Suitability of Patients with Autosomal Dominant Polycystic Kidney Disease for Renal Transcatheter Arterial Embolization

Suwabe, Tatsuya; Ubara, Yoshifumi; Mise, Kazuyuki; Ueno, Toshiharu; Sumida, Keiichi; Yamanouchi, Masayuki; Hayami, Noriko; Hoshino, Junichi; Kawada, Manabu; Imafuku, Aya; Hiramatsu, Rikako; Hasegawa, Eiko; Sawa, Naoki; Takaichi, Kenmei

doi:10.1681/asn.2015010067

Cited by 26 publications

(21 citation statements)

References 60 publications

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“…When renal transcatheter arterial embolization (TAE) is performed, coils are employed to obstruct blood flow in the main renal arteries, resulting in ischemia and kidney shrinkage [11]. For hepatic TAE, coils are placed in certain hepatic artery branches to obstruct blood flow to the regions occupied by cysts, resulting in shrinkage of the hepatic cysts [12].…”

Section: Renal or Hepatic Transcatheter Arterial Embolizationmentioning

confidence: 99%

Factors Influencing Cyst Infection in Autosomal Dominant Polycystic Kidney Disease

Suwabe

Ubara

Hayami

et al. 2018

Nephron

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Background: Cyst infection is a frequent and serious complication of autosomal dominant polycystic kidney disease (ADPKD) that is often difficult to treat. However, the factors influencing cyst infection are still unknown. Therefore, we investigated clinical factors related to the duration of hospitalization and death due to cyst infection. Methods: All ADPKD patients undergoing cyst drainage or nephrectomy or partial hepatectomy at Toranomon Hospital from January 2004 to March 2016, in whom cyst fluid analysis showed bacteria or neutrophils indicating definite cyst infection, were reviewed retrospectively. Factors influencing the duration of hospitalization and death due to cyst infection were analyzed. Results: A total of 243 patients with cyst infection were enrolled, including 104 men and 139 women (mean age: 62.6 ± 10.0 years). Seventeen patients died of cyst infection. Multivariate logistic regression analysis revealed that hepatomegaly, positive cyst contents culture, and the maximum white blood cell (WBC) count were significantly associated with death from cyst infection. Death was significantly more likely if patients had massive hepatomegaly (≥5,113.2 mL) compared with mild hepatomegaly (< 1,898.7 mL; odds ratio 38.1; 95% CI 2.9–492.6, p = 0.0004). Multivariate Cox proportional hazards analysis revealed that older age, dialysis duration, hepatic transcatheter arterial embolization, maximum WBC count, and hepatomegaly were significantly associated with longer hospital stay for cyst infection, while female sex, nephrectomy, serum albumin, and serum cholinesterase were significantly associated with shorter hospital stay. Discharge alive from hospital was significantly associated with massive hepatomegaly versus mild hepatomegaly (hazard ratio 0.0072; 95% CI 0.0008–0.0659, p < 0.0001). Conclusions: Hepatomegaly was strongly associated with both death and longer hospital stay due to cyst infection.

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Section: Renal or Hepatic Transcatheter Arterial Embolizationmentioning

confidence: 99%

Factors Influencing Cyst Infection in Autosomal Dominant Polycystic Kidney Disease

Suwabe

Ubara

Hayami

et al. 2018

Nephron

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“…For massive enlarged kidney or liver, we perform renal or hepatic transcatheter arterial embolization (TAE). The total kidney volume decreases by about 45% on average at 1 year after renal TAE [ 10 ], while the liver volume decreases by about 9.2% on average [ 11 ]. The effectiveness of hepatic TAE is limited, which is why markedly fewer patients receive hepatic TAE than renal TAE.…”

Section: Introductionmentioning

confidence: 99%

Cyst infection in autosomal dominant polycystic kidney disease: our experience at Toranomon Hospital and future issues

Suwabe

2020

Clin Exp Nephrol

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Cyst infection is a frequent and serious complication of autosomal dominant polycystic kidney disease (ADPKD) that is often difficult to treat and can be fatal. However, much is still unknown about cyst infection. Positron emission tomography (PET) is generally recommended for detecting infected cysts, but it has the disadvantages of limited availability, high cost, and radiation exposure. We have devised magnetic resonance imaging (MRI) diagnostic criteria for cyst infection. Lipid-soluble antibiotics such as fluoroquinolones show good penetration into cysts and are recommended for cyst infection. However, we reported that fluoroquinolone-resistant microorganisms showed a high prevalence in cyst infection. We should, therefore, reconsider the empirical use of fluoroquinolones for ADPKD patients with cyst infection. We have suggested a new antibiotic strategy according to the severity of cyst infection. It may be important to consider the drug half-life in serum in addition to the drug susceptibility when selecting antibiotics Cyst drainage is necessary for some patients with refractory cyst infection; however, cyst drainage can be associated with severe adverse events. We suggest adaptation criteria for cyst drainage in patients with cyst infection in ADPKD. Most causative bacteria of cyst infection are enterobacteria, and hematogenous spread via bacterial translocation in the intestine is considered the main cause of cyst infection. Therefore, intestinal flora may be important for cyst infection. The role of the intestinal flora in cyst infection in ADPKD is unknown and should be explored in future research.

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“…Renal transcatheter arterial embolization (TAE) also can reduce kidney volume, and many ADPKD patients undergoing hemodialysis have received TAE treatment. Suwabe et al reported renal volume reduction rate by TAE treatment ranged from 3.9 to 84.8% [2]. She strongly complained to remove the left kidney completely because of distress.…”

Section: Discussionmentioning

confidence: 97%

A case of unilateral nephrectomy performed for autosomal dominant polycystic kidney disease with marked unilateral enlargement

et al. 2018

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Autosomal dominant polycystic kidney disease (ADPKD) is characterized by the occurrence of multiple cysts that increase the size of both kidneys, progressively reducing kidney function. Usually the cysts occur bilaterally, and there is no difference in the degree of cyst enlargement between the left and right. Here, we report a case of ADPKD in which kidney size increased markedly on the left side and was accompanied by severe abdominal distension and discomfort. Renal dynamic scintigraphy revealed a severe reduction in function of the left kidney compared with the right. Open left nephrectomy was performed. No change in renal function was observed postoperatively [preoperative estimated glomerular filtration rate (eGFR): 57.6 mL/min/1.73 m, 3-month postoperative eGFR: 56.4 mL/min/1.73 m], and the abdominal symptoms subsided. When one kidney is markedly larger than the other, the cause and status of the laterality should be evaluated by using renal dynamic scintigraphy in addition to other examinations such as computed tomography or magnetic resonance imaging. Unilateral nephrectomy should be considered as a potential treatment.

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Suitability of Patients with Autosomal Dominant Polycystic Kidney Disease for Renal Transcatheter Arterial Embolization

Cited by 26 publications

References 60 publications

Factors Influencing Cyst Infection in Autosomal Dominant Polycystic Kidney Disease

Factors Influencing Cyst Infection in Autosomal Dominant Polycystic Kidney Disease

Cyst infection in autosomal dominant polycystic kidney disease: our experience at Toranomon Hospital and future issues

A case of unilateral nephrectomy performed for autosomal dominant polycystic kidney disease with marked unilateral enlargement

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