Nephrectomy in autosomal dominant polycystic kidney disease: a consensus statement of the ERA Genes & Kidney Working Group
Por:
Geertsema, P, Gansevoort, RT, Arici, M, Capasso, G, Gall, ECL, Furlano, M, Fuster, DG, Galletti, F, Dos Santos, VG, Gomez, MVP, Goumenos, D, Halbritter, J, Jambon, E, Korst, U, Leliveld-Kors, AM, Musquera, M, Figueiredo, A, Nijenhuis, T, Olsburgh, J, Pol, RA, Sayer, JA, Stippel, D, Torra, R, Müller, RU, Casteleijn, NF
Publicada:
1 may 2025
Ahead of Print:
1 mar 2025
Resumen:
A substantial number of patients with autosomal dominant polycystic kidney disease (ADPKD) undergo a nephrectomy, especially in workup for a kidney transplantation. Currently, there is no evidence-based algorithm to guide clinicians about which patients should undergo nephrectomy, the optimal timing of this procedure, or the preferred surgical technique. This systematic review-based consensus statement aimed to answer important questions regarding nephrectomy in ADPKD. A literature review was performed and extended to a meta-analysis when possible. For this purpose, PubMed and EMBASE were searched up to May 2024. Fifty-four publications, describing a total of 2391 procedures, were included. In addition, an exploratory questionnaire was sent to urologists, nephrologists, and transplant surgeons. These sources were used to develop practice points about indications, complications, mortality, and timing and technique of nephrectomy. In addition, data on renal embolization as a potential alternative to nephrectomy were explored and summarized. To reach consensus, practice points were defined and improved in three Delphi survey rounds by experts of the European Renal Association Working Group Genes & Kidney and the European Association of Urology Section of Transplantation Urology. A total of 23 practice points/statements were developed, all of which reached consensus. Among others, it was deemed that nephrectomy can be performed successfully for various indications and is an intermediate risk procedure with acceptable mortality and minimal impact on kidney graft function when performed before, in the same session or after transplantation. The complication rate seems to increase when the procedure is performed as an emergency. During the workup for transplantation, patient complaints should be assessed routinely by questionnaires to indicate symptom burden. Deciding on the need for nephrectomy and exploring potential alternatives such as kidney embolization should be a process of shared decision-making, preferably after multidisciplinary consultation.
10.1093/ndt/gfaf019 Video Abstract Watch the video of this contribution at https://academic.oup.com/ndt/pages/author_videos gfaf019Media1 6370233061112
Filiaciones:
Geertsema, P:
Univ Groningen, Univ Med Ctr Groningen, Dept Nephrol, Groningen, Netherlands
Gansevoort, RT:
Univ Groningen, Univ Med Ctr Groningen, Dept Nephrol, Groningen, Netherlands
Arici, M:
Hacettepe Univ, Fac Med, Dept Ophthalmol, Altindag, Ankara, Turkiye
Capasso, G:
Univ Campania Luigi Vanvitelli, Dept Translat Med Sci, Naples, Italy
Biogem Inst Mol Biol & Genet, Ariano Irpino, Italy
Gall, ECL:
Univ Brest, Ctr Hospitalier Reg, Ctr Invest Clin, Unite Mixte Rech 1078,Genet Genomique fonct & Biot, Brest, France
Furlano, M:
Univ Autonoma Barcelona, Nephrol Dept, Fundacio Puigvert, Barcelona, Spain
Univ Autonoma Barcelona, Inst Recerca St Pau IR St Pau, Barcelona, Spain
Univ Autonoma Barcelona, Dept Med, Barcelona, Spain
Fuster, DG:
Univ Bern, Bern Univ Hosp, Dept Nephrol & Hypertens, Inselspital, Bern, Switzerland
Galletti, F:
PKD Int, Geneva, Switzerland
Dos Santos, VG:
Univ Alcala, Hosp Univ Ramon & Cajal, Dept Urol, Inst Ramon & Cajal Invest Sanitaria IRYCIS, Madrid, Spain
Gomez, MVP:
IIS Fdn Jimenez Diaz UAM, Dept Nephrol & Hypertens, Madrid, Spain
Goumenos, D:
Univ Hosp Patras, Dept Nephrol & Renal Transplantat, Patras, Greece
Halbritter, J:
Free Univ Berlin, Dept Nephrol & Med Intens Care, Charite Univ Med Berlin, Berlin, Germany
Humboldt Univ, Berlin, Germany
Jambon, E:
Pellegrin Univ Hosp, Dept Diagnost & Intervent Radiol, Bordeaux, France
Korst, U:
PKD Int, Geneva, Switzerland
Leliveld-Kors, AM:
Univ Groningen, Univ Med Ctr Groningen, Dept Urol, Groningen, Netherlands
Musquera, M:
Univ Barcelona, Hosp Clin Barcelona, Dept Urol, Barcelona, Spain
Figueiredo, A:
Hosp Univ Coimbra, Dept Pathol, Unidade Local Saude Coimbra, Coimbra, Portugal
Univ Coimbra, Fac Med, Coimbra, Portugal
Nijenhuis, T:
Radboud Univ Nijmegen, Med Ctr, Res Inst Med Innovat, Med Ctr, Nijmegen, Netherlands
Olsburgh, J:
Guys & St ThomasNHS Fdn Trust, Dept Anaesthesia, London, England
Pol, RA:
Univ Groningen, Univ Med Ctr Groningen, Dept Surg, Groningen, Netherlands
Sayer, JA:
Newcastle Univ, Biosci Inst, Fac Med Sci, Newcastle Upon Tyne, England
Newcastle Tyne Hosp NHS Fdn Trust, Newcastle Upon Tyne, England
Stippel, D:
Univ Hosp Cologne, Dept Gen Visceral Canc & Transplant Surg, Cologne, Germany
Torra, R:
Univ Autonoma Barcelona, Nephrol Dept, Fundacio Puigvert, Barcelona, Spain
Univ Autonoma Barcelona, Inst Recerca St Pau IR St Pau, Barcelona, Spain
Univ Autonoma Barcelona, Dept Med, Barcelona, Spain
Müller, RU:
Univ Cologne, Dept Internal Med 2, Cologne, Germany
Ctr Mol Med Cologne, Cologne, Germany
Fac Med, Cologne, Germany
Univ Hosp Cologne, Cologne, Germany
Univ Cologne, Fac Med, Ctr Rare Dis Cologne, Cologne, Germany
Univ Cologne, Univ Hosp Cologne, Ctr Rare Dis Cologne, Cologne, Germany
Univ Cologne, Cologne, Germany
Casteleijn, NF:
Univ Groningen, Univ Med Ctr Groningen, Dept Urol, Groningen, Netherlands
Ommelander Ziekenhuis Groningen, Dept Urol, Scheemda, Netherlands
Green Submitted, hybrid
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