Lesson of the week: Causes of haematuria in adult polycystic kidney disease

Dedi, Robert; Bhandari, Sunil; Turney, J. H.; Brownjohn, A. M.; Eardley, Ian

doi:10.1136/bmj.323.7309.386

Cited by 12 publications

(4 citation statements)

References 11 publications

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“…17 Approximately two-thirds of patients with ADPKD develop micro-or macroscopic haematuria, which is most often due to uTIs, cyst rupture or stone disease. 18,19 There has been ongoing controversy as to whether ADPKD is a risk factor for RCC. While the literature is inconclusive with regards to this, it seems that malignancy is at least as common in this subgroup as in the general population.…”

Section: Discussionmentioning

confidence: 99%

Native nephrectomy in transplant patients with autosomal dominant polycystic kidney disease

Patel

Horsfield

Compton

et al. 2011

annals

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INTRODUCTION This study examined the clinical indications and timing for native nephrectomy (NN), together with the associated pathological findings in transplant patients with autosomal dominant polycystic kidney disease (ADPKD) at our institute over a period of 20 years. METHODS A retrospective review was performed of ADPKD patients who had undergone both kidney transplantation and NN. Patients were identified from the kidney transplant database between 1988 and 2008 at Guy's and St Thomas' Hospital and the notes reviewed. All NN specimens were re-reviewed and reported according to current guidelines. RESULTS There were 157 kidney transplants performed for ADPKD (114 cadaveric and 43 living donor). Of these, 31 required NN (28 bilateral). The timing of NN was pre-transplant in 10 cases, at the time of the transplant in 1 case and post-transplant in 20 cases. The indications for NN were urinary tract infection (n=14, 45%), pain (n=12, 39%), tumour suspicion (n=3, 10%), haematuria (n=1, 3%) and space (n=1, 3%). Mortality in this NN series was 3%, with a 65% surgical morbidity rate. The length of hospital stay post-NN was significantly longer with open compared with laparoscopic techniques (p=0.003). There were two renal cell carcinomas (RCCs) in this series. Both patients presented with macroscopic haematuria (bilateral pT1a papillary RCCs in one case and a pT3b clear cell RCC in the other case). The incidence of RCC in this series of ADPKD transplant patients was 1.3%. CONCLUSIONS We have demonstrated that the majority of ADPKD patients do not require NN, with only 20% of our series undergoing this procedure. The timing of NN is variable and dictated by indication. NN was only required to make space for transplantation in one case (combined kidney and pancreas transplant). The main indications for NN were recurrent infection and pain, where NN can provide a successful outcome. Laparoscopic NN can be performed safely in patients with ADPKD. Haematuria in such patients should not be assumed to be of benign origin and requires exclusion of urinary tract malignancy as the incidence of RCC in this population is at least as common as in the general population.

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Section: Discussionmentioning

confidence: 99%

Native nephrectomy in transplant patients with autosomal dominant polycystic kidney disease

Patel

Horsfield

Compton

et al. 2011

annals

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“…After extensive literature search, we were able to find an article reporting two such cases of bladder cancer in patients with ADPKD 8. Both cases were detected by transabdominal ultrasonography.…”

Section: Discussionmentioning

confidence: 99%

Haematuria in ADPKD: not always benign. Be aware!

Agarwal¹,

Sokhal

Kumar

et al. 2017

BMJ Case Reports

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Haematuria in patients with autosomal dominant polycystic kidney disease (ADPKD) is a very common manifestation. The cause of haematuria is often benign with the most common cause being haemorrhage within the renal cyst. But haematuria may also be caused by a coincident malignancy, the diagnosis of which may be missed if not investigated thoroughly. Herein, we present a case of ADPKD who presented to us with haematuria and was later found to have bladder cancer.

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“…The reason of proteinuria in ADPKD is still unclear; however possible explanation would be damage to capillary endothelium and glomerulosclerosis due to hypertension [15]. Hematuria is usually due to rupture of a cyst into the pelvis of the kidney [16]. Approximately 68% of patients had hematuria on urinalysis and 17.9% had gross hematuria.…”

Section: Discussionmentioning

confidence: 99%

Clinical Presentation and Outcomes of Autosomal Dominant Polycystic Kidney Disease in the Elderly

Helal¹,

Lassoued²,

Maı̈z³

et al. 2013

AJMSM

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The patient characteristics and outcomes associated with autosomal dominant polycystic kidney disease (ADPKD) have not been characterized in elderly population. The purpose of theis study was to delineate clinical presentation and outcome of ADPKD in elderly patients. We performed a retrospective study. Thirty four elderly patients were diagnosed with ADPKD between 1975 and 2005. The diagnosis of ADPKD was made using family history and ultrasound. There were 21 (61.7%) males and 13 (38.3%) females. The mean age at the time of diagnosis of ADPKD was 69.74 ± 3.36 years (range, 65-79 years). The earliest clinical features were renal failure in 67.6%, back pain in 38.2%, and hypertension in 17.6%. Most common form of presentation was hypertension in 70.6%. Kidneys were palpable in 26.5%, and liver was palpable in 32.4%. Left ventricular hypertrophy confirmed by transthoracic echocardiography was found in 5(1.5%) patients. Three (0.8%) patients had colonic diverticula and two (0.6%) had neurological manifestation. Twenty six 26 patients (76.5%) patients had end stage renal disease and 30 patients (88.23 %) patients had anemia. Median follow-up period for all patients was 17.9 months (range, 1-120 months). Two (0.6%) patients developed renal carcinoma while five patients (14.7%) died within six years following diagnosis Anemia was the strongest and an independent predictor of poor renal outcome. (p<0.03). The diagnosis of ADPKD in elderly patients was made late in most cases, with patients already at end stage renal disease. Anemia is risk factor of poor renal prognosis. Eearly diagnosis and efforts at prevention of the disease progression and complications are most essential.

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Lesson of the week: Causes of haematuria in adult polycystic kidney disease

Abstract: Do not assume that haematuria in association with adult polycystic kidney disease is always benign

Cited by 12 publications

References 11 publications

Native nephrectomy in transplant patients with autosomal dominant polycystic kidney disease

Native nephrectomy in transplant patients with autosomal dominant polycystic kidney disease

Haematuria in ADPKD: not always benign. Be aware!

Clinical Presentation and Outcomes of Autosomal Dominant Polycystic Kidney Disease in the Elderly

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