Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Urology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Nephrol Dial Transplant. 2018 Apr 1;33(4):614-619. doi: 10.1093/ndt/gfx086.
Loin pain haematuria syndrome (LPHS) and autosomal dominant polycystic kidney disease (ADPKD) are the most important non-urological conditions to cause chronic severe kidney-related pain. Multidisciplinary programmes and surgical methods have shown inconsistent results with respect to pain reduction. Percutaneous catheter-based renal denervation (RDN) could be a less invasive treatment option for these patients.
Our aim was to explore the change in perceived pain and use of analgesic medication from baseline to 3, 6 and 12 months after RDN. Patients with LPHS or ADPKD, who experienced kidney-related pain ≥3 months with a visual analogue scale (VAS) score ≥ 50/100 could be included. Percutaneous RDN was performed with a single-electrode radiofrequency ablation catheter.
RDN was performed in 11 patients (6 with LPHS and 5 with ADPKD). Perceived pain declined in the whole group by 23 mm (P = 0.012 for the total group). In patients with LPHS and ADPKD, the median daily defined dosage of analgesic medication decreased from 1.6 [interquartile range (IQR) 0.7-2.3] and 1.4 (IQR 0.0-7.4) at baseline to 0.3 (IQR 0.0-1.9; P = 0.138) and 0.0 (IQR 0.0-0.8; P = 0.285) at 12 months, respectively. Mean estimated glomerular filtration rate decreased in the whole group by 5.4 mL/min/1.73 m2 at 6 months compared with baseline (P = 0.163).
These results suggest that percutaneous catheter-based RDN reduces pain complaints and the use of analgesic medication in patients with LPHS or ADPKD. The present results can serve as the rationale for a larger, preferably randomized (sham) controlled study.
腰痛血尿综合征（LPHS）和常染色体显性多囊肾病（ADPKD）是导致慢性严重肾相关疼痛的最重要的非泌尿系统疾病。多学科方案和手术方法在减轻疼痛方面的结果不一致。经皮导管内肾脏去神经支配（RDN）可能是这些患者的一种侵袭性较小的治疗选择。
我们的目的是探讨 RDN 后 3、6 和 12 个月时患者感知疼痛的变化和镇痛药的使用情况。纳入腰痛血尿综合征或常染色体显性多囊肾病患者，这些患者经历肾相关疼痛≥3 个月，视觉模拟评分（VAS）≥50/100。采用单电极射频消融导管进行经皮 RDN。
11 例患者（6 例腰痛血尿综合征和 5 例常染色体显性多囊肾病）接受了 RDN。整个组的感知疼痛下降了 23 毫米（总组 P=0.012）。在腰痛血尿综合征和常染色体显性多囊肾病患者中，每日定义剂量的镇痛药中位数从基线时的 1.6（IQR 0.7-2.3）和 1.4（IQR 0.0-7.4）分别降至 12 个月时的 0.3（IQR 0.0-1.9；P=0.138）和 0.0（IQR 0.0-0.8；P=0.285）。与基线相比，整个组的平均估计肾小球滤过率在 6 个月时下降了 5.4 mL/min/1.73 m2（P=0.163）。
这些结果表明，经皮导管内 RDN 可减轻腰痛血尿综合征或常染色体显性多囊肾病患者的疼痛主诉和镇痛药的使用。目前的结果可以作为更大的、最好是随机（假）对照研究的依据。
