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Acute renal intracystic hemorrhage in patients with autosomal dominant polycystic kidney disease

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Abstract

Background

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.

Methods

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).

Conclusion

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.

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Data availability

Deidentified data are available on reasonable request from the corresponding author.

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Acknowledgements

Mr. Toshihito Furukawa (Biostatistical Research Co., Ltd. Tokyo, Japan) assisted with the analysis and interpretation of data. This manuscript has been checked by a native English-speaking medical editor, Andrea Baird, MD, from Edanz (https://jp.edanz.com/ac).

Funding

This study was supported by JSPS KAKENHI (Grant Number JP19K17758). This study was also supported in part by a grant from the Japanese Association of Dialysis Physicians (JADP Grant 2018-5), a Grant-in-Aid for Progressive Renal Disease Research from the Ministry of Health, Labour and Welfare of Japan, and by Okinaka Memorial Institute for Medical Research, Toranomon Hospital.

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Authors and Affiliations

  1. Department of Nephrology, Toranomon Hospital, Tokyo, Japan

    Tatsuya Suwabe, Yoshifumi Ubara, Yuki Oba, Hiroki Mizuno, Daisuke Ikuma, Masayuki Yamanouchi, Akinari Sekine, Kiho Tanaka, Eiko Hasegawa, Junichi Hoshino & Naoki Sawa

  2. Department of Nephrology, Toranomon Hospital, 1-3-1 Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-0015, Japan

    Tatsuya Suwabe, Yoshifumi Ubara, Yuki Oba, Hiroki Mizuno, Daisuke Ikuma, Masayuki Yamanouchi & Naoki Sawa

  3. Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan

    Tatsuya Suwabe, Yoshifumi Ubara, Masayuki Yamanouchi, Akinari Sekine, Junichi Hoshino & Naoki Sawa

  4. Department of Nephrology, Tokyo Women’s Medical University, Tokyo, Japan

    Junichi Hoshino

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  1. Tatsuya Suwabe
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  2. Yoshifumi Ubara
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Contributions

Research idea and study design: TS, YU, NS; data acquisition: TS, YU, YO, HM, DI, MY, NS; data analysis/interpretation: TS, YU, NS; statistical analysis: TS, YU, NS. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved.

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Correspondence to Tatsuya Suwabe.

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The authors declare that they have no conflict of interest.

Ethical approval

The study was conducted according to the guidelines of the Declaration of Helsinki. This study was reviewed and approved by the ethics committee of Toranomon Hospital in June 2020.

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Suwabe, T., Ubara, Y., Oba, Y. et al. Acute renal intracystic hemorrhage in patients with autosomal dominant polycystic kidney disease. J Nephrol 36, 999–1010 (2023). https://doi.org/10.1007/s40620-022-01562-z

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  • DOI: https://doi.org/10.1007/s40620-022-01562-z

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