Diagnosis of cyst infection in patients with autosomal dominant polycystic kidney disease: attributes and limitations of the current modalities

Jouret, François; Lhommel, Renaud; Devuyst, Olivier; Annet, Laurence; Pirson, Yves; Hassoun, Ziad; Kanaan, Nada

doi:10.1093/ndt/gfs352

Cited by 79 publications

(67 citation statements)

References 20 publications

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“…Clinical signs vary with the localization of the cyst. Superinfection of a biliary cyst can modify the typical radiologic appearance of the cyst and can mimic other more serious disorders, especially with minimally symptomatic infectious and/or hemorrhagic episodes [34,35].…”

Section: Superinfected Biliary Cystsmentioning

confidence: 99%

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Hepatic abscess: Diagnosis and management

Lardière-Deguelte

Ragot

Amroun

et al. 2015

Journal of Visceral Surgery

224

247

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Microbial contamination of the liver parenchyma leading to hepatic abscess (HA) can occur via the bile ducts or vessels (arterial or portal) or directly, by contiguity. Infection is usually bacterial, sometimes parasitic, or very rarely fungal. In the Western world, bacterial (pyogenic) HA is most prevalent; the mortality is high approaching 15%, due mostly to patient debilitation and persistence of the underlying cause. In South-East Asia and Africa, amebic infection is the most frequent cause. The etiologies of HA are multiple including lithiasic biliary disease (cholecystitis, cholangitis), intra-abdominal collections (appendicitis, sigmoid diverticulitis, Crohn's disease), and bile duct ischemia secondary to pancreatoduodenectomy, liver transplantation, interventional techniques (radio-frequency ablation, intra-arterial chemo-embolization), and/or liver trauma. More rarely, HA occurs in the wake of septicemia either on healthy or preexisting liver diseases (biliary cysts, hydatid cyst, cystic or necrotic metastases). The incidence of HA secondary to Klebsiella pneumoniae is increasing and can give rise to other distant septic metastases. The diagnosis of HA depends mainly on imaging (sonography and/or CT scan), with confirmation by needle aspiration for bacteriology studies. The therapeutic strategy consists of bactericidal antibiotics, adapted to the germs, sometimes in combination with percutaneous or surgical drainage, and control of the primary source. The presence of bile in the aspirate or drainage fluid attests to communication with the biliary tree and calls for biliary MRI looking for obstruction. When faced with HA, the attending physician should seek advice from a multi-specialty team including an interventional radiologist, a hepatobiliary surgeon and an infectious disease specialist. This should help to determine the origin and mechanisms responsible for the abscess, and to then propose the best appropriate treatment. The presence of chronic enteric biliary contamination (i.e., sphincterotomy, bilio-enterostomy) should be determined before performing radio-frequency ablation and/or chemo-embolization; substantial stenosis of the celiac trunk should be detected before performing pancreatoduodenectomy to help avoid iatrogenic HA.

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Section: Superinfected Biliary Cystsmentioning

confidence: 99%

“…4). MRI and PET scan (for certain authors) are the two most important investigations to localize infected cysts [34,35].…”

Section: Superinfected Biliary Cystsmentioning

confidence: 99%

Hepatic abscess: Diagnosis and management

Lardière-Deguelte

Ragot

Amroun

et al. 2015

Journal of Visceral Surgery

224

247

View full text Add to dashboard Cite

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“…The actual role of PET/CT is still not clear. A few reports described the role of PET in detecting cyst infection, either renal [9][10][11][12][13] or hepatic [14][15][16][17] or both [18][19][20][21], in patients with ADPKD, particularly recognizing …”

Section: Discussionmentioning

confidence: 99%

18F-FDG PET/CT demonstrated renal and hepatic cyst infection in a patient with autosomal dominant polycystic kidney disease

2016

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Infection of renal or hepatic cyst is a serious complication of autosomal dominant polycystic kidney disease (ADPKD) and early diagnosis is crucial for the correct management. We report a case of 64-year-old male with ADPKD, who required renal transplantation some years before, with recent recurrent episodes of fever and abdominal pain, who underwent 18 F-FDG PET/CT twice at 18 months intervals, after not conclusive conventional imaging studies (CT, ultrasonography).18 F-FDG PET/CT has proven to be a useful method for the diagnosis of renal and hepatic cyst infection in a patient with ADPKD and for the subsequent management.

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“…Positron emission tomography can be utilized to identify a cyst that may be infected. 25 Once acute causes are ruled out and pain appears to be more chronic, evaluation should attempt to differentiate between mechanical, hepatic, renal, or other causes of pain.…”

Section: Initial Evaluation Of Painmentioning

confidence: 99%

Management of Pain in Autosomal Dominant Polycystic Kidney Disease and Anatomy of Renal Innervation

et al. 2015

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Purpose: Chronic pain is a prominent feature of autosomal dominant polycystic kidney disease (ADPKD) that is difficult to treat and manage, often resulting in a decrease in quality of life. Understanding the underlying anatomy of renal innervation and different etiologies of pain that occur in ADPKD can help to guide proper treatments to manage pain. Reviewing the previously studied treatments for pain in ADPKD can help to characterize treatment in a stepwise fashion. Materials and Methods: We performed a literature search of the etiology and management of pain in ADPKD and the anatomy of renal innervation using Pubmed® and Embase® from January 1985 to April 2014 with limitations to human studies and English language. Results: Pain occurs in the majority of patients with ADPKD due to renal, hepatic, and mechanical origins. Patients may experience different types of pain, which can make it difficult to clinically confirm its etiology. An anatomical and histological evaluation of the complex renal innervation helps with an understanding of the mechanisms that can lead to renal pain. Understanding the complex nature of renal innervation is essential for surgeons to perform a renal denervation procedure. The management of pain in ADPKD should be approached in a stepwise fashion. Acute causes of renal pain must first be ruled out due to the high incidence in ADPKD. For chronic pain, non-opioid analgesics and conservative interventions can be first used before opioid analgesics are considered. If pain continues, there are surgical interventions that can target pain produced by renal or hepatic cysts. Surgical options include renal cyst decortication, renal denervation, and nephrectomy. Conclusion: Chronic pain in patients with ADPKD is often refractory to conservative, medical, and other non-invasive treatments. There are effective surgical procedures that can be implemented when more conservative treatments fail. Laparoscopic cyst decortication has been well studied and results in relief of chronic renal pain in the majority of patients. In addition, renal denervation has successfully been utilized and could be performed concurrently with cyst decortication. Nephrectomy should be reserved for patients with intractable pain and renal failure when other modalities have failed.

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Diagnosis of cyst infection in patients with autosomal dominant polycystic kidney disease: attributes and limitations of the current modalities

Cited by 79 publications

References 20 publications

Hepatic abscess: Diagnosis and management

Hepatic abscess: Diagnosis and management

18F-FDG PET/CT demonstrated renal and hepatic cyst infection in a patient with autosomal dominant polycystic kidney disease

Management of Pain in Autosomal Dominant Polycystic Kidney Disease and Anatomy of Renal Innervation

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