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Gulati A, Watnick T. Vascular Complications in Autosomal Dominant Polycystic Kidney Disease: Perspectives, Paradigms, and Current State of Play. ADVANCES IN KIDNEY DISEASE AND HEALTH 2023; 30:429-439. [PMID: 38097333 DOI: 10.1053/j.akdh.2023.09.004] [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: 06/09/2023] [Revised: 09/06/2023] [Accepted: 09/12/2023] [Indexed: 12/18/2023]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the leading cause of inherited kidney disease with significant contributions to CKD and end-stage kidney disease. The underlying polycystin proteins (PC1 and PC2) have widespread tissue expression and complex functional roles making ADPKD a systemic disease. Vascular complications, particularly intracranial aneurysms (ICA) are the most feared due to their potential for devastating neurological complications and sudden death. Intracranial aneurysms occur in 8-12% of all patients with ADPKD, but the risk is intensified 4-5-fold in those with a positive family history. The basis for this genetic risk is not well understood and could conceivably be due to features of the germline mutation with a significant contribution of other genetic modifiers and/or environmental factors. Here we review what is known about the natural history and genetics of unruptured ICA in ADPKD including the prevalence and risk factors for aneurysm formation and subarachnoid hemorrhage. We discuss two alternative screening strategies and recommend a practical algorithm that targets those at highest risk for ICA with a positive family history for screening.
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Affiliation(s)
- Ashima Gulati
- Division of Nephrology, Children's National Hospital and Children's National Research Institute, Washington, DC
| | - Terry Watnick
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD.
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Haemmerli J, Morel S, Georges M, Haidar F, Chebib FT, Morita A, Nozaki K, Tominaga T, Bervitskiy AV, Rzaev J, Schaller K, Bijlenga P. Characteristics and Distribution of Intracranial Aneurysms in Patients with Autosomal Dominant Polycystic Kidney Disease Compared with the General Population: A Meta-Analysis. KIDNEY360 2023; 4:e466-e475. [PMID: 36961086 PMCID: PMC10278849 DOI: 10.34067/kid.0000000000000092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/30/2023] [Indexed: 03/25/2023]
Abstract
Key Points IAs location distribution in patients with ADPKD differ from the ones in non-ADPKD patients IAs in patients with ADPKD are more commonly located in the anterior circulation and in large caliber arteries Because of IA multiplicity and singular IA distribution, patients with ADPKD represent a special population who need to be closely followed Background Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic condition associated with intracranial aneurysms (IAs). The associated pathophysiology remains unknown, but an association with wall shear stress is suspected. Cerebral arterial location is the principal factor influencing IA natural history. This study aims to compare IA location-specific distribution between ADPKD and non-ADPKD patients. Methods The ADPKD group comprised data from a systematic review of the literature (2016–2020, N =7) and three cohorts: integrated biomedical informatics for the management of cerebral aneurysms, Novosibirsk, and Unruptured Cerebral Aneurysms Study. The non-ADPKD group was formed from the integrated biomedical informatics for the management of cerebral aneurysms, Unruptured Cerebral Aneurysms Study, International Stroke Genetics Consortium, and the Finnish cohort from the literature. Patients and IAs characteristics were compared between ADPKD and non-ADPKD groups, and a meta-analysis for IA locations was performed. Results A total of 1184 IAs from patients with ADPKD were compared with 21,040 IAs from non-ADPKD patients. In total, 78.6% of patients with ADPKD had hypertension versus 39.2% of non-ADPKD patients. A total of 32.4% of patients with ADPKD were smokers versus 31.5% of non-ADPKD patients. In total, 30.1% of patients with ADPKD had a positive family history for IA versus 15.8% of the non-ADPKD patients. Patients with ADPKD showed a higher rate of IA multiplicity (33.2% versus 23.1%). IAs from patients with ADPKD showed a significant predominance across the internal carotid and middle cerebral arteries. Posterior communicating IAs were more frequently found in the non-ADPKD group. The meta-analysis confirmed a predominance of IAs in the patients with ADPKD across large caliber arteries (odds ratio [95% confidence interval]: internal carotid artery: 1.90 [1.10 to 3.29]; middle cerebral artery: 1.18 [1.02–1.36]). Small diameter arteries, such as the posterior communicating, were observed more in non-ADPKD patients (0.21 [0.11–0.88]). Conclusion This analysis shows that IAs diagnosed in patients with ADPKD are more often localized in large caliber arteries from the anterior circulation in comparison with IAs in non-ADPKD patients. It shows that primary cilia driven wall shear stress vessel remodeling to be more critical in cerebral anterior circulation large caliber arteries.
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Affiliation(s)
- Julien Haemmerli
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sandrine Morel
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Marc Georges
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Fadi Haidar
- Division of Nephrology, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Division of Transplantation, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Fouad T. Chebib
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Anatoliy V. Bervitskiy
- The “Federal Centre of Neurosurgery” of the Ministry of Health of the Russian Federation Novosibirsk, Novosibirsk Region, Novosibirsk, Russia
| | - Jamil Rzaev
- The “Federal Centre of Neurosurgery” of the Ministry of Health of the Russian Federation Novosibirsk, Novosibirsk Region, Novosibirsk, Russia
| | - Karl Schaller
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Philippe Bijlenga
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Walker EYX, Marlais M. Should we screen for intracranial aneurysms in children with autosomal dominant polycystic kidney disease? Pediatr Nephrol 2023; 38:77-85. [PMID: 35106642 PMCID: PMC8807382 DOI: 10.1007/s00467-022-05432-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 01/10/2023]
Abstract
This is an overview of the challenges associated with screening for asymptomatic intracranial aneurysms (ICA) in children with autosomal dominant polycystic kidney disease (ADPKD). ADPKD is the most common inherited kidney disease affecting 1 in 1,000 people. ICAs are an extra-kidney manifestation of ADPKD, and while the exact pathophysiology of how they develop is unknown, we know that they more commonly occur in the adult rather than paediatric population. ICAs can be found in up to 9-11.5% of adults with ADPKD, but ICA rupture remains a rare event in adults with an incidence of 0.04 per 100 patient years. ICA size is an important factor in determining the risk of aneurysm rupture and therefore affects the decision on intervention in asymptomatic adults. For some, unruptured aneurysms cause no clinical significance, but those that rupture can be associated with devastating morbidity and mortality. Therefore, if detected, the treatment for unruptured ICAs is usually endovascular coiling, alongside recognising the importance of preventative interventions such as hypertension management. There are, however, no current guidelines for either adult or paediatric patients with ADPKD supporting regular screening for asymptomatic ICAs, although there is a suggestion for individualised practice, for example, with those with a positive family history. The UK clinical guidelines for ADPKD in children make research recommendations due to a lack of published literature, which in itself indicates that ICA rupture is an extremely rare phenomenon in children.
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Affiliation(s)
- Emma Y. X. Walker
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH UK
| | - Matko Marlais
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK. .,UCL Great Ormond Street Institute for Child Health, London, UK.
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Eisa-Beygi S, Burrows PE, Link BA. Endothelial cilia dysfunction in pathogenesis of hereditary hemorrhagic telangiectasia. Front Cell Dev Biol 2022; 10:1037453. [PMID: 36438574 PMCID: PMC9686338 DOI: 10.3389/fcell.2022.1037453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/21/2022] [Indexed: 09/09/2023] Open
Abstract
Hereditary hemorrhagic telangiectasia (HHT) is associated with defective capillary network, leading to dilated superficial vessels and arteriovenous malformations (AVMs) in which arteries connect directly to the veins. Loss or haploinsufficiency of components of TGF-β signaling, ALK1, ENG, SMAD4, and BMP9, have been implicated in the pathogenesis AVMs. Emerging evidence suggests that the inability of endothelial cells to detect, transduce and respond to blood flow, during early development, is an underpinning of AVM pathogenesis. Therefore, components of endothelial flow detection may be instrumental in potentiating TGF-β signaling in perfused blood vessels. Here, we argue that endothelial cilium, a microtubule-based and flow-sensitive organelle, serves as a signaling hub by coupling early flow detection with potentiation of the canonical TGF-β signaling in nascent endothelial cells. Emerging evidence from animal models suggest a role for primary cilia in mediating vascular development. We reason, on recent observations, that endothelial cilia are crucial for vascular development and that embryonic loss of endothelial cilia will curtail TGF-β signaling, leading to associated defects in arteriovenous development and impaired vascular stability. Loss or dysfunction of endothelial primary cilia may be implicated in the genesis of AVMs due, in part, to inhibition of ALK1/SMAD4 signaling. We speculate that AVMs constitute part of the increasing spectrum of ciliopathy-associated vascular defects.
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Affiliation(s)
- Shahram Eisa-Beygi
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Patricia E. Burrows
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Brian A. Link
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI, United States
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Okuda KS, Hogan BM. Endothelial Cell Dynamics in Vascular Development: Insights From Live-Imaging in Zebrafish. Front Physiol 2020; 11:842. [PMID: 32792978 PMCID: PMC7387577 DOI: 10.3389/fphys.2020.00842] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/23/2020] [Indexed: 01/16/2023] Open
Abstract
The formation of the vertebrate vasculature involves the acquisition of endothelial cell identities, sprouting, migration, remodeling and maturation of functional vessel networks. To understand the cellular and molecular processes that drive vascular development, live-imaging of dynamic cellular events in the zebrafish embryo have proven highly informative. This review focusses on recent advances, new tools and new insights from imaging studies in vascular cell biology using zebrafish as a model system.
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Affiliation(s)
- Kazuhide S Okuda
- Organogenesis and Cancer Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Benjamin M Hogan
- Organogenesis and Cancer Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.,Department of Anatomy and Neuroscience, University of Melbourne, Melbourne, VIC, Australia
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Wilkinson DA, Heung M, Deol A, Chaudhary N, Gemmete JJ, Thompson BG, Pandey AS. Cerebral Aneurysms in Autosomal Dominant Polycystic Kidney Disease: A Comparison of Management Approaches. Neurosurgery 2020; 84:E352-E361. [PMID: 30060240 DOI: 10.1093/neuros/nyy336] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 06/23/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) is a risk factor for formation of intracranial aneurysms (IAs), though the ideal screening and treatment strategies in this population are unclear. OBJECTIVE To report outcomes of observation, open surgical, or endovascular management of ruptured and unruptured aneurysms in patients with ADPKD. METHODS We performed a retrospective analysis of all patients with ADPKD and IAs at a single center from 2000 to 2016. RESULTS Forty-five patients with ADPKD harboring 71 aneurysms were identified, including 11 patients with subarachnoid hemorrhage (SAH). Of 22 aneurysms managed with observation, none ruptured in 136 yr of clinical follow-up. Thirty-five aneurysms were treated with open surgery and 14 with an endovascular approach. Among treated aneurysms, poor neurologic outcome (modified Rankin scale >2) was seen only in patients presenting with SAH (17% SAH vs 0% elective, P = .06). Acute kidney injury (AKI) was also significantly associated with SAH presentation (22% SAH vs 0% elective, P = .05). Neither procedural complications nor AKI were associated with treatment modality. Among 175 yr of radiographic follow-up in patients with known IAs, 8 de novo aneurysms were found, including 3 that were treated. Of 11 patients with SAH, 7 ruptured in the setting of previously known ADPKD, including 2 with prior angiographic screening and 5 without screening. CONCLUSION Poor outcomes occurred only with ruptured presentation but were equivalent between treatment modalities. Screening is performed only selectively, and 64% (7 of 11) of patients presenting with SAH had previously known ADPKD.
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Affiliation(s)
| | - Michael Heung
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Amrit Deol
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Neeraj Chaudhary
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Joseph J Gemmete
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | | | - Aditya S Pandey
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
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Nobakht N, Hanna RM, Al-Baghdadi M, Ameen KM, Arman F, Nobahkt E, Kamgar M, Rastogi A. Advances in Autosomal Dominant Polycystic Kidney Disease: A Clinical Review. Kidney Med 2020; 2:196-208. [PMID: 32734239 PMCID: PMC7380379 DOI: 10.1016/j.xkme.2019.11.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Polycystic kidney disease (PKD) is a multiorgan disorder resulting in fluid-filled cyst formation in the kidneys and other systems. The replacement of kidney parenchyma with an ever-increasing volume of cysts eventually leads to kidney failure. Recently, increased understanding of the pathophysiology of PKD and genetic advances have led to new approaches of treatment targeting physiologic pathways, which has been proven to slow the progression of certain types of the disease. We review the pathophysiologic patterns and recent advances in the clinical pharmacotherapy of autosomal dominant PKD. A multipronged approach with pharmacologic and nonpharmacologic treatments can be successfully used to slow down the rate of progression of autosomal dominant PKD to kidney failure.
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Affiliation(s)
- Niloofar Nobakht
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Ramy M. Hanna
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Division of Nephrology, Department of Medicine, University of California Irvine, Orange, CA
| | - Maha Al-Baghdadi
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Department of Medicine, University of Alabama Birmingham Huntsville Regional Campus, Huntsville, AL
| | - Khalid Mohammed Ameen
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Farid Arman
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Department of Medicine, University of Pennsylvania Medical Center, Philadelphia, PA
| | - Ehsan Nobahkt
- Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University, Washington, DC
| | - Mohammad Kamgar
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Anjay Rastogi
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Subarachnoid Hemorrhage in Hospitalized Renal Transplant Recipients with Autosomal Dominant Polycystic Kidney Disease: A Nationwide Analysis. J Clin Med 2019; 8:jcm8040524. [PMID: 30999564 PMCID: PMC6517948 DOI: 10.3390/jcm8040524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/12/2019] [Accepted: 04/15/2019] [Indexed: 12/21/2022] Open
Abstract
Background: This study aimed to evaluate the hospitalization rates for subarachnoid hemorrhage (SAH) among renal transplant patients with adult polycystic kidney disease (ADPKD) and its outcomes, when compared to non-ADPKD renal transplant patients. Methods: The 2005–2014 National Inpatient Sample databases were used to identify all hospitalized renal transplant patients. The inpatient prevalence of SAH as a discharge diagnosis between ADPKD and non-ADPKD renal transplant patients was compared. Among SAH patients, the in-hospital mortality, use of aneurysm clipping, hospital length of stay, total hospitalization cost and charges between ADPKD and non-ADPKD patients were compared, adjusting for potential confounders. Results: The inpatient prevalence of SAH in ADPKD was 3.8/1000 admissions, compared to 0.9/1000 admissions in non-ADPKD patients (p < 0.01). Of 833 renal transplant patients with a diagnosis of SAH, 30 had ADPKD. Five (17%) ADPKD renal patients with SAH died in hospitals compared to 188 (23.4%) non-ADPKD renal patients (p = 0.70). In adjusted analysis, there was no statistically significant difference in mortality, use of aneurysm clipping, hospital length of stay, or total hospitalization costs and charges between ADPKD and non-ADPKD patients with SAH. Conclusion: Renal transplant patients with ADPKD had a 4-fold higher inpatient prevalence of SAH than those without ADPKD. Further studies are needed to compare the incidence of overall admissions in ADPKD and non-ADPKD patients. When renal transplant patients developed SAH, inpatient mortality rates were high regardless of ADPKD status. The outcomes, as well as resource utilization, were comparable between the two groups.
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Malhotra A, Wu X, Matouk CC, Forman HP, Gandhi D, Sanelli P. MR Angiography Screening and Surveillance for Intracranial Aneurysms in Autosomal Dominant Polycystic Kidney Disease: A Cost-effectiveness Analysis. Radiology 2019; 291:400-408. [PMID: 30777807 DOI: 10.1148/radiol.2019181399] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Autosomal dominant polycystic kidney disease (ADPKD) affects one in 400 to one in 1000 individuals; 10%-11% of these individuals have intracranial aneurysms. The frequency and patterns of screening for intracranial aneurysms have not been defined. Purpose To evaluate different MR angiography screening and surveillance strategies for unruptured intracranial aneurysms in patients with ADPKD. Materials and Methods A Markov decision-analytic model was constructed accounting for both costs and outcomes from a societal perspective. Five different management strategies were evaluated: (a) no screening for intracranial aneurysm, (b) one-time screening with annual MR angiography follow-up in patients with intracranial aneurysm, (c) MR angiographic screening every 5 years with endovascular treatment in detected intracranial aneurysm, (d) MR angiography screening every 5 years with annual MR angiography follow-up in patients with intracranial aneurysm, and (e) MR angiography screening every 5 years with biennial follow-up in patients with intracranial aneurysm. One-way, two-way, and probabilistic sensitivity analyses were performed. Results Base case calculation shows that MR angiography screening of patients with ADPKD every 5 years and annual follow-up in patients with detected intracranial aneurysm is the optimal strategy (cost, $19 839; utility, 25.86 quality-adjusted life years), which becomes more favorable as the life expectancy increases beyond 6 years. The conclusion remains robust in probabilistic and one-way sensitivity analyses. When the prevalence of intracranial aneurysms is greater than 10%, annual rupture risk is 0.35%-2.5%, and the rate of de novo aneurysm detection is lower than 1.8%, MR angiography screening every 5 years with annual MR angiography follow-up is the favorable strategy. Conclusion Screening for intracranial aneurysms with MR angiography in patients with autosomal dominant polycystic kidney disease is cost-effective. Repeat screening every 5 years should be performed after a negative initial study. Annual surveillance MR angiography is optimal in patients with detected, incidental intracranial aneurysm, and treatment may be considered in patients with growing, high-risk aneurysms. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Anzai in this issue.
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Affiliation(s)
- Ajay Malhotra
- From the Departments of Radiology and Biomedical Imaging (A.M., X.W., C.C.M., H.P.F.), Neurosurgery (C.C.M.), Economics (H.P.F.), Management (H.P.F.), and Public Health (H.P.F.), Yale School of Medicine, 333 Cedar St, Box 208042, Tompkins East 2, New Haven, CT 06520-8042; Department of Radiology, University of Maryland School of Medicine, Baltimore, Md (D.G.); and Department of Radiology, Northwell Health, Manhasset, NY (P.S.)
| | - Xiao Wu
- From the Departments of Radiology and Biomedical Imaging (A.M., X.W., C.C.M., H.P.F.), Neurosurgery (C.C.M.), Economics (H.P.F.), Management (H.P.F.), and Public Health (H.P.F.), Yale School of Medicine, 333 Cedar St, Box 208042, Tompkins East 2, New Haven, CT 06520-8042; Department of Radiology, University of Maryland School of Medicine, Baltimore, Md (D.G.); and Department of Radiology, Northwell Health, Manhasset, NY (P.S.)
| | - Charles C Matouk
- From the Departments of Radiology and Biomedical Imaging (A.M., X.W., C.C.M., H.P.F.), Neurosurgery (C.C.M.), Economics (H.P.F.), Management (H.P.F.), and Public Health (H.P.F.), Yale School of Medicine, 333 Cedar St, Box 208042, Tompkins East 2, New Haven, CT 06520-8042; Department of Radiology, University of Maryland School of Medicine, Baltimore, Md (D.G.); and Department of Radiology, Northwell Health, Manhasset, NY (P.S.)
| | - Howard P Forman
- From the Departments of Radiology and Biomedical Imaging (A.M., X.W., C.C.M., H.P.F.), Neurosurgery (C.C.M.), Economics (H.P.F.), Management (H.P.F.), and Public Health (H.P.F.), Yale School of Medicine, 333 Cedar St, Box 208042, Tompkins East 2, New Haven, CT 06520-8042; Department of Radiology, University of Maryland School of Medicine, Baltimore, Md (D.G.); and Department of Radiology, Northwell Health, Manhasset, NY (P.S.)
| | - Dheeraj Gandhi
- From the Departments of Radiology and Biomedical Imaging (A.M., X.W., C.C.M., H.P.F.), Neurosurgery (C.C.M.), Economics (H.P.F.), Management (H.P.F.), and Public Health (H.P.F.), Yale School of Medicine, 333 Cedar St, Box 208042, Tompkins East 2, New Haven, CT 06520-8042; Department of Radiology, University of Maryland School of Medicine, Baltimore, Md (D.G.); and Department of Radiology, Northwell Health, Manhasset, NY (P.S.)
| | - Pina Sanelli
- From the Departments of Radiology and Biomedical Imaging (A.M., X.W., C.C.M., H.P.F.), Neurosurgery (C.C.M.), Economics (H.P.F.), Management (H.P.F.), and Public Health (H.P.F.), Yale School of Medicine, 333 Cedar St, Box 208042, Tompkins East 2, New Haven, CT 06520-8042; Department of Radiology, University of Maryland School of Medicine, Baltimore, Md (D.G.); and Department of Radiology, Northwell Health, Manhasset, NY (P.S.)
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10
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AlNuaimi D, AlKetbi R, AlFalahi A, AlBastaki U, Pierre-Jerome C. Ruptured Berry Aneurysm as the initial presentation of Polycystic Kidney Disease: A case report and review of literature. J Radiol Case Rep 2019; 12:1-8. [PMID: 30651918 DOI: 10.3941/jrcr.v12i9.3448] [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] [Indexed: 11/15/2022] Open
Abstract
Intra-cranial saccular aneurysms, also known as Berry aneurysms, have a well-known association with autosomal dominant polycystic kidney disease (ADPKD). Aneurysmal rupture can be the initial presentation of the disease. ADPKD has two types of gene mutations: PKD1 and PKD2. The latter one is of a milder form presenting later in life. Imaging plays a crucial role in the diagnosis and assessment in order to provide adequate management of these patients however, there are no official standardized guidelines established for screening of these intracranial aneurysms.
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MESH Headings
- Aneurysm, Ruptured/complications
- Aneurysm, Ruptured/diagnostic imaging
- Aneurysm, Ruptured/etiology
- Aneurysm, Ruptured/surgery
- Cerebral Angiography
- Contrast Media
- Diagnosis, Differential
- Embolization, Therapeutic
- Endovascular Procedures
- Humans
- Intracranial Aneurysm/complications
- Intracranial Aneurysm/diagnostic imaging
- Intracranial Aneurysm/etiology
- Intracranial Aneurysm/surgery
- Male
- Middle Aged
- Mutation
- Polycystic Kidney, Autosomal Dominant/complications
- Polycystic Kidney, Autosomal Dominant/diagnostic imaging
- Polycystic Kidney, Autosomal Dominant/genetics
- Subarachnoid Hemorrhage/diagnostic imaging
- Subarachnoid Hemorrhage/etiology
- Subarachnoid Hemorrhage/surgery
- TRPP Cation Channels/genetics
- Tomography, X-Ray Computed/methods
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Affiliation(s)
- Dana AlNuaimi
- Department of Radiology, Rashid hospital, Dubai, UAE
| | - Reem AlKetbi
- Department of Radiology, Rashid hospital, Dubai, UAE
| | - Afra AlFalahi
- Department of Radiology, Rashid hospital, Dubai, UAE
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11
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Eisa-Beygi S, Benslimane FM, El-Rass S, Prabhudesai S, Abdelrasool MKA, Simpson PM, Yalcin HC, Burrows PE, Ramchandran R. Characterization of Endothelial Cilia Distribution During Cerebral-Vascular Development in Zebrafish ( Danio rerio). Arterioscler Thromb Vasc Biol 2018; 38:2806-2818. [PMID: 30571172 PMCID: PMC6309420 DOI: 10.1161/atvbaha.118.311231] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective- Endothelial cells (ECs) sense and respond to flow-induced mechanical stress, in part, via microtubule-based projections called primary cilia. However, many critical steps during vascular morphogenesis occur independent of flow. The involvement of cilia in regulating these stages of cranial vascular morphogenesis is poorly understood because cilia have not been visualized in primary head vessels. The objective of this study was to investigate involvement of cilia in regulating the early stages of cranial vascular morphogenesis. Approach and Results- Using high-resolution imaging of the Tg(kdrl:mCherry-CAAX) y171 ;(bactin::Arl13b:GFP) zebrafish line, we showed that cilia are enriched in the earliest formed cranial vessels that assemble via vasculogenesis and in angiogenic hindbrain capillaries. Cilia were more prevalent around the boundaries of putative intravascular spaces in primary and angiogenic vessels. Loss of cardiac contractility and blood flow, because of knockdown of cardiac troponin T type 2a ( tnnt2a) expression, did not affect the distribution of cilia in primary head vasculature. In later stages of development, cilia were detected in retinal vasculature, areas of high curvature, vessel bifurcation points, and during vessel anastomosis. Loss of genes crucial for cilia biogenesis ( ift172 and ift81) induced intracerebral hemorrhages in an EC-autonomous manner. Exposure to high shear stress induced premature cilia disassembly in brain ECs and was associated with intracerebral hemorrhages. Conclusions- Our study suggests a functional role for cilia in brain ECs, which is associated with the emergence and remodeling of the primary cranial vasculature. This cilia function is flow-independent, and cilia in ECs are required for cerebral-vascular stability.
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Affiliation(s)
- Shahram Eisa-Beygi
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA 53226
| | | | - Suzan El-Rass
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | - Patricia E. Burrows
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA 53226
| | - Ramani Ramchandran
- Department of Pediatrics, Division of Neonatology
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee WI 53226
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12
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Wilkinson DA, Burke JF, Nadel JL, Maher CO, Chaudhary N, Gemmete JJ, Heung M, Thompson BG, Pandey AS. A Large Database Analysis of Rates of Aneurysm Screening, Elective Treatment, and Subarachnoid Hemorrhage in Patients With Polycystic Kidney Disease. Neurosurgery 2018; 85:E266-E274. [DOI: 10.1093/neuros/nyy551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 10/23/2018] [Indexed: 01/20/2023] Open
Abstract
Abstract
BACKGROUND
Professional societies provide conflicting guidelines on aneurysm screening in patients with polycystic kidney disease (PKD), and the rate of subarachnoid hemorrhage (SAH) is poorly understood.
OBJECTIVE
To evaluate screening, elective treatment, and the rate of SAH in patients with known PKD.
METHODS
We examined longitudinally linked claims data from a large private insurer, identifying screening, elective treatment, aneurysmal subarachnoid hemorrhage (aSAH) and secured aneurysmal SAH (saSAH) in 2004 to 2014 amongst patients with known PKD.
RESULTS
We identified 20 704 patients diagnosed with PKD. Among patients with an initial PKD diagnosis, 51/446 (15.9%) underwent angiographic screening within 2 yr. Forty aneurysms were treated electively in 48 868 yr at risk in PKD patients (82/100K patient yr, 95% confidence interval [CI] 60-112) vs 24 elective treatments in 349 861 yr at risk in age- and sex-matched controls (7/100K patient yr, 95% CI 5-10, P < .0001). Eleven admissions for aSAH were identified in PKD patients (23/100K patient yr, 95% CI 13-41) and 22 admissions for aSAH in controls (6/100K patient yr, 95% CI 4-10), giving an incidence rate ratio (IRR) of 3.6 (95% CI 1.7-7.4, P < .0001) and a comorbidity-adjusted IRR of 3.1 (95% CI 1.4-6.9). The incidence of saSAH was proportionally even higher in PKD patients than controls, 16 vs 2/100K patient years, IRR 9.5 (95% CI 3.3-27.5, P < .0001).
CONCLUSION
Screening in PKD is performed only selectively, though resulting rates of elective treatment were over 10× those of controls. Despite screening and treatment, the rate of SAH remains significantly elevated over that of controls.
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Affiliation(s)
| | - James F Burke
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Jeffrey L Nadel
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Cormac O Maher
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Neeraj Chaudhary
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Joseph J Gemmete
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Michael Heung
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | | | - Aditya S Pandey
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
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13
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Demartini Z, Galdino J, Koppe GL, Bignelli AT, Francisco AN, Gatto LAM. Endovascular treatment of cerebral aneurysm after renal transplantation in polycystic kidney disease. Interv Neuroradiol 2018; 24:284-287. [PMID: 29444616 PMCID: PMC5967191 DOI: 10.1177/1591019918758037] [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: 11/26/2017] [Accepted: 01/16/2018] [Indexed: 11/16/2022] Open
Abstract
Background Patients with polycystic kidney disease have a higher prevalence of intracranial aneurysms and may progress to renal failure requiring transplantation. The endovascular treatment of intracranial aneurysms may improve prognosis, since rupture often causes premature death or disability, but the nephrotoxicity risk associated with contrast medium must be always considered in cases of renal impairment. Methods A 55-year-old female patient with polycystic kidney disease and grafted kidney associated with anterior communicant artery aneurysm was successfully treated by embolization. Results The renal function remained normal after the procedure. To the authors' knowledge, this is the first case of endovascular treatment of brain aneurysm in a transplanted patient reported in the medical literature. Conclusions The endovascular procedure in renal transplant patients is feasible and can be considered to treat this population. Further studies and cases are needed to confirm its safety.
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Affiliation(s)
- Zeferino Demartini
- Department of Neurosurgery, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - Jennyfer Galdino
- Department of Neurosurgery, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - Gelson L Koppe
- Department of Neurosurgery, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - Alexandre T Bignelli
- Department of Internal Medicine, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - Alexandre N Francisco
- Department of Neurosurgery, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - Luana AM Gatto
- Department of Neurosurgery, Pontifical Catholic University of Paraná, Curitiba, Brazil
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14
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Kocyigit I, Eroglu E, Gungor O. Clinical problems in hemodialysis patients with autosomal dominant polycystic kidney disease. Semin Dial 2018; 31:268-277. [DOI: 10.1111/sdi.12696] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Ismail Kocyigit
- Department of Nephrology; Erciyes University Medical Faculty; Kayseri Turkey
| | - Eray Eroglu
- Department of Nephrology; Erciyes University Medical Faculty; Kayseri Turkey
| | - Ozkan Gungor
- Department of Nephrology; Sutcu Imam University Medical Faculty; Kahramanmaras Turkey
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15
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Flahault A, Trystram D, Nataf F, Fouchard M, Knebelmann B, Grünfeld JP, Joly D. Screening for intracranial aneurysms in autosomal dominant polycystic kidney disease is cost-effective. Kidney Int 2017; 93:716-726. [PMID: 29061331 DOI: 10.1016/j.kint.2017.08.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 08/16/2017] [Accepted: 08/24/2017] [Indexed: 12/16/2022]
Abstract
Intracranial aneurysm rupture is a dramatic complication of autosomal dominant polycystic kidney disease (ADPKD). It remains uncertain whether screening should be widespread or only target patients with risk factors (personal or familial history of intracranial aneurysm), with an at-risk profession, or those who request screening. We evaluated this in a single-center cohort of 495 consecutive patients with ADPKD submitted to targeted intracranial aneurysm screening. Cerebral magnetic resonance angiography was proposed to 110 patients with a familial history of intracranial aneurysm (group 1), whereas it was not our intention to propose it to 385 patients without familial risk (group 2). Magnetic resonance angiography results, intracranial aneurysm prophylactic repair, rupture events, and cost-effectiveness of intracranial aneurysm screening strategies were retrospectively analyzed. During a median follow up of 5.9 years, five non-fatal intracranial aneurysm ruptures occurred (incidence rate 2.0 (0.87-4.6)/1000 patients-year). In group 1, 90% of patients were screened and an intracranial aneurysm was detected in 14, treated preventively in five, and ruptured in one patient despite surveillance. In group 2, 21% of patients were screened and an intracranial aneurysm was detected in five, and treated preventively in one. Intracranial aneurysm rupture occurred in four patients in group 2. Systematic screening was deemed cost-effective and provides a gain of 0.68 quality-adjusted life years compared to targeted screening. Thus, the intracranial aneurysm rupture rate is high in ADPKD despite targeted screening, and involves mostly patients without familial risk factors. Hence, cost-utility analysis suggests that intracranial aneurysm screening could be proposed to all ADPKD patients.
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Affiliation(s)
- Adrien Flahault
- Université Paris-Descartes, Faculté de Médecine, AP-HP, Service de Néphrologie, Hôpital Necker-Enfants Malades, Paris, France; College de France, Laboratory of Central Neuropeptides in the Regulation of Body Fluid Homeostasis and Cardiovascular Functions, CIRB, INSERM U1050, Paris, France
| | - Denis Trystram
- Université Paris-Descartes, INSERM UMR 894, Service de Neuroradiologie, Centre Hospitalier Sainte-Anne, Paris, France
| | - François Nataf
- Université Paris-Descartes, INSERM UMR 894, Service de Neurochirurgie, Centre Hospitalier Sainte-Anne, Paris, France
| | - Marie Fouchard
- Université Paris-Descartes, Faculté de Médecine, AP-HP, Service de Néphrologie, Hôpital Necker-Enfants Malades, Paris, France
| | - Bertrand Knebelmann
- Université Paris-Descartes, Faculté de Médecine, AP-HP, Service de Néphrologie, Hôpital Necker-Enfants Malades, Paris, France
| | - Jean-Pierre Grünfeld
- Université Paris-Descartes, Faculté de Médecine, AP-HP, Service de Néphrologie, Hôpital Necker-Enfants Malades, Paris, France
| | - Dominique Joly
- Université Paris-Descartes, Faculté de Médecine, AP-HP, Service de Néphrologie, Hôpital Necker-Enfants Malades, Paris, France; Investigation Network Initiative, Cardiovascular and Renal Clinical Trialists, Paris, France.
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16
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Flahault A, Knebelmann B, Nataf F, Trystram D, Grünfeld JP, Joly D. [Screening and management of intracranial aneurisms in patients with autosomal dominant polycystic kidney disease]. Nephrol Ther 2017; 13 Suppl 1:S147-S153. [PMID: 28577737 DOI: 10.1016/j.nephro.2017.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 01/21/2017] [Indexed: 12/17/2022]
Abstract
Autosomal dominant polycystic kidney disease is the most frequent hereditary kidney disease. Intracranial aneurysm prevalence in this population is four to five times higher than the prevalence in the general population. The most frequent complication of intracranial aneurysms is rupture with subarachnoidal hemorrhage, which is associated with a high morbidity and mortality. The only identified risk factor for unruptured intracranial aneurysm is a family history of intracranial aneurysm. However, most cases of aneurysm rupture occur without any family history of intracranial aneurysm. Magnetic resonance angiography without contrast medium injection facilitates screening, and progress have been made in preventive (endovascular or neurosurgical) treatment of intracranial aneurysm. Recommendations have recently been published concerning intracranial aneurysm screening, and suggest screening patients with autosomal dominant polycystic kidney disease and a family history of intracranial aneurysm, those who have an at-risk activity and those who request screening despite adequate information. Conflicting opinions exist, however, in the literature. Furthermore, a study of practice was conducted among French-speaking nephrologists in Europe and showed that approximately a third of the participants were in favor of systematic screening for intracranial aneurysm in all patients with autosomal dominant polycystic kidney disease. Beyond intracranial aneurysm prevalence, it is necessary to better define rupture rates in the autosomal dominant polycystic kidney disease population, with and without familial history of intracranial aneurysm. This would allow optimizing intracranial aneurysm screening practices in autosomal dominant polycystic kidney disease.
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Affiliation(s)
- Adrien Flahault
- Faculté de médecine, université Paris-Descartes, 149, rue de Sèvres, 75015 Paris, France; Service de néphrologie, hôpital Necker-enfants malades, 149, rue de Sèvres, 75015 Paris, France; Laboratory of Central Neuropeptides in the Regulation of Body Fluid Homeostasis and Cardiovascular Functions, Center of Interdisciplinary Research in Biology (CIRB), collège de France, 11, place Marcelin-Berthelot, 75231 Paris cedex 05, France; Inserm U1050, 11, place Marcelin-Berthelot, 75231 Paris cedex 05, France
| | - Bertrand Knebelmann
- Faculté de médecine, université Paris-Descartes, 149, rue de Sèvres, 75015 Paris, France; Service de néphrologie, hôpital Necker-enfants malades, 149, rue de Sèvres, 75015 Paris, France
| | - François Nataf
- Faculté de médecine, université Paris-Descartes, 149, rue de Sèvres, 75015 Paris, France; Inserm UMR 894, 2, ter rue d'Alésia, 75014 Paris, France; Service de neurochirurgie, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75674 Paris cedex 14, France
| | - Denis Trystram
- Faculté de médecine, université Paris-Descartes, 149, rue de Sèvres, 75015 Paris, France; Inserm UMR 894, 2, ter rue d'Alésia, 75014 Paris, France; Service de neuroradiologie, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75674 Paris cedex 14, France
| | - Jean-Pierre Grünfeld
- Faculté de médecine, université Paris-Descartes, 149, rue de Sèvres, 75015 Paris, France; Service de néphrologie, hôpital Necker-enfants malades, 149, rue de Sèvres, 75015 Paris, France
| | - Dominique Joly
- Faculté de médecine, université Paris-Descartes, 149, rue de Sèvres, 75015 Paris, France; Service de néphrologie, hôpital Necker-enfants malades, 149, rue de Sèvres, 75015 Paris, France.
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17
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Intracranial aneurysms in patients with autosomal dominant polycystic kidney disease: prevalence, risk of rupture, and management. A systematic review. Acta Neurochir (Wien) 2017; 159:811-821. [PMID: 28283868 DOI: 10.1007/s00701-017-3142-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 02/28/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disorder associated with high incidences of intracranial aneurysms. We performed a systematic review with the purpose of clarifying the prevalence, risk of rupture, and appropriate management of intracranial aneurysms in the ADPKD population. METHOD PRISMA guidelines were followed. We conducted a comprehensive literature search of three databases (PubMed, Ovid MEDLINE, and Ovid EMBASE) on all series reporting ADPKD patients with intracranial aneurysms. RESULTS Our systematic review included 16 articles with a total of 563 patients with ADPKD and intracranial aneurysms. The prevalence of unruptured aneurysms was 11.5% (95% CI = 10.1-13%), whereas 1.9% (95% CI = 1.3-2.6%) of aneurysms were ruptured. Hypertension was present in 79.3% of patients with ADPKD and renal impairment in 65%. The mean size of ruptured aneurysms was slightly higher than unruptured (6 mm vs. 4.4 mm). The most common locations of unruptured and ruptured aneurysms were the ICA (40.5%) and MCA (45%), respectively. Asymptomatic patients studied with four-vessel angiography experienced 25% transient complications. Overall, 74% unruptured aneurysms were surgically treated with lower complication rates compared to endovascular treatment (11% vs. 27.7%). Among conservatively treated aneurysms, 2.9% ruptured at follow-up (rupture rate 0.4%/patient-year). Finally, the growth rate was 0.4% per patient-year, and the incidence of de novo aneurysm formation was 1.4% per patient-year. CONCLUSIONS The prevalence of unruptured intracranial aneurysms in the ADPKD population is approximately 11%. Given the non-negligible rate of procedural complications, the management of these patients must be cautious and individualised. The rupture rate appears comparable to that of the general population. On the other hand, the 1.4% rate per patient-year of de novo aneurysms is non-negligible. These findings should be considered when counselling ADPKD patients regarding the appropriate management of intracranial aneurysms.
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18
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Jung SC, Kim CH, Ahn JH, Cho YD, Kang HS, Cho WS, Kim JE, Ahn C, Han MH. Endovascular Treatment of Intracranial Aneurysms in Patients With Autosomal Dominant Polycystic Kidney Disease. Neurosurgery 2016; 78:429-35; discussion 435. [PMID: 26492429 DOI: 10.1227/neu.0000000000001068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Little is known about the outcome of endovascular treatment for intracranial aneurysms in patients with autosomal dominant polycystic kidney disease (ADPKD). OBJECTIVE To present clinical outcomes in terms of safety, effectiveness, and renal functions to assess contrast-induced nephropathy in endovascular coil embolization for intracranial aneurysms in ADPKD patients. METHODS Nineteen ADPKD patients (female:male, 15:4; mean age, 49.8 years; range, 20-67 years) had 26 aneurysms (mean size, 5.86 mm; range, 2.5-11.6 mm) and underwent 22 endovascular treatment sessions from 2001 to 2013. Four patients presented with ruptured aneurysms. Periprocedural complications, clinical outcomes with modified Rankin Scale scores, laboratory findings, and chronic kidney disease (CKD) stage before and after treatment were documented. Acute renal impairment was defined as serum creatinine (Cr) elevation by ≥ 0.5 mg/dL or 25% relative to baseline. RESULTS Symptomatic periprocedural complications developed after 1 endovascular procedure (1 of 22, 4.5%), and good clinical outcomes (modified Rankin Scale scores, 0-1) were achieved in 90% of patients (17 of 19). Overall, acute renal impairment occurred in 9.1% of treatment sessions (2 of 22). Acute renal impairment developed in 25% of high-risk patients (baseline Cr > 2.0 mg/dL) and 33.3% of baseline CKD stage 5 sessions but in none of the low-risk patients (baseline Cr ≤ 2.0 mg/dL) and in no CKD stage 1 to 4 sessions. CONCLUSION With appropriate management, coil embolization may be safe and effective for intracranial aneurysms in ADPKD. There is a concern about contrast-induced nephropathy in patients with CKD stage 5 or high serum Cr level (>2.0 mg/dL).
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Affiliation(s)
- Seung Chai Jung
- *Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea; ‡Department of Neurology, Myongji Hospital, Goyang, Republic of Korea; §Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea; ¶Departments of Radiology, ‖Neurosurgery, and #Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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19
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Messa P, Alfieri CM, Montanari E, Ferraresso M, Cerutti R. ADPKD: clinical issues before and after renal transplantation. J Nephrol 2016; 29:755-763. [DOI: 10.1007/s40620-016-0349-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 08/29/2016] [Indexed: 12/17/2022]
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20
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Hao S, Feng J, Park DM, Gao Z. Glioma in Patients with Autosomal-Dominant Polycystic Kidney Disease. World Neurosurg 2016; 98:885.e1-885.e5. [PMID: 27565461 DOI: 10.1016/j.wneu.2016.08.045] [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: 04/05/2016] [Revised: 08/09/2016] [Accepted: 08/10/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Autosomal-dominant polycystic kidney disease (ADPKD) is an inherited systemic condition with a predominant feature of cyst formation in both kidneys. An association with intracranial glioma has not been described previously in ADPKD. CASE DESCRIPTION We report 2 cases of glioma in patients with ADPKD. One patient had a cystic lesion with contrast enhancement in the right temporal lobe as revealed by magnetic resonance imaging and an aneurysm in left sylvian fissure confirmed by computed tomography angiography. Subsequent histopathologic analysis of the resected enhancing lesion confirmed the diagnosis of glioblastoma (World Health Organization grade IV). The second patient was found to harbor a solid lesion in the right parietal lobe. This lesion also proved to be an astrocytoma (World Health Organization grade II). CONCLUSIONS These 2 independent cases of glioma suggest an unusual clinical manifestation of ADPKD. The potential association between ADPKD and glioma pathogenesis should be further explored.
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Affiliation(s)
- Shuyu Hao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Neuro-Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Jie Feng
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Deric M Park
- Neuro-Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Zhixian Gao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China.
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Rangan GK, Alexander SI, Campbell KL, Dexter MAJ, Lee VW, Lopez-Vargas P, Mai J, Mallett A, Patel C, Patel M, Tchan MC, Tong A, Tunnicliffe DJ, Vladica P, Savige J. KHA-CARI guideline recommendations for the diagnosis and management of autosomal dominant polycystic kidney disease. Nephrology (Carlton) 2016; 21:705-16. [DOI: 10.1111/nep.12658] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 10/20/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Gopala K Rangan
- Centre for Transplant and Renal Research, Westmead Millennium Institute; The University of Sydney; Sydney New South Wales Australia
- Department of Renal Medicine; Westmead Hospital, Western Sydney Local Health District; Sydney New South Wales Australia
| | - Stephen I Alexander
- Centre for Kidney Research; The Children's Hospital at Westmead; Sydney New South Wales Australia
- Department of Nephrology; The Children's Hospital at Westmead; Sydney New South Wales Australia
| | - Katrina L Campbell
- Department of Nutrition and Dietetics; The Princess Alexandra Hospital; Brisbane Queensland Australia
- Faculty of Health Sciences and Medicine; Bond University; Brisbane Queensland Australia
| | - Mark AJ Dexter
- Department of Neurological Surgery; Westmead Private Hospital; Sydney New South Wales Australia
| | - Vincent W Lee
- Centre for Transplant and Renal Research, Westmead Millennium Institute; The University of Sydney; Sydney New South Wales Australia
- Department of Renal Medicine; Westmead Hospital, Western Sydney Local Health District; Sydney New South Wales Australia
| | - Pamela Lopez-Vargas
- Centre for Kidney Research; The Children's Hospital at Westmead; Sydney New South Wales Australia
- Sydney School of Public Health; The University of Sydney; Sydney New South Wales Australia
| | - Jun Mai
- Department of Nephrology; Liverpool Hospital and Bankstown Hospital; Sydney New South Wales Australia
| | - Andrew Mallett
- Kidney Health Service and Conjoint Kidney Research Laboratory; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- Centre for Kidney Disease Research, Centre for Chronic Disease and CKD, QLD, School of Medicine; The University of Queensland; Brisbane Queensland Australia
- Centre for Rare Diseases Research, Institute for Molecular Bioscience; The University of Queensland; Brisbane Queensland Australia
| | - Chirag Patel
- Genetic Health Queensland; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Manish Patel
- Discipline of Surgery, Western Clinical School; The University of Sydney; Sydney New South Wales Australia
- Department of Urology; Westmead Hospital; Sydney New South Wales Australia
| | - Michel C Tchan
- Department of Genetic Medicine; Westmead Hospital; Sydney New South Wales Australia
- Sydney Medical School; The University of Sydney; Sydney New South Wales Australia
| | - Allison Tong
- Centre for Kidney Research; The Children's Hospital at Westmead; Sydney New South Wales Australia
- Sydney School of Public Health; The University of Sydney; Sydney New South Wales Australia
| | - David J Tunnicliffe
- Centre for Kidney Research; The Children's Hospital at Westmead; Sydney New South Wales Australia
- Sydney School of Public Health; The University of Sydney; Sydney New South Wales Australia
| | - Philip Vladica
- Department of Radiology; Westmead Hospital, Western Sydney Local Health District; Sydney New South Wales Australia
| | - Judy Savige
- Department of Nephrology; The Royal Melbourne Hospital; Parkville Victoria Australia
- Department of Medicine; The University of Melbourne; Victoria Australia
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Flahault A, Trystram D, Fouchard M, Knebelmann B, Nataf F, Joly D. Screening for Unruptured Intracranial Aneurysms in Autosomal Dominant Polycystic Kidney Disease: A Survey of 420 Nephrologists. PLoS One 2016; 11:e0153176. [PMID: 27054719 PMCID: PMC4824518 DOI: 10.1371/journal.pone.0153176] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 03/24/2016] [Indexed: 12/18/2022] Open
Abstract
Background Despite a high prevalence of intracranial aneurysm (ICA) in autosomal dominant polycystic kidney disease (ADPKD), rupture events are rare. The current recommendations for ICA screening are based on expert opinions and studies with low levels of evidence. Objectives The aim of our study was to describe the attitudes of practicing nephrologists in Europe towards screening for ICA using magnetic resonance angiography (MRA). Methods We conducted a web-based survey among 1315 European French-speaking nephrologists and nephrology residents. An anonymous, electronic questionnaire including 24 independent questions related to ICA screening modalities, indications and participant profiles was sent by email between September and December 2014. Four hundred and twenty nephrologists (mostly from France) participated, including 31 nephrology residents; the response rate was 32%. Results Systematic screening for ICA was advocated by 28% of the nephrologists. A family history of ICA rupture, sudden death, stroke and migraine were consensual indications for screening (> 90% of the panel). In other clinical situations largely not covered by the recommendations (pregnancy, nephrectomy, kidney transplantation, cardiac or hepatic surgery, uncontrolled hypertension, lack of familial ADPKD history, at-risk activity, tobacco use), the attitudes towards screening were highly divergent. ICA screening was influenced by nephrologists experience with ADPKD and by their practice setting. The majority of participants (57%) would not repeat a normal ICA screening. Only a few participants (22%) knew that non-contrast MRA was the reference diagnostic tool for ICA screening, whereas most participants thought that contrast enhancement was necessary to screen for ICA. The results from the nephrology residents were analyzed separately and yielded similar results. Conclusion This practice survey revealed that most nephrologists follow the current recommendations for the initial screening of ICAs. However, more than a quarter of the panel was in favor of systematic ICA screening, most nephrologists did not know that contrast medium was not necessary to screen for ICA using MRA, and many areas of uncertainty remain.
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Affiliation(s)
- Adrien Flahault
- Université Paris-Descartes; Faculté de Médecine; AP-HP; Service de Néphrologie, Hôpital Necker-Enfants Malades, Paris, France
| | - Denis Trystram
- Université Paris-Descartes, INSERM UMR 894, Service de Neuroradiologie, Centre Hospitalier Sainte-Anne, Paris, France
| | - Marie Fouchard
- Université Paris-Descartes; Faculté de Médecine; AP-HP; Service de Néphrologie, Hôpital Necker-Enfants Malades, Paris, France
| | - Bertrand Knebelmann
- Université Paris-Descartes; Faculté de Médecine; AP-HP; Service de Néphrologie, Hôpital Necker-Enfants Malades, Paris, France
| | - François Nataf
- Université Paris-Descartes, INSERM UMR 894, Service de Neurochirurgie, Centre Hospitalier Sainte-Anne, Paris, France
| | - Dominique Joly
- Université Paris-Descartes; Faculté de Médecine; AP-HP; Service de Néphrologie, Hôpital Necker-Enfants Malades, Paris, France
- * E-mail:
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Rozenfeld MN, Ansari SA, Mohan P, Shaibani A, Russell EJ, Hurley MC. Reply. AJNR Am J Neuroradiol 2015; 37:296. [PMID: 26680457 DOI: 10.3174/ajnr.a4657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- M N Rozenfeld
- Department of Radiology Northwestern University Feinberg School of Medicine Chicago, Illinois
| | - S A Ansari
- Department of Radiology Northwestern University Feinberg School of Medicine Chicago, Illinois
| | - P Mohan
- Department of Radiology University of Miami Miami, Florida
| | - A Shaibani
- Department of Radiology Northwestern University Feinberg School of Medicine Chicago, Illinois
| | - E J Russell
- Department of Radiology Northwestern University Feinberg School of Medicine Chicago, Illinois
| | - M C Hurley
- Department of Radiology Northwestern University Feinberg School of Medicine Chicago, Illinois
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KHA-CARI Autosomal Dominant Polycystic Kidney Disease Guideline: Management of Intracranial Aneurysms. Semin Nephrol 2015; 35:612-617.e20. [DOI: 10.1016/j.semnephrol.2015.10.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Perrone RD, Malek AM, Watnick T. Vascular complications in autosomal dominant polycystic kidney disease. Nat Rev Nephrol 2015; 11:589-98. [PMID: 26260542 PMCID: PMC4904833 DOI: 10.1038/nrneph.2015.128] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease. Relentless cyst growth substantially enlarges both kidneys and culminates in renal failure. Patients with ADPKD also have vascular abnormalities; intracranial aneurysms (IAs) are found in ∼10% of asymptomatic patients during screening and in up to 25% of those with a family history of IA or subarachnoid haemorrhage. As the genes responsible for ADPKD—PKD1 and PKD2—have complex integrative roles in mechanotransduction and intracellular calcium signalling, the molecular basis of IA formation might involve focal haemodynamic conditions exacerbated by hypertension and altered flow sensing. IA rupture results in substantial mortality, morbidity and poor long-term outcomes. In this Review, we focus mainly on strategies for screening, diagnosis and treatment of IAs in patients with ADPKD. Other vascular aneurysms and anomalies—including aneurysms of the aorta and coronary arteries, cervicocephalic and thoracic aortic dissections, aortic root dilatation and cerebral dolichoectasia—are less common in this population, and the available data are insufficient to recommend screening strategies. Treatment decisions should be made with expert consultation and be based on a risk-benefit analysis that takes into account aneurysm location and morphology as well as patient age and comorbidities.
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Affiliation(s)
- Ronald D Perrone
- Department of Medicine, Division of Nephrology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Adel M Malek
- Department of Neurosurgery, Cerebrovascular and Endovascular Division, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Terry Watnick
- Department of Medicine, Division of Nephrology, University of Maryland, 720 Rutland Avenue, Baltimore, MD 21205, USA
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Akoh JA. Current management of autosomal dominant polycystic kidney disease. World J Nephrol 2015; 4:468-479. [PMID: 26380198 PMCID: PMC4561844 DOI: 10.5527/wjn.v4.i4.468] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 06/23/2015] [Accepted: 08/31/2015] [Indexed: 02/06/2023] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD), the most frequent cause of genetic renal disease affecting approximately 4 to 7 million individuals worldwide and accounting for 7%-15% of patients on renal replacement therapy, is a systemic disorder mainly involving the kidney but cysts can also occur in other organs such as the liver, pancreas, arachnoid membrane and seminal vesicles. Though computed tomography and magnetic resonance imaging (MRI) were similar in evaluating 81% of cystic lesions of the kidney, MRI may depict septa, wall thickening or enhancement leading to upgrade in cyst classification that can affect management. A screening strategy for intracranial aneurysms would provide 1.0 additional year of life without neurological disability to a 20-year-old patient with ADPKD and reduce the financial impact on society of the disease. Current treatment strategies include reducing: cyclic adenosine monophosphate levels, cell proliferation and fluid secretion. Several randomised clinical trials (RCT) including mammalian target of rapamycin inhibitors, somatostatin analogues and a vasopressin V2 receptor antagonist have been performed to study the effect of diverse drugs on growth of renal and hepatic cysts, and on deterioration of renal function. Prophylactic native nephrectomy is indicated in patients with a history of cyst infection or recurrent haemorrhage or to those in whom space must be made to implant the graft. The absence of large RCT on various aspects of the disease and its treatment leaves considerable uncertainty and ambiguity in many aspects of ADPKD patient care as it relates to end stage renal disease (ESRD). The outlook of patients with ADPKD is improving and is in fact much better than that for patients in ESRD due to other causes. This review highlights the need for well-structured RCTs as a first step towards trying newer interventions so as to develop updated clinical management guidelines.
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Noël N, Rieu P. [Pathophysiology, epidemiology, clinical presentation, diagnosis and treatment options for autosomal dominant polycystic kidney disease]. Nephrol Ther 2015; 11:213-25. [PMID: 26113401 DOI: 10.1016/j.nephro.2015.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 04/07/2015] [Accepted: 04/08/2015] [Indexed: 01/12/2023]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the leading genetic cause of end-stage renal disease (ESRD) worldwide. Its prevalence is evaluated according to studies and population between 1/1000 and 1/4000 live births and it accounts for 6 to 8% of incident ESRD patients in developed countries. ADPKD is characterized by numerous cysts in both kidneys and various extrarenal manifestations that are detailed in this review. Clinico-radiological and genetic diagnosis are also discussed. Mutations in the PKD1 and PKD2 codifying for polycystin-1 (PC-1) and polycystin-2 (PC-2) are responsible for the 85 and 15% of ADPKD cases, respectively. In primary cilia of normal kidney epithelial cells, PC-1 and PC-2 interact forming a complex involved in flow- and cilia-dependant signalling pathways where intracellular calcium and cAMP play a central role. Alteration of these multiple signal transduction pathways leads to cystogenesis accompanied by dysregulated planar cell polarity, excessive cell proliferation and fluid secretion, and pathogenic interactions of epithelial cells with an abnormal extracellular matrix. The mass effect of expanding cyst is responsible for the decline in glomerular filtration rate that occurs late in the course of the disease. For many decades, the treatment for ADPKD aims to lessen the condition's symptoms, limit kidney damage, and prevent complications. Recently, the development of promising specific treatment raises the hope to slow the growth of cysts and delay the disease. Treatment strategies targeting cAMP signalling such as vasopressin receptor antagonists or somatostatin analogs have been tested successfully in clinical trials with relative safety. Newer treatments supported by preclinical trials will become available in the next future. Recognizing early markers of renal progression (clinical, imaging, and genetic markers) to identify high-risk patients and multidrug approaches with synergistic effects may provide new opportunities for the treatment of ADPKD.
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Affiliation(s)
- Natacha Noël
- Service de néphrologie, centre hospitalier universitaire de Reims, 51100 Reims, France
| | - Philippe Rieu
- Service de néphrologie, centre hospitalier universitaire de Reims, 51100 Reims, France.
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28
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Niemczyk M, Niemczyk S, Bujko M, Pączek L. Headache as a manifestation of intracranial aneurysm in autosomal dominant polycystic kidney disease. Neurol Neurochir Pol 2015; 49:126-8. [PMID: 25890928 DOI: 10.1016/j.pjnns.2015.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 02/13/2015] [Accepted: 02/18/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disorder that affects 1 in 1.000 people in the general population, and is connected to increased risk for intracranial aneurysms (ICANs). In this work, we made an attempt to identify risk factors for subarachnoid hemorrhage (SAH) due to a rupture of an ICAN. METHODS Retrospective analysis of series of cases including 8 ADPKD patients who passed a nonfatal stroke due to the rupture of an ICAN. RESULTS The mean age at SAH was 40.13 years. In 88% of patients the renal function at SAH was normal. At least 63% of patients were hypertensive. The family history for ICAN and/or SAH was positive in 38% of patients, and in 63% of patients there were neurological symptoms preceding SAH, with headache as the most common one. CONCLUSIONS Similarly to ICAN and/or SAH in the family history, headache and/or other neurological symptoms should be indication for screening for ICANs in all ADPKD patients irrespectively of their age. We propose a set of criteria, which may enable detection of most cases of ICANs in ADPKD patients.
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Affiliation(s)
- Mariusz Niemczyk
- Department of Immunology, Transplant Medicine, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
| | - Stanisław Niemczyk
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland
| | - Maciej Bujko
- Department of Neurosurgery, The Medical Centre of Postgraduate Education, Warsaw, Poland
| | - Leszek Pączek
- Department of Immunology, Transplant Medicine, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
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Kurschat CE, Müller RU, Franke M, Maintz D, Schermer B, Benzing T. An approach to cystic kidney diseases: the clinician's view. Nat Rev Nephrol 2014; 10:687-99. [DOI: 10.1038/nrneph.2014.173] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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30
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Casteleijn NF, Spithoven EM, Rookmaaker MB, Vergouwen MDI, Gansevoort RT. Bilateral cysts in the choroid plexus in a patient with autosomal dominant polycystic kidney disease. Nephrol Dial Transplant 2014; 30:859-60. [PMID: 25104083 DOI: 10.1093/ndt/gfu264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 07/03/2014] [Indexed: 11/14/2022] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is a genetic systemic disorder, which is associated with cyst formation in several organs, renal function decline and a higher prevalence of intracranial aneurysms. We report a 52-year-old, otherwise healthy, man with ADPKD who had asymptomatic, bilateral, multiple cysts in the choroid plexus, which is an extremely rare abnormality. Recent evidence suggests that the polycystin proteins, which are dysfunctional in ADPKD, are found in ciliated choroid plexus cells that are involved with regulation of cerebrospinal fluid homeostasis. We hypothesize therefore that choroid plexus cysts may be part of the ADPKD phenotype, which has not been described before.
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Affiliation(s)
- Niek F Casteleijn
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Edwin M Spithoven
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Maarten B Rookmaaker
- Department of Nephrology and Hypertension, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Mervyn D I Vergouwen
- Department of Neurology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Ron T Gansevoort
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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