Diagnosis of infected kidney cysts in patients with autosomal dominant polycystic kidney disease and end-stage renal disease


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Abstract

Aim: to improve the differential diagnosis of infected cysts in patients with ADPKD and to reduce false-positive rate of MR-urography. Materials and methods: a total of 33 patients with ADPKD who underwent bilateral nephrectomy from 2015 to 2020 were included in the retrospective single-center study. In the group 1 (n=17) patients with histologically confirmed infected cyst (s) were included, while in the group 2 (n=16) there were patients without infected cysts. The frequency of symptoms (pain in the loin area, fever), the level of leukocytes in blood and urine, C-reactive protein (CRP) and the results of kidney MRI were compared. Results. Pain, fever, leukocytosis, leukocyturia, and increased CRP levels were significantly associated with infected cysts. The sensitivity and specificity of MRI was 88.2% and 43.8%, respectively. The infected cysts were characterized by a significantly (p=0.004) lower value of the apparent diffusion coefficient (ADC): 0.67±0.21x10-3 mm2/s (95% confidence interval (CI) 0.56-0.79), versus 1.2±0.59*10-3 mm2/s (95% CI 0.89-1.5) in group 2. According to ROC analysis, the ADC value at the cut-off point was 0.83*10-3 mm2/s. The frequency of infected cysts during histological examination increased when the volume of the cyst was more than 13 ml. In multivariate analysis, only the CRP level was a reliable predictor of the presence of infected cysts. ROC analysis showed that the CRP level at the cut-off point was 83 mg/L (sensitivity 70.6%, specificity 75%). Conclusion: In case of fever, pain in the loin area and high CRP level in patients with ADPKD, it is necessary to exclude infected cysts. MRI of the kidneys with the determination of the ADC level in cysts with limited diffusion on diffusion-weighted images is a highly informative method that allows to clarify the content of cysts.

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About the authors

A. E Lubennikov

City clinical hospital No 52, Moscow Healthcare Department

Email: lualev@yandex.ru
Ph.D., urologist at the Department of Urology

A. A Shishimorov

City clinical hospital No 52, Moscow Healthcare Department

Email: dr.shishimorov@mail.ru
radiologist

R. N Trushkin

City clinical hospital No 52, Moscow Healthcare Department

Email: uro52@mail.ru
Ph.D., head of the Department of Urology

T. K Isaev

City clinical hospital No 52, Moscow Healthcare Department

Email: dr.isaev@mail.ru
PhD, urologist at the Department of Urology

O. N Kotenko

City clinical hospital No 52, Moscow Healthcare Department

Email: olkotenko@yandex.ru
Ph.D., chief nephrologist of the Moscow Healthcare Department

G. E Krupinov

FGAOU VO I.M. Sechenov First Moscow State Medical University

Email: gekrupinov@mail.ru
Ph.D., Professor at the Institute of Urology and Reproductive Health

References

  1. Chapman A.B., Devuyst O., Eckardt K.U., Gansevoort R.T., Harris T., Horie S., Kasiske B.L., Odland D., Pei Y., Perrone R.D., Pirson Y., Schrier RW, Torra R., Torres V.E., Watnick T., Wheeler D.C. Conference Participants. Autosomal-dominant polycystic kidney disease (ADPKD): executive summary from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2015;88(1):17-27. Doi: 10.1038/ ki.2015.59.
  2. Sakhuja A., Nanchal, R.S., Gupta S., Amer H., Kumar G., Albright R., et al. Trends and Outcomes of Severe Sepsis in Patients on Maintenance Dialysis. American journal of nephrology. 2016:43(2) ;97-103. doi: 10.1159/000444684.
  3. Sallee M., Rafat C., Zahar J.R., Paulmier B., Gmnfeld J.P., Knebelmann B., Fakhouri F. Cyst infections in patients with autosomal dominant polycystic kidney disease. Clin J. Am Soc Nephrol. 2009;4(7):1183-1189. doi: 10.2215/CJN.01870309.
  4. Lantinga M.A., Drenth J.P., Gevers T.J. Diagnostic criteria in renal and hepatic cyst infection. Nephrol Dial Transplant. 2015 ;30(5) :744-751. doi: 10.1093/ndt/gfu22.7
  5. Bobot M., Ghez C., Gondouin B., Sallee M., Fournier P.E., Burtey S., Legris T., Dussol B., Berland Y., Souteyrand P., Tessonnier L., Cammilleri S., Jourde-Chiche N. Diagnostic performance of [(18)F]fluorodeoxyglucose positron emission tomography-computed tomography in cyst infection in patients with autosomal dominant polycystic kidney disease. Clin Microbiol Infect. 2016;22(1):71-77. doi: 10.1016/j.cmi.2015.09.024.
  6. Laffon E., Cazeau A.L., Monet A., de Clermont H., Fernandez P., Marthan R., Ducassou D. The effect of renal failure on 18F-FDG uptake: a theoretic assessment. J. Nucl Med Technol. 2008;36(4):200-202. Doi: 10.2967/ jnmt.107.049627.
  7. Zhang W., Blumenfeld J.D., Prince M.R. MRI in autosomal dominant polycystic kidney disease. J. Magn Reson Imaging. 2019;50( 1) :41-51. doi: 10.1002/jmri.26627.
  8. Suwabe T., Ubara Y., Ueno T., Hayami N., Hoshino J., Imafuku A., Kawada M., Hiramatsu R., Hasegawa E., Sawa N., Saitoh S., Okuda I., Takaichi K. Intracystic magnetic resonance imaging in patients with autosomal dominant polycystic kidney disease: features of severe cyst infection in a case-control study. BMC Nephrol. 2016;17(1):170. doi: 10.1186/s12882-016-0381-9.
  9. Jouret F., Lhommel R., Devuyst O., Annet L., Pirson Y., Hassoun Z., Kanaan N. Diagnosis of cyst infection in patients with autosomal dominant polycystic kidney disease: attributes and limitations of the current modalities. Nephrol Dial Transplant. 2012;27(10):3746-3751. doi: 10.1093/ndt/gfs352.
  10. Rathod S.B., Kumbhar S.S., Nanivadekar A., Aman K. Role of diffusion-weighted MRI in acute pyelonephritis: a prospective study. Acta Radiol. 2015;56(2):244-249. doi: 10.1177/0284185114520862.
  11. Rea L.M., Parker R.A. Designing and conducting survey research A Comprehensive Guide / L. M. Rea, R. A. Parker, 2014
  12. Faletti R., Cassinis M.C., Gatti M., et al. Acute pyelonephritis in transplanted kidneys: can diffusion-weighted magnetic resonance imaging be useful for diagnosis and follow-up? Abdom Radiol (NY). 2016;41(3):531-537. doi: 10.1007/s00261-015-0618-2.
  13. Chan J.H., Tsui E.Y., Luk S.H., et al. MR diffusion-weighted imaging of kidney: differentiation between hydronephrosis and pyonephrosis. Clin Imaging. 2001;25(2):110-113. doi: 10.1016/s0899-7071(01)00246-7.
  14. Neuville M., Hustinx R., Jacques J., Krzesinski J.M., Jouret F. Diagnostic Algorithm in the Management of Acute Febrile Abdomen in Patients with Autosomal Dominant Polycystic Kidney Disease. PLoS One. 2016;11(8):e0161277. doi: 10.1371/journal.pone.0161277.
  15. Samouilidou E.C., Grapsa E. Relationship of serum cystatin C. with C-reactive protein and apolipoprotein A1 in patients on hemodialysis. Ren Fail. 2008;30(7):711-715. doi: 10.1080/08860220802212973.
  16. Demir N.A., Sumer S., Celik G., Afsar R.E., Demir L.S., Ural O. How should procalcitonin and C-reactive protein levels be interpreted in haemodialysis patients?. Intern Med J. 2018;48(10): 1222-1228. doi: 10.1111/imj.13952.
  17. Hyodo T., Yoshida K., Sakai T., Baba S. Asymptomatic hyperleukocyturia in hemodialysis patients analyzed by the automated urinary flow cytometer. Ther Apher Dial. 2005;9(5):402-406. doi: 10.1111/j.1744- 9987.2005.00278.x.
  18. Oikonomou K.G., Alhaddad A. The Diagnostic Value of Urinalysis in Hemodialysis Patients with Fever, Sepsis or Suspected Urinary Tract Infection. J. Clin Diagn Res. 2016;10(10):OC11-OC13. Doi: 10.7860/ JCDR/2016/21992.8617.
  19. Vij R., Nataraj S., Peixoto A.J. Diagnostic utility of urinalysis in detecting urinary tract infection in hemodialysis patients. Nephron Clin Pract. 2009;113(4):281-285. doi: 10.1159/000235243.
  20. Banzo J., Ubieto M.A., Gil D., Prats E., Razola P., Tardi'n L., Andres A., Rambalde E.F., Ayala S.M., Cancer L., Velilla J. Diagnostico mediante 18F-FDG PET-TAC de infeccion quistica hepatica en paciente con enfermedad poliquistica renal autosomica dominante y fiebre de origen desconocido [18F-FDG PET/CT diagnosis of liver cyst infection in a patient with autosomal dominant polycystic kidney disease and fever of unknown origin]. Rev Esp Med Nucl Imagen Mol. 2013;32(3):187-189. Spanish. doi: 10.1016/j.remn.2012.09.003.
  21. Verswijvel G., Vandecaveye V., Gelin G., Vandevenne J., Grieten M.,Horvath M., Oyen R., Palmers Y. Diffusion-weighted MR imaging in the evaluation of renal infection: preliminary results. JBR-BTR. 2002;85(2):100-103.
  22. Ichioka K., Saito R., Matsui Y., Terai A. Diffusion-weighted magnetic resonance imaging ofinfected renal cysts in a patient with polycystic kidney disease. Urology. 2007;70(6):1219. doi: 10.1016/j.urology.2007.09.040. '
  23. Chan J.H., Tsui E.Y.,LukS.H.,Fung S.L., Cheung Y.K., Chan M.S., Yuen M.K., Mak S.F., Wong K.P. MR diffusion-weighted imaging of kidney: differentiation between hydronephrosis and pyonephrosis. Clin Imaging. 2001;25(2):110-113. doi: 10.1016/s0899-7071(01)00246-7.
  24. Caroli A., Schneider M., Friedli I., Ljimani A., De Seigneux S., Boor P., Gullapudi L., Kazmi I., Mendichovszky I.A., Notohamiprodjo M., Selby N.M., Thoeny H.C., Grenier N., Vallee J.P. Diffusion-weighted magnetic resonance imaging to assess diffuse renal pathology: a systematic review and statement paper. Nephrol Dial Transplant. 2018;33(suppl_2):ii29-ii40. doi: 10.1093/ndt/gfy163.
  25. Suwabe T., Ubara Y., Sumida K., Hayami N., Hiramatsu R., Yamanouchi M., Hasegawa E., Hoshino J., Sawa N., Saitoh S., Okuda I., Takaichi K. Clinical features of cyst infection and hemorrhage in ADPKD: new diagnostic criteria. Clin Exp Nephrol. 2012;16(6):892-902. Doi: 10.1007/ s10157-012-0650-2.

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