Department of Nephrology, Toranomon Hospital, Tokyo, Japan.
Department of Nephrology, Toranomon Hospital, 1-3-1 Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-0015, Japan.
J Nephrol. 2023 May;36(4):999-1010. doi: 10.1007/s40620-022-01562-z. Epub 2023 Feb 8.
Renal cyst bleeding is a frequent problem in patients with autosomal dominant polycystic kidney disease (ADPKD). However, information is still limited on its frequency, causative factors, and effects on enlargement of polycystic kidneys in ADPKD.
We investigated the total volume of acute renal intracystic hemorrhage and its association with total kidney volume (TKV) in a large series of patients with ADPKD on dialysis, referred for renal transcatheter arterial embolization. All patients had undergone CT scan and MRI scan before the procedure. We evaluated factors potentially associated with acute renal intracystic hemorrhage. The association between the volume of acute renal intracystic hemorrhage and the potential predisposing and associated factors was analysed by univariable and multivariable regressions. RESULTS: We enrolled 199 patients who underwent renal transcatheter arterial embolization from 2014 to 2018 (107 men, 92 women; mean age 59.1 ± 8.6 years). The median volume of acute renal intracystic hemorrhage was 97.3 ml (interquartile range 36.6-261.7 ml). Multivariable analysis revealed that body weight, kidney stones, systolic blood pressure, and total volume of acute renal intracystic hemorrhage were significantly associated with TKV; age, body mass index, smoking, renal cyst infection, serum alkaline phosphatase, and TKV were significantly associated with the volume of acute renal intracystic hemorrhage ; and sex, age, dialysis vintage, TKV, and total volume of acute renal intracystic hemorrhage were significantly associated with the number of microcoils required to achieve renal transcatheter arterial embolization. Total volume of acute renal intracystic hemorrhage was significantly associated with TKV (r = 0.15, p = 0.0325) and was greater in younger patients (r= - 0.32, p < 0.0001). Total volume of acute renal intracystic hemorrhage was also correlated with the number of microcoils required for renal transcatheter arterial embolization (r = 0.23, p = 0.0012).
Acute renal intracystic hemorrhage is frequent among ADPKD patients on dialysis, and total volume of acute renal intracystic hemorrhage significantly associated with TKV. Total volume of acute renal intracystic hemorrhage was greater in younger patients with higher renal artery luminal size. These results suggest that renal cyst bleeding and renal artery blood flow may synergistically accelerate the enlargement of polycystic kidneys in ADPKD patients on dialysis.
常染色体显性多囊肾病（ADPKD）患者的肾囊肿出血是一个常见问题。然而，关于其发生频率、病因以及对 ADPKD 患者多囊肾增大的影响，目前的信息仍然有限。
我们对在透析期间因肾经导管动脉栓塞术就诊的大量 ADPKD 患者的急性肾内囊内出血总量及其与总肾体积（TKV）的关系进行了研究。所有患者在术前均行 CT 扫描和 MRI 扫描。我们评估了与急性肾内囊内出血相关的潜在因素。通过单变量和多变量回归分析了急性肾内囊内出血总量与潜在诱发和相关因素之间的关系。
我们纳入了 2014 年至 2018 年间进行肾经导管动脉栓塞术的 199 例患者（107 例男性，92 例女性；平均年龄 59.1±8.6 岁）。急性肾内囊内出血的中位数为 97.3ml（四分位间距 36.6-261.7ml）。多变量分析显示，体重、肾结石、收缩压和急性肾内囊内出血总量与 TKV 显著相关；年龄、体重指数、吸烟、肾囊肿感染、血清碱性磷酸酶和 TKV 与急性肾内囊内出血量显著相关；性别、年龄、透析龄、TKV 和急性肾内囊内出血总量与实现肾经导管动脉栓塞术所需的微线圈数量显著相关。急性肾内囊内出血总量与 TKV 显著相关（r=0.15，p=0.0325），且在年轻患者中更大（r=-0.32，p<0.0001）。急性肾内囊内出血总量与肾经导管动脉栓塞术所需的微线圈数量也呈正相关（r=0.23，p=0.0012）。
透析的 ADPKD 患者中急性肾内囊内出血较为常见，急性肾内囊内出血总量与 TKV 显著相关。在肾动脉管腔较大的年轻患者中，急性肾内囊内出血总量更大。这些结果表明，肾囊肿出血和肾动脉血流可能协同加速透析的 ADPKD 患者多囊肾的增大。
