Yin Xiaorui, Blumenfeld Jon D, Riyahi Sadjad, Luo Xianfu, Rennert Hanna, Barash Irina, Prince Martin R
Department of Radiology, Weill Cornell Medicine, New York, New York, USA.
Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Kidney Int Rep. 2020 Nov 1;6(1):168-178. doi: 10.1016/j.ekir.2020.10.027. eCollection 2021 Jan.
Kidney and liver cysts in autosomal dominant polycystic kidney disease (ADPKD) can compress the inferior vena cava (IVC), but IVC compression prevalence and its risk factors are unknown.
Patients who have ADPKD (n = 216) with abdominal magnetic resonance imaging (MRI) studies and age-/sex-matched controls (n = 216) were evaluated for IVC compression as well as azygous vein diameter (a marker of collateral blood flow) and IVC aspect ratio (left-to-right dimension divided by anterior-to-posterior dimension with a value of 1 corresponding to a circular (high pressure) IVC caudal to compression.
Severe IVC compression (≥70%) was observed in 33 (15%) ADPKD subjects and mild compression (≥50% to <70%) was observed in 33 (15%) subjects; whereas controls had no IVC compression ( < 0.001). Severe IVC compression was associated with larger azygous vein (4.0 ± 1.3 mm versus 2.3 ± 0.8 mm without IVC compression; < 0.001) and a more circular IVC cross-section upstream (mean IVC aspect ratio: 1.16 ± 0.27 vs. 1.69 ± 0.67, < 0.001), suggesting higher pressure upstream from the compression. IVC compression was associated with older age, lower estimated glomerular filtration rate (eGFR), greater height-adjusted total kidney volumes, greater height-adjusted liver volume (ht-LV), and greater liver and renal cyst fractions ( < 0.001). No subject younger than 30 years had IVC compression, but ADPKD subjects ≥40 years old had 12-fold higher risk of IVC compression (95% confidence interval [CI]: 4.2-42.4), with highest predicted probability for Mayo Clinic classes 1D (59%; 95% CI: 39%-76%) and 1E (74%; 95% CI: 49%-90%) after adjustment ( < 0.001). Women with ht-LV ≥ 2000 ml/m had 83% (95% CI: 59%-95%) prevalence of IVC compression. Complications of IVC compression included deep vein thrombosis (DVT) and symptomatic hypotension.
IVC compression is common in ADPKD patients >40 years old, with Mayo Clinic class 1D/E, and in females with ht-LV > 2000 ml/m.
常染色体显性多囊肾病（ADPKD）中的肾囊肿和肝囊肿可压迫下腔静脉（IVC），但IVC压迫的患病率及其危险因素尚不清楚。
对216例进行腹部磁共振成像（MRI）检查的ADPKD患者以及年龄和性别匹配的216例对照者进行IVC压迫评估，同时评估奇静脉直径（侧支血流标志物）和IVC纵横比（左右径除以前后径，值为1对应于压迫部位尾侧的圆形（高压）IVC）。
33例（15%）ADPKD患者观察到严重IVC压迫（≥70%），33例（15%）患者观察到轻度压迫（≥50%至<70%）；而对照组无IVC压迫（P<0.001）。严重IVC压迫与奇静脉较大有关（4.0±1.3mm对比无IVC压迫者的2.3±0.8mm；P<0.001），且压迫部位上游的IVC横截面更圆（平均IVC纵横比：1.16±0.27对比1.69±0.67，P<0.001），提示压迫部位上游压力较高。IVC压迫与年龄较大、估计肾小球滤过率（eGFR）较低、身高校正后的总肾体积较大、身高校正后的肝体积（ht-LV）较大以及肝和肾囊肿比例较高有关（P<0.001）。年龄小于30岁的患者无IVC压迫，但年龄≥40岁的ADPKD患者IVC压迫风险高12倍（95%置信区间[CI]：4.2-42.4），调整后梅奥诊所1D级（59%；95%CI：39%-76%）和1E级（74%；95%CI：49%-90%）预测概率最高（P<0.001）。ht-LV≥2000ml/m的女性IVC压迫患病率为83%（95%CI：59%-95%）。IVC压迫的并发症包括深静脉血栓形成（DVT）和症状性低血压。
IVC压迫在年龄>40岁、梅奥诊所1D/E级的ADPKD患者以及ht-LV>2000ml/m的女性中常见。
