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Cyst infection in hospital-admitted autosomal dominant polycystic kidney disease patients is predominantly multifocal and associated with kidney and liver volume
Balbo, B.E.P.; Sapienza, M.T.; Ono, C.R.; Jayanthi, S.K.; Dettoni, J.B.; Castro, I.; Onuchic, L.F..
  • Balbo, B.E.P.; Universidade de São Paulo. Faculdade de Medicina. Divisão de Nefrologia. São Paulo. BR
  • Sapienza, M.T.; Universidade de São Paulo. Faculdade de Medicina. Divisão de Nefrologia. São Paulo. BR
  • Ono, C.R.; Universidade de São Paulo. Faculdade de Medicina. Divisão de Nefrologia. São Paulo. BR
  • Jayanthi, S.K.; Universidade de São Paulo. Faculdade de Medicina. Divisão de Nefrologia. São Paulo. BR
  • Dettoni, J.B.; Universidade de São Paulo. Faculdade de Medicina. Divisão de Nefrologia. São Paulo. BR
  • Castro, I.; Universidade de São Paulo. Faculdade de Medicina. Divisão de Nefrologia. São Paulo. BR
  • Onuchic, L.F.; Universidade de São Paulo. Faculdade de Medicina. Divisão de Nefrologia. São Paulo. BR
Braz. j. med. biol. res ; 47(7): 584-593, 07/2014. tab, graf
Article in English | LILACS | ID: lil-712971
ABSTRACT
Positron-emission tomography/computed tomography (PET/CT) has improved cyst infection (CI) management in autosomal dominant polycystic kidney disease (ADPKD). The determinants of kidney and/or liver involvement, however, remain uncertain. In this study, we evaluated clinical and imaging factors associated with CI in kidney (KCI) and liver (LCI) in ADPKD. A retrospective cohort study was performed in hospital-admitted ADPKD patients with suspected CI. Clinical, imaging and surgical data were analyzed. Features of infected cysts were evaluated by PET/CT. Total kidney (TKV) and liver (TLV) volumes were measured by CT-derived multiplanar reconstruction. CI was detected in 18 patients who experienced 24 episodes during an interval of 30 months (LCI in 12, KCI in 10 and concomitant infection in 2). Sensitivities of CT, magnetic resonance imaging and PET/CT were 25.0, 71.4, and 95.0%. Dysuria (P<0.05), positive urine culture (P<0.01), and previous hematuria (P<0.05) were associated with KCI. Weight loss (P<0.01) and increased C-reactive protein levels (P<0.05) were associated with LCI. PET/CT revealed that three or more infected cysts were present in 70% of the episodes. TKV was higher in kidney-affected than in LCI patients (AUC=0.91, P<0.05), with a cut-off of 2502 mL (72.7% sensitivity, 100.0% specificity). TLV was higher in liver-affected than in KCI patients (AUC=0.89, P<0.01) with a cut-off of 2815 mL (80.0% sensitivity, 87.5% specificity). A greater need for invasive procedures was observed in LCI (P<0.01), and the overall mortality was 20.8%. This study supports PET/CT as the most sensitive imaging method for diagnosis of cyst infection, confirms the multifocal nature of most hospital-admitted episodes, and reveals an association of kidney and liver volumes with this complication.
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Full text: Available Index: LILACS (Americas) Main subject: Polycystic Kidney, Autosomal Dominant / Cysts / Hospitalization / Kidney / Liver Type of study: Diagnostic study / Observational study / Risk factors Limits: Adult / Female / Humans / Male Country/Region as subject: South America / Brazil Language: English Journal: Braz. j. med. biol. res Journal subject: Biology / Medicine Year: 2014 Type: Article Affiliation country: Brazil Institution/Affiliation country: Universidade de São Paulo/BR

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Full text: Available Index: LILACS (Americas) Main subject: Polycystic Kidney, Autosomal Dominant / Cysts / Hospitalization / Kidney / Liver Type of study: Diagnostic study / Observational study / Risk factors Limits: Adult / Female / Humans / Male Country/Region as subject: South America / Brazil Language: English Journal: Braz. j. med. biol. res Journal subject: Biology / Medicine Year: 2014 Type: Article Affiliation country: Brazil Institution/Affiliation country: Universidade de São Paulo/BR