Screening by ARM can detect aneurysms related to kidney disease

Mayo Clinic researchers in Rochester, Minnesota, found cerebral aneurysms in up to 10% of presymptomatic PKRAD patients who had undergone MRA scans, which is four times the detection rate of the population General.

"Our approach has been to recommend screening in patients with PKRAD who have a family history of aneurysm," said co-author of the study, Vicente Torres, PhD, of the Division of Nephrology and hypertension of Mayo Clinic, in a statement. "We also recommend screening patients with PKRAD before major non-emergency surgical procedures (including transplantation), those who practice a high-risk occupation, and those who, having been properly informed about the available data, wish to be screened. to rebadure oneself. "

Patients with autosomal dominant polycystic renal failure treat not only bilateral renal cysts, but may also develop abnormalities outside their renal system, most commonly in the form of intracranial aneurysms. A broken aneurysm implies a high risk of mortality, which should make screening all the more important.

Although the need for screening in this patient population remains debatable, a study by Malhotra et al. Conducted in February 2019 supported the ARM for the screening and monitoring of patients with intracranial aneurysms related to MPRK. This made sense for both profitability and clinical outcomes.

To deepen the question of using ARM to screen for aneurysms in patients, Torres and his colleagues examined 812 patients with MPKD evaluated between 1989 and 2017. Patients had undergone a brain scan by ARM despite the absence of neurological symptoms.

The current study includes newly diagnosed cases between 2009 and 2017, extended the follow-up period and recorded the rate of intracranial aneurysm rupture in longitudinal studies and recent clinical trials on PKRAD. Only abnormalities of 2 mm or more were considered aneurysms.

Mayo Clinic researchers found 94 intracranial aneurysms among 75 patients (9%) screened with MRA, of whom 12 (16%) had two aneurysms and one patient (1.3%) six. The median diameter was 4 mm (range, 2-12 mm).

According to previous research, the prevalence of intracranial aneurysms with MRA screening was four times higher in patients with PKRAD (8% to 12%) compared to the general population (2% to 3%). The good news is that none of the 94 intracranial aneurysms of the current study have broken down during an average nine-year follow-up period.

Torres and his colleagues also concluded that:

• 29% of patients with aneurysms had a family history of meningeal hemorrhage, compared to 11% of subjects with no family history of aneurysms.
• Among patients with aneurysms during initial screening of ARM, new brain aneurysms were detected in five patients during an average follow-up of eight years, but none broke up.
• Of 135 patients (18%) with no cerebral aneurysm at first screening, three patients developed aneurysms after a mean follow-up of seven years, two patients having had aneurysm rupture. cerebral.

"Our results and the review of the literature do not make it possible to determine with certainty whether the generalized or targeted screening of intracranial aneurysms is beneficial for PKRAD," the authors concluded. "A large prospective study would be needed to determine the clinical utility and cost-effectiveness of these strategies, and at this time we prefer to continue to target presymptomatic screening with MRA (or CT angiography). patients with a family history of documented or unruptured aneurysmal rupture, intracranial aneurysm ".

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