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

Abstract

Renal cyst bleeding is a frequent problem in patients with autosomal dominant polycystic kidney disease (ADPKD). However, information is still limitedon 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 seriesofpatients with ADPKD on dialysis, referred forrenal 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 thevolume 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 ± 8.6years). The median volume of acute renal intracystic hemorrhage was 97.3ml (interquartile range 36.6-261.7ml). 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 withthe volume ofacute 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 wasgreater inyounger patients (r= - 0.32, p < 0.0001). Total volume of acute renal intracystic hemorrhagewas also correlated with the number ofmicrocoils 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 kidneysin ADPKDpatients on dialysis.