USA
| | - Martin R. Prince
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
- Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY 10032, USA
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Schönauer R, Sierks D, Boerrigter M, Jawaid T, Caroff L, Audrezet MP, Friedrich A, Shaw M, Degenhardt J, Forberger M, de Fallois J, Bläker H, Bergmann C, Gödiker J, Schindler P, Schlevogt B, Müller RU, Berg T, Patterson I, Griffiths WJ, Sayer JA, Popp B, Torres VE, Hogan MC, Somlo S, Watnick TJ, Nevens F, Besse W, Cornec-Le Gall E, Harris PC, Drenth JPH, Halbritter J. Sex, Genotype, and Liver Volume Progression as Risk of Hospitalization Determinants in Autosomal Dominant Polycystic Liver Disease. Gastroenterology 2024; 166:902-914. [PMID: 38101549 DOI: 10.1053/j.gastro.2023.12.007] [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: 08/22/2023] [Revised: 12/04/2023] [Accepted: 12/10/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND & AIMS Autosomal dominant polycystic liver disease is a rare condition with a female preponderance, based mainly on pathogenic variants in 2 genes, PRKCSH and SEC63. Clinically, autosomal dominant polycystic liver disease is characterized by vast heterogeneity, ranging from asymptomatic to highly symptomatic hepatomegaly. To date, little is known about the prediction of disease progression at early stages, hindering clinical management, genetic counseling, and the design of randomized controlled trials. To improve disease prognostication, we built a consortium of European and US centers to recruit the largest cohort of patients with PRKCSH and SEC63 liver disease. METHODS We analyzed an international multicenter cohort of 265 patients with autosomal dominant polycystic liver disease harboring pathogenic variants in PRKCSH or SEC63 for genotype-phenotype correlations, including normalized age-adjusted total liver volumes and polycystic liver disease-related hospitalization (liver event) as primary clinical end points. RESULTS Classifying individual total liver volumes into predefined progression groups yielded predictive risk discrimination for future liver events independent of sex and underlying genetic defects. In addition, disease severity, defined by age at first liver event, was considerably more pronounced in female patients and patients with PRKCSH variants than in those with SEC63 variants. A newly developed sex-gene score was effective in distinguishing mild, moderate, and severe disease, in addition to imaging-based prognostication. CONCLUSIONS Both imaging and clinical genetic scoring have the potential to inform patients about the risk of developing symptomatic disease throughout their lives. The combination of female sex, germline PRKCSH alteration, and rapid total liver volume progression is associated with the greatest odds of polycystic liver disease-related hospitalization.
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Affiliation(s)
- Ria Schönauer
- Department of Nephrology and Internal Intensive Care Medicine, Charité Universitätsmedizin Berlin (corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin), Berlin, Germany; Division of Nephrology, Department of Internal Medicine, University of Leipzig Medical Center, Leipzig, Germany
| | - Dana Sierks
- Division of Nephrology, Department of Internal Medicine, University of Leipzig Medical Center, Leipzig, Germany; Department of Pediatric Surgery, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Melissa Boerrigter
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tabinda Jawaid
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Lea Caroff
- University of Brest, Institut National de la Santé et de la Recherche Médicale, UMR 1078, Génétique, Génomique Fonctionnelle et Biotechnologies, Brest, France; Centre Hospitalier Universitaire Brest, Service de Néphrologie, Centre de Référence Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Brest, France
| | - Marie-Pierre Audrezet
- Centre Hospitalier Universitaire Brest, Service de Génétique Moléculaire, Brest, France
| | - Anja Friedrich
- Medizinische Genetik Mainz, Limbach Genetics, Mainz, Germany
| | - Melissa Shaw
- Departments of Internal Medicine and Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | - Jan Degenhardt
- Department 2 of Internal Medicine, University of Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Mirjam Forberger
- Department of Pathology, University of Leipzig Medical Center, Leipzig, Germany
| | - Jonathan de Fallois
- Division of Nephrology, Department of Internal Medicine, University of Leipzig Medical Center, Leipzig, Germany
| | - Hendrik Bläker
- Department of Pathology, University of Leipzig Medical Center, Leipzig, Germany
| | | | - Juliana Gödiker
- Department of Internal Medicine B, University Hospital Münster, Münster, Germany
| | | | - Bernhard Schlevogt
- Department of Internal Medicine B, University Hospital Münster, Münster, Germany; Department of Gastroenterology, Medical Center Osnabrück, Osnabrück, Germany
| | - Roman-U Müller
- Department 2 of Internal Medicine, University of Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany; Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD) University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, University of Leipzig Medical Center, Leipzig, Germany
| | - Ilse Patterson
- Department of Radiology, Cambridge University Hospitals, Cambridge, United Kingdom
| | - William J Griffiths
- Department of Hepatology, Cambridge Liver Unit, Cambridge University Hospitals, Cambridge, United Kingdom
| | - John A Sayer
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; Renal Services, Newcastle upon Tyne National Health Service Foundation Trust, Newcastle upon Tyne, United Kingdom; National Institute for Health Research Newcastle Biomedical Research Centre, Newcastle upon Tyne, United Kingdom
| | - Bernt Popp
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, Center of Functional Genomics, Berlin, Germany
| | - Vicente E Torres
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Marie C Hogan
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Stefan Somlo
- Departments of Internal Medicine and Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | - Terry J Watnick
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Frederik Nevens
- Department of Hepatology and Liver Transplantation Unit, University Hospitals Katholieke Universiteit Leuven, Leuven, Belgium
| | - Whitney Besse
- Departments of Internal Medicine and Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | - Emilie Cornec-Le Gall
- University of Brest, Institut National de la Santé et de la Recherche Médicale, UMR 1078, Génétique, Génomique Fonctionnelle et Biotechnologies, Brest, France; Centre Hospitalier Universitaire Brest, Service de Néphrologie, Centre de Référence Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Brest, France
| | - Peter C Harris
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Jan Halbritter
- Department of Nephrology and Internal Intensive Care Medicine, Charité Universitätsmedizin Berlin (corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin), Berlin, Germany; Division of Nephrology, Department of Internal Medicine, University of Leipzig Medical Center, Leipzig, Germany.
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Barten TRM, Atsma F, van der Meer AJ, Gansevoort R, Nevens F, Drenth JPH, Gevers TJG. Higher need for polycystic liver disease therapy in female patients: Sex-specific association between liver volume and need for therapy. Hepatology 2024; 79:551-559. [PMID: 37725713 DOI: 10.1097/hep.0000000000000602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/23/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND AND AIMS Prognostic tools or biomarkers are urgently needed in polycystic liver disease (PLD) to monitor disease progression and evaluate treatment outcomes. Total liver volume (TLV) is currently used to assess cross-sectional disease severity, and female patients typically have larger livers than males. Therefore, this study explores the sex-specific association between TLV and volume-reducing therapy (VRT). APPROACH AND RESULTS In this prospective cohort study, we included patients with PLD from European treatment centers. We explored sex-specific differences in the association between baseline TLV and initiation of volume-reducing therapy and determined the cumulative incidence rates of volume-reducing therapy in our cohort.We included 358 patients, of whom 157 (43.9%) received treatment. Treated patients had a higher baseline TLV (median TLV 2.16 vs. 4.34 liter, p < 0.001), were more frequently female (69.7% vs. 89.8%, p < 0.001), and had a higher risk of liver events (HR 4.381, p < 0.001). The cumulative volume-reducing therapy rate at 1 year of follow-up was 21.0% for females compared to 9.1% for males. Baseline TLV was associated with volume-reducing therapy, and there was an interaction with sex (HR females 1.202, p < 0.001; HR males 1.790, p < 0.001; at 1.5 l). CONCLUSION Baseline TLV is strongly associated with volume-reducing therapy initiation at follow-up in patients with PLD, with sex-specific differences in this association. Disease staging systems should use TLV to predict the need for future volume-reducing therapy in PLD separately for males and females.
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Affiliation(s)
- Thijs R M Barten
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
- European Reference Network RARE-LIVER, Germany
| | - Femke Atsma
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Adriaan J van der Meer
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Ron Gansevoort
- Department of Nephrology, University Medical Centre Groningen, University Hospital Groningen, Groningen, Netherlands
| | - Frederik Nevens
- European Reference Network RARE-LIVER, Germany
- Department of Hepatology, University Hospitals KU Leuven, Leuven, Belgium
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
- European Reference Network RARE-LIVER, Germany
| | - Tom J G Gevers
- European Reference Network RARE-LIVER, Germany
- Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
- Nutrim School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
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Ni Y, Wang W, Liu Y, Jiang Y. Causal associations between liver traits and Colorectal cancer: a Mendelian randomization study. BMC Med Genomics 2023; 16:316. [PMID: 38057864 PMCID: PMC10699049 DOI: 10.1186/s12920-023-01755-w] [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: 06/22/2023] [Accepted: 11/27/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the causal associations between several liver traits (liver iron content, percent liver fat, alanine transaminase levels, and liver volume) and colorectal cancer (CRC) risk using a Mendelian randomization (MR) approach to improve our understanding of the disease and its management. METHODS Genetic variants were used as instrumental variables, extracted from genome-wide association studies (GWAS) datasets of liver traits and CRC. The Two-Sample MR package in R was used to conduct inverse variance weighted (IVW), MR Egger, Maximum likelihood, Weighted median, and Inverse variance weighted (multiplicative random effects) MR approaches to generate overall estimates of the effect. MR analysis was conducted with Benjamini-Hochberg method-corrected P values to account for multiple testing (P < 0.013). MR-PRESSO was used to identify and remove outlier genetic variants in Mendelian randomization (MR) analysis. The MR Steiger test was used to assess the validity of the assumption that exposure causes outcomes. Leave-one-out validation, pleiotropy, and heterogeneity testing were also conducted to ensure the reliability of the results. Multivariable MR was utilized for validation of our findings using the IVW method while also adjusting for potential confounding or pleiotropy bias. RESULTS The MR analysis suggested a causal effect between liver volume and a reduced risk of CRC (OR 0.60; 95% CI, 0.44-0.82; P = 0.0010) but did not provide evidence for causal effects of liver iron content, percent liver fat, or liver alanine transaminase levels. The MR-PRESSO method did not identify any outliers, and the MR Steiger test confirmed that the causal direction of the analysis results was correct in the Mendelian randomization analysis. MR results were consistent with heterogeneity and pleiotropy analyses, and leave-one-out analysis demonstrated the overall values obtained were consistent with estimates obtained when all available SNPs were included in the analysis. Multivariable MR was utilized for validation of our findings using the IVW method while also adjusting for potential confounding or pleiotropy bias. CONCLUSION The study provides tentative evidence for a causal role of liver volume in CRC, while genetically predicted levels of liver iron content, percent liver fat, and liver alanine transaminase levels were not associated with CRC risk. The findings may inform the development of targeted therapeutic interventions for colorectal liver metastasis (CRLM) patients, and the study highlights the importance of MR as a powerful epidemiological tool for investigating causal associations between exposures and outcomes.
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Affiliation(s)
- Ying Ni
- Beijing Normal University, 100875, Beijing, China
| | - Wenkai Wang
- Department of Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, 200021, Shanghai, China
| | - Yongming Liu
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, 200021, Shanghai, China
- Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, 200021, Shanghai, China
| | - Yun Jiang
- Beijing Normal University, 100875, Beijing, China.
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Hogan MC, Simmons K, Ullman L, Gondal M, Dahl NK. Beyond Loss of Kidney Function: Patient Care in Autosomal Dominant Polycystic Kidney Disease. KIDNEY360 2023; 4:1806-1815. [PMID: 38010035 PMCID: PMC10758524 DOI: 10.34067/kid.0000000000000296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/26/2023] [Indexed: 11/29/2023]
Abstract
Patients with autosomal dominant polycystic kidney disease benefit from specialized care over their lifetimes, starting with diagnosis of the condition with ongoing discussion of both the renal course and extra-renal issues. Both renal and extra-renal issues may continue to cause major morbidity even after successful kidney transplant or initiation of RRT, and extra-renal disease aspects should always be considered as part of routine management. In this review, we will focus on updates in pain/depression screening, cardiac manifestations, liver and pancreatic cysts, kidney stone management, and genetic counseling. In some instances, we have shared our current clinical practice rather than an evidence-based guideline. We anticipate more standardization of care after the release of the Kidney Disease Improving Global Outcomes guidelines for management in autosomal dominant polycystic kidney disease later this year.
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Affiliation(s)
- Marie C. Hogan
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Kathryn Simmons
- Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | - Lawrence Ullman
- Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | - Maryam Gondal
- Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | - Neera K. Dahl
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
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Bugazia S, Hogan MC. Extrarenal Manifestations: Polycystic Liver Disease and Its Complications. ADVANCES IN KIDNEY DISEASE AND HEALTH 2023; 30:440-453. [PMID: 37943238 DOI: 10.1053/j.akdh.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
The liver is the commonest site of involvement outside of the kidney in autosomal dominant polycystic kidney disease. Most individuals with polycystic liver disease are asymptomatic and require no therapeutic interventions, but a small number of affected individuals who experience symptomatic polycystic liver disease develop medical complications as a result of massive enlargement of cyst number and size and hepatic parenchyma and its subsequent associated complications. This can lead to deterioration in overall health and quality of life, increasing morbidity and mortality. In this review, we will touch upon disease pathogenesis, prevalence, and complications and discuss recent advances in surgical and medical management.
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Affiliation(s)
- Seif Bugazia
- Division of Nephrology & Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Marie C Hogan
- Division of Nephrology & Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
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Al Sayyab M, Chapman A. Pregnancy in Autosomal Dominant Polycystic Kidney Disease. ADVANCES IN KIDNEY DISEASE AND HEALTH 2023; 30:454-460. [PMID: 38032583 DOI: 10.1053/j.akdh.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disorder occurring in approximately 1:1000 individuals. ADPKD is characterized by gradual cyst expansion and kidney enlargement and is a slowly progressive disorder where patients typically initiate renal replacement therapy in the sixth decade of life. The vast majority of women with ADPKD become pregnant in the third or fourth decade, often before knowing that they have ADPKD, in the setting of normal kidney function or chronic kidney disease Stage 1. In ADPKD, pregnancy outcomes for mother and baby differ from the general population, and long-term consequences of maternal complications from pregnancy are common in ADPKD. In the current era of genetic testing, options to consider pre-implantation genetic screening are becoming more available. This chapter will review renal physiologic and anatomic changes that occur in pregnancy, the potential impact of ADPKD on maternal and fetal outcomes, medical management during pregnancy, the impact of pregnancy on long-term outcomes in women with ADPKD, and options for families with ADPKD planning to undergo pregnancy with regard to genetic testing.
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Affiliation(s)
- Mina Al Sayyab
- Department of Medicine, University of Chicago, Chicago, IL
| | - Arlene Chapman
- Department of Medicine, University of Chicago, Chicago, IL.
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