Catheter-Based Renal Denervation in ADPKD: Just for Pain Control?

Abstract

We read with interest the case report by Casteleijn et al,1Casteleijn N.F. De Jager R.L. Neeleman M.P. et al.Chronic kidney pain in autosomal dominant polycystic kidney disease: a case report of successful treatment by catheter-based renal denervation.Am J Kidney Dis. 2014; 63: 1019-1021Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar which reported successful use of catheter-based renal denervation to reduce chronic kidney pain in a patient with autosomal dominant polycystic kidney disease (ADPKD). There have been several published cases of renal denervation to provide pain relief for patients with ADPKD (eg, Walsh and Sarria2Walsh N. Sarria J.E. Management of chronic pain in a patient with autosomal dominant polycystic kidney disease by sequential celiac plexus blockade, radiofrequency ablation, and spinal cord stimulation.Am J Kidney Dis. 2012; 59: 858-861Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar), but none has highlighted the positive effect of this procedure on blood pressure (BP). Sympathetic overactivity plays a crucial pathogenetic role in hypertension of ADPKD,3Klein I.H.H.T. Ligtenberg G. Oey P.L. Koomans H.A. Blankestijn P.J. Sympathetic activity is increased in polycystic kidney disease and is associated with hypertension.J Am Soc Nephrol. 2001; 12: 2427-2433PubMed Google Scholar and fewer than 30% of patients undergoing treatment for the disease achieve BPs less than 130/80 mm Hg. Recently, we described an exceptional case of renal denervation in a woman with single-kidney stage 4 chronic kidney disease secondary to ADPKD and uncontrolled treatment-resistant hypertension.4Riccio E. Esposito G. Franzone A. Imbriaco M. Santangelo M. Pisani A. Renal sympathetic-nerve ablation for uncontrolled hypertension in a single-kidney ADPKD patient.J Clin Hypertens (Greenwich). 2014; 16: 385-386Crossref PubMed Scopus (9) Google Scholar Due to failure of all other therapeutic strategies, including uninephrectomy, renal denervation by radiofrequency ablation of the single renal artery was performed. After the procedure, the patient’s BP declined remarkably, decreasing her need for antihypertensive medication. Moreover, the patient did not experience a significant decline in kidney function. Several studies support the safety and efficacy of renal denervation.5Krum H. Schlaich M. Whitbourn R. et al.Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study.Lancet. 2009; 373: 1275-1281Abstract Full Text Full Text PDF PubMed Scopus (1785) Google Scholar, 6Sclaich M.P. Sobotka P.A. Krum H. et al.Renal denervation as a therapeutic approach for hypertension.Hypertension. 2009; 54: 1195-1201Crossref PubMed Scopus (215) Google Scholar However, the existing evidence is limited by small studies and short follow-up. A large trial,7Renal denervation in patients with uncontrolled hypertension (SYMPLICITY HTN-3). http://clinicaltrials.gov/show/NCT01418261. Accessed March 11, 2014.Google Scholar recently completed but not yet published (at the time of writing), as well as ongoing clinical trials,8Renal denervation in patients with chronic heart failure & renal impairment. Clinical Trial (SymplicytyHF). http://www.clinicaltrials.gov/show/NCT01392196. Accessed March 11, 2014.Google Scholar, 9Renal denervation in patients with resistant hypertension and obstructive sleep apnea. http://www.clinicaltrials.gov/show/NCT01366625. Accessed March 11, 2014.Google Scholar, 10Study of catheter based renal denervation therapy in hypertension. http://clinicaltrials.gov/show/NCT01522430. Accessed March 24, 2014.Google Scholar, 11Renal denervation by ultrasound transcatheter emission. http://clinicaltrials.gov/show/NCT01529372. Accessed March 24, 2014.Google Scholar, 12Renal Sympathectomy in Treatment Resistant Essential Hypertension, a Sham Controlled Randomized Trial (ReSet). http://clinicaltrials.gov/show/NCT01459900. Accessed March 24, 2014.Google Scholar, 13Renal sympathetic modification in patients with essential hypertension. http://clinicaltrials.gov/show/NCT01417221. Accessed March 24, 2014.Google Scholar, 14Renal nerve ablation in chronic kidney disease patients. http://clinicaltrials.gov/show/NCT01442883. Accessed March 24, 2014.Google Scholar should provide important information regarding the safety and efficacy of renal denervation for resistant hypertension or other indications. Financial Disclosure: The authors declare that they have no relevant financial interests. Chronic Kidney Pain in Autosomal Dominant Polycystic Kidney Disease: A Case Report of Successful Treatment by Catheter-Based Renal DenervationAmerican Journal of Kidney DiseasesVol. 63Issue 6PreviewChronic pain is a common concern in patients with autosomal dominant polycystic kidney disease (ADPKD). We report what to our knowledge is the first catheter-based renal denervation procedure in a patient with ADPKD resulting in successful management of chronic pain. The patient was a 43-year-old woman whose chronic pain could not be controlled by pain medication or splanchnic nerve blockade. Transluminal radiofrequency renal denervation was performed as an experimental therapeutic option with an excellent result, indicating that this procedure should be considered for chronic pain management in ADPKD. Full-Text PDF In Reply to ‘Catheter-Based Renal Denervation in ADPKD: Just for Pain Control?’American Journal of Kidney DiseasesVol. 64Issue 6PreviewThe letter by Riccio et al1 deals with a timely topic, adding catheter-based renal denervation as a potential therapeutic option for resistant hypertension in patients with autosomal dominant polycystic kidney disease (ADPKD). Full-Text PDF