Ioan-Andrei Iliuta, Beili Shi, Marina Pourafkari, Pedram Akbari, Giancarlo Bruni, Ralph Hsiao, Steffan F. Stella, Korosh Khalili, Eran Shlomovitz, and York Pei. Kidney Medicine. November-December 2019, Volume 1, Issue 6, Pages 366–375.
Rationale & Objective
Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disorder. Progressive increase in cyst number and size leads to kidney failure in a majority of patients. Large kidney cysts, although few, can be especially deleterious by impeding kidney blood flow and obstructing urine flow over a large region. Foam sclerotherapy is a minimally invasive procedure that may be used to ablate large cysts. We examined the effectiveness and safety of foam sclerotherapy for kidney volume reduction in patients with ADPKD.
Study Design
Prospective cohort study.
Setting & Participants
Adults with ADPKD at a tertiary referral center in Toronto.
Predictor
Foam sclerotherapy.
Outcomes
Volume of treated kidneys and adverse events.
Analytical Approach
Treated and nontreated kidney volume, kidney function, tolerability, and symptoms were analyzed within each patient.
Results
We performed 77 foam sclerotherapy treatment sessions in 66 patients. Foam sclerotherapy was associated with a 21.8% volume reduction of the treated kidneys (n = 95; median, 1,138 [IQR, 801-1,582] mL before vs 891 [IQR, 548-1,450] mL after; P < 0.001), while the volume of the nontreated kidneys increased by 3.4% during the same time frame (n = 37; median, 655 [IQR, 352-998] mL before vs 677 [IQR, 371-1,164] mL after; P < 0.001). 4 (6%) patients had a higher measured creatinine clearance by at least 10 mL/min at least 12 months after foam sclerotherapy. 9 (14%) patients experienced self-limiting pain at the procedure site and 2 (3%) had cyst or urinary tract infection. Most patients with flank/back pain, abdominal pain, and abdominal distension had improvement in their symptoms.
Limitations
Small sample, observational data.
Conclusions
Foam sclerotherapy is a safe and effective procedure for kidney volume reduction and amelioration of compressive symptoms in select patients with ADPKD. Further studies are needed to assess its effects on kidney blood flow and kidney function and determine the subgroups of patients most likely to benefit.
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