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Intracranial aneurysms (IAs) are a common extra-renal manifestation of Autosomal Dominant Polycystic Kidney Disease (ADPKD), with prevalences of up to 17%, contrasting with occurrences in the general population (typically 1-2%). However, the need for selective or generalized screening remains controversial. The present study aimed to characterize the prevalence and clinical course of IAs in a sample of Brazilian ADPKD patients.
A retrospective analysis of medical records of adult patients followed at an outpatient clinic for ADPKD between 2002 and 2022 was conducted. Patients with Magnetic Resonance Angiography (MRA) were selected, and demographic, clinical, and aneurysm-related data were analyzed.
Three hundred fifty-two (352) out of a total of 753 patients with ADPKD, who had available MRA, were included. Thirty-seven (37) of the 352 patients (10.5%) were diagnosed with IA (8 males/29 females). Hypertension, smoking, and dyslipidemia were present in 97.3%, 49.6%, and 45.9% of the patients, respectively. A positive family history of IA and stroke was present in 29.7% and 21.6% of them. The mean age at ADPKD diagnosis was 39 ± 15 years. Among the patients with available Mayo Clinic classification (N=23), 13 (65.9%) were classified as rapid progressors. A total of 53 aneurysms were found, with 11 patients having 2 or more IAs. At the time of IA diagnosis, patients were classified as CKD stages 1 (17.1%), 2 (22.9%), 3A (14.3%), 3B (28.6%), 4 (8.6%), and 5 (8.6%). Regarding location and size, 90.6% were in the anterior circulation (the middle cerebral artery was the most frequent, occurring in 56.5%), with 17.0% being ≥ 7mm. Only 1 patient (2.7%) had an aneurysm rupture, and 10 underwent surgery (90% by clipping). Among the patients who underwent surgery, only 60% had a positive family history of IA or stroke, suggesting that without MRA screening, IA could likely rupture at some point.
Present findings showed a similar prevalence of IAs to the literature, affecting more women, especially the ones smoking and with arterial hypertension, even without a family history. By means of a generalized screening, one third of the patients received surgical treatment, potentially preventing severe complications, suggesting that a regular screening approach might be of utmost importance in ADPKD patients. This abstract was presented at the Congresso Paulista de Nefrologia held in 2023 (Atibaia, São Paulo, Brazil). The event organizers permit resubmission of abstracts.