Does hydration status influence kidney volume in autosomal dominant polycystic kidney disease?

Autosomal dominant polycystic kidney disease (ADPKD) is a progressive kidney disease where the size of the kidneys is correlated to the stage of kidney failure. Total kidney volume (TKV) is used as a prognostic marker to determine disease stage, progression, and possible effect of treatment. It has been shown that water restriction is associated with reduced kidney volume in healthy subjects. The aim of this study was to evaluate the relationship between TKV and hydration status in ADPKD patients. 40 ADPKD patients with chronic kidney disease stage 1 - 3 were randomized to either 3 hours of water restriction (n = 21) or 1 hour of water loading (n = 19; intake: 20 mL/kg). The patients had a mean age of 38 years (19 - 73) and mean plasma creatinine level of 91 (54 - 178) µmol/L. Magnetic resonance imaging of the kidneys was performed before and after intervention, and TKV was measured using the ellipsoid formula. Water restriction resulted in an insignificant 0.67% increase in TKV (median: 1.48, interquartile range (IQR): 6.1, range: -1. - 4.5). Water loading resulted in an insignificant 2.67% increase in TKV (median: 3.18, IQR: 11.4, range: -3.6 - 7.8). Interestingly, a 7.09% increase in right-kidney volume was found after water loading (median: 5.58, IQR: 9.4 range: 1.9 - 11.3, p < 0.05), whereas the left-kidney volume showed an insignificant decrease of 0.18% after water loading (median: -1.65, IQR: 18.0, range: -12.5 - 5.5). We found in ADPKD patients that neither short-term water restriction nor acute water loading had significant effects, suggesting that the use of TKV for disease staging is independent of hydration level in these patients.

[Autosomal dominant polycystic kidney disease].

Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic disorder which causes end stage renal disease. In Denmark, estimated 5,000 patients are living with the disease. Most of the patients are in regular contact with physicians due to the progression of kidney failure causing hypertension as well as cyst infections, back pain, abdominal distension and other symptoms caused by the enlarged kidneys. In this article we describe the clinical presentation, the genetics, the pathophysiology and the current and future treatment modalities of the disease.

[Fatal intracerebral haemorrhage possibly caused by interaction between paracetamol and warfarin]. / Fatal cerebral blødning på grund af mulig interaktionmellem paracetamol og warfarin

This is a case report of an 83-year-old man in warfarin treatment with stable international normalised ratio (INR) after aortic valve replacement and atrial fibrillation. Due to back pain he took paracetamol (acetaminophen) 4 g/day, morphine 30 mg/day and diclofenac as rescue medication for two weeks. After 14 days of treatment he was admitted to a hospital with acute neurological deficits, and a blood sample showed INR levels above 10. A CT-scan of the brain showed an intracerebral haemorrhage. The patient died eight days after admission. Mechanisms of the possible interaction between paracetamol and warfarin are discussed.