Should patients with polycystic kidney disease be screened for cerebral aneurysms?

Autosomal dominant polycystic kidney disease (ADPKD) is characterized by the progressive development of renal cysts, as well as external abnormalities of the kidneys, including cerebral aneurysms, or weakness of cerebral blood vessels that swell and fill with blood and may then break. A new study published in CJASN examined whether patients with PKRAD should be systematically screened for cerebral aneurysms.

For the study, Vincente E. Torres, MD, Ph.D. (Mayo Clinic) and colleagues reviewed the medical records of 812 PKRAD patients badessed between 1989 and 2017 and subjected to medical tests. brain imaging despite the absence of neurological symptoms.

Among the main discoveries:

• 94 brain aneurysms were diagnosed in 75 out of 812 (9%) patients who underwent screening. None of the aneurysms failed after a mean follow-up of 9 years.
• Sex, age, race, and genetics related to PKRAD were similar in groups with and without aneurysm, but hypertension and smoking history were more common in the aneurysm group.
• 29% of patients with aneurysms compared to 11% of those who did not have had a family history of meningeal hemorrhage, a type of stroke caused by bleeding in the space surrounding the brain.
• Among patients who had aneurysms during initial screening, new cerebral aneurysms were detected in 5 patients during an average follow-up of 8 years and none of the aneurysms failed.
• Of 135 of the 737 patients without cerebral aneurysms detected during the first screening and who were screened for additional screening, 3 patients developed aneurysms after an average follow-up of 7 years and 2 patients had a rupture. cerebral aneurysm. Both patients had significant risk factors for development and rupture of cerebral aneurysm.

The researchers noted that their findings were inconclusive as to whether generalized or selective screening of brain aneurysms was beneficial for PKRAD. A large prospective study would be needed to determine the benefits and costs of such strategies.

"Our approach has been to recommend screening for patients with MPKD with a family history of aneurysm." We also recommend screening for patients with MPKD prior to major elective surgery (including transplantation), those who exercise high-risk profession and those who, having been properly informed about the available data wish to be reinsured, "said Dr. Torres. "We are making our patients aware of the importance of correcting conditions badociated with development and / or aneurysmal rupture, particularly with regard to smoking and inadequately controlled hypertension." The results of our study provide no reason to change our current approach ".

In an accompanying editorial, Ivana Kuo, Ph.D. (Loyola University School of Medicine) and Arlene Chapman, MD (University of Chicago) stated that "this report provides additional confirmation information regarding the increased frequency of intracranial aneurysms, traditional features of intracranial aneurysm in MPRK, similar to those of the general population, an important need for more mechanistic studies to determine the central role that PKRAD proteins play in the formation of intracranial aneurysms . "

In an accompanying Patient Voice editorial, Kevin Fowler shared his personal experiences with ADPKD and his opinion on the study.