Nephrectomy seen as effective as intermediate risk procedure in autosomal dominant PKD
Key takeaways:
- Nephrectomy can be effectively performed in patients with autosomal dominant PKD for various indications, such as symptom relief.
- Risk for complications may rise when nephrectomy is done in emergency situations.
Nephrectomy can serve as an intermediate risk procedure in patients with autosomal dominant polycystic kidney disease when performed in conjunction with transplantation.
A systematic review-based consensus underlined the safety and efficacy of the procedure before, during or after kidney transplant in managing symptoms to optimize outcomes.
“When patients with [autosomal dominant polycystic kidney disease] ADPKD reach kidney failure, kidney transplantation is the preferred modality in most patients,” Paul Geertsema, MD, of the University Medical Center Groningen Department of Nephrology in The Netherlands, wrote with colleagues. “In a substantial number of patients, nephrectomy of one or both native kidneys is performed in the time period around a transplantation.” Yet, “at present, there is no evidence-based algorithm to guide clinicians on which patients with ADPKD should undergo nephrectomy, the optimal timing of the procedure, or the preferred technique. Protocols vary among hospitals, highlighting the lack of consensus,” they wrote.
University researchers conducted a literature review and meta-analysis of the PubMed and EMBASE databases, up to May 2024, to assess nephrectomy indications, complications and timing for patients with ADPKD. Overall, 54 studies of 2,391 nephrectomy procedures were included.
The study employed an exploratory questionnaire among urologists, nephrologists and transplant surgeons to finalize 23 key practice points, which all reached consensus through three Delphi surveys by members of the European Renal Association Working Group Genes and Kidney, and European Association of Urology Section of Transplantation Urology.
Researchers concluded that nephrectomy can be effectively performed for patients with ADPKD for various indications, such as symptom relief, with acceptable mortality and minimal impact on kidney graft function.
Risk for complications may rise when nephrectomy is done in emergency situations, highlighting the need for regular evaluations in pre-transplant work-up, according to the researchers.
“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,” according to the researchers. “We propose a dedicated work-up to decide whether a nephrectomy is indicated in the period just before a kidney transplantation. This will help improve targeted decision-making processes in the future.”
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