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Successful Peritoneal Dialysis After Renal Transcatheter Arterial Embolization in Autosomal Dominant Polycystic Kidney Disease

2011; Elsevier BV; Volume: 58; Issue: 5 Linguagem: Inglês

10.1053/j.ajkd.2011.07.008

1523-6838

Takafumi Toyohara, Noriko Hayami, Yoshifumi Ubara,

Renal and Vascular Pathologies

When continuous ambulatory peritoneal dialysis (CAPD) is performed in patients with autosomal dominant polycystic kidney disease (ADPKD), various complications specific to ADPKD, such as abdominal hernias, leakage of dialysate from the peritoneal cavity, and enlargement of the kidneys or liver, need to be considered.1Del Peso G. Bajo M.A. Costero O. et al.Risk factors for abdominal wall complications in peritoneal dialysis patients.Perit Dial Int. 2003; 23: 249-254PubMed Google Scholar, 2De V. Scalamogna A. Scanziani R. Castelnovo C. Dozio B. Rovere G. Polycystic kidney disease and late peritoneal leakage in CAPD: are they related?.Perit Dial Int. 2002; 22: 82-84PubMed Google Scholar, 3Fletcher S. Turney J.H. Brownjohn A.M. Increased incidence of hydrothorax complicating peritoneal dialysis in patients with adult polycystic kidney disease.Nephrol Dial Transplant. 1994; 9: 832-833PubMed Google Scholar We encountered a patient with ADPKD who had severe nephromegaly and abdominal swelling that progressed even after starting CAPD. To treat enlarged kidneys in patients with ADPKD, renal transcatheter arterial embolization (TAE) is a therapeutic option.4Ubara Y. Tagami T. Sawa N. et al.Renal contraction therapy for enlarged polycystic kidneys by transcatheter arterial embolization in hemodialysis patients.Am J Kidney Dis. 2002; 39: 571-579Abstract Full Text Full Text PDF PubMed Scopus (74) Google Scholar We report the outcome of TAE in our CAPD patient, a 63-year-old Japanese woman who was admitted to our hospital to treat enlarged kidneys 4 years after starting CAPD for end-stage renal disease secondary to ADPKD. Residual kidney function was minimal. TAE was performed for both kidneys using platinum microcoils under epidural anesthesia.5Schena F.P. Alpers C.E. Membranoproliferative glomerulonephritis and cryoglobulinemic glomerulopathy.in: Feehally J. Floege J. Johnson R.J. Comprehensive Clinical Nephropathy. 3rd ed. Mosby Elsevier, Philadelphia, PA2007: 243-252Google Scholar Six months after TAE, volumes of the left and right kidneys had decreased from 3,037 to 1,440 cm3 and 5,251 to 1,884 cm3, respectively, and the patient's abdominal distension (with umbilical and inguinal hernias) subsided (Fig 1). Peritoneal dialysis (PD) fluid volume could be increased from 1,200 to 1,600 mL. Weekly Kt/V increased from 1.38 to 1.76, and total creatinine clearance increased from 27.8 to 44.4 L/wk when using 1,600 mL of PD fluid (Fig 1). Prolongation of the duration of PD was achieved. We conclude that renal TAE is a therapeutic option for patients with ADPKD for whom PD fluid volume is limited by nephromegaly. We acknowledge Tatsuya Suwabe, Junichi Hoshino, Keiichi Sumida, Rikako Hiramatsu, Eiko Hasegawa, Masayuki Yamanouchi, Yuji Marui, Naoki Sawa, Michio Nakamura, Shinji Tomikawa, and Kenmei Takaichi for valuable discussions regarding therapeutic strategy and Keisuke Maruyama and Makoto Hiramatsu (Okayama Saiseikai General Hospital) for managing the patient with us. This work was funded by the Okinaka Memorial Institute for Medical Research. Financial Disclosure: The authors declare that they have no relevant financial interests.