Risk Factors for Cerebral Aneurysms, Including Genetic Variants, in Japanese Patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD)

 

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Risk Factors for Cerebral Aneurysms, Including Genetic Variants, in Japanese Patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD)

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Hanna
Miura
Hanna Miura h.suetsugu.lj@juntendo.ac.jp Juntendo University Hospital, Faculty of Medicine, Juntendo University Urology Tokyo Japan *
Keiji Takahashi kei-takahashi@juntendo.ac.jp Juntendo University Hospital, Faculty of Medicine, Juntendo University Urology Tokyo Japan -
Tomoki Kimura to-kimura@juntendo.ac.jp Juntendo University Hospital, Faculty of Medicine, Juntendo University Urology Tokyo Japan -
Satoru Muto s-muto@juntendo.ac.jp Juntendo University Nerima Hospital, Faculty of Medicine, Juntendo University Urology Tokyo Japan -
Haruna Kawano harunase@juntendo.ac.jp Juntendo University Hospital, Faculty of Medicine, Juntendo University Urology Tokyo Japan -
Shigeo Horie shorie@juntendo.ac.jp Juntendo University Hospital, Faculty of Medicine, Juntendo University Urology Tokyo Japan -
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Intracranial aneurysm (IA) is a highly significant comorbid condition of autosomal dominant polycystic kidney disease (ADPKD). To date, no study in Japan has investigated ADPKD-associated IA using genetic analysis. While the prevalence of IA in the general population is reported to be 2–4%, it is markedly higher in ADPKD patients, ranging from 9% to 23%, leading to an increased risk of subarachnoid hemorrhage (SAH). The present study aims to elucidate the prevalence and clinical features of IA and SAH in ADPKD, and to identify associated risk factors, including genetic determinants.

Among 370 ADPKD patients at our institution who provided informed consent and underwent genetic analysis, 70 patients with intracranial aneurysm (IA) or subarachnoid hemorrhage (SAH) were retrospectively identified, and risk factors for IA/SAH were analyzed.


The median age at diagnosis of IA/SAH was 48 years (range, 21–77), with 40% male (n=28) and 60% female (n=42). A family history of IA was observed in 28.6% (n=20), and rupture occurred in 11.4% (n=8). The median aneurysm size was 2.5 mm (range, 1.0–8.0 mm). The distribution of genetic variants among patients with IA/SAH was as follows: PKD1-truncated, 42.6% (n=29); PKD1-non-truncated, 29.7% (n=20); PKD2-truncated, 21.8% (n=14); and PKD2-non-truncated, 6.3% (n=5). These proportions were not significantly different compared with those in the overall ADPKD cohort at our institution. In patients with PKD2-non-truncated variants, however, the likelihood of having a family history of IA was significantly higher (p=0.0213).


Our analysis suggests that there is no difference in aneurysm risk based on ADPKD genotype. This finding indicates that screening for IA and raising awareness of preventive measures are also necessary for patients with PKD2, in whom renal function is relatively preserved. Furthermore, our analysis confirmed that avoiding smoking and achieving early smoking cessation are critical for the prevention of IA/SAH, and that strict blood pressure control is of paramount importance.

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