Foam Sclerotherapy for Cyst Volume Reduction in Autosomal Dominant Polycystic Kidney Disease: A Prospective Cohort Study

Ioan-Andrei Iliuta; Beili Shi; Marina Pourafkari; Pedram Akbari; Giancarlo Bruni; Ralph Hsiao; Steffan F Stella; Korosh Khalili; Eran Shlomovitz; York Pei

doi:10.1016/j.xkme.2019.07.015

Foam Sclerotherapy for Cyst Volume Reduction in Autosomal Dominant Polycystic Kidney Disease: A Prospective Cohort Study

Kidney Med. 2019 Oct 18;1(6):366-375. doi: 10.1016/j.xkme.2019.07.015. eCollection 2019 Nov-Dec.

Authors

Affiliations

¹ Division of Nephrology, University Health Network and University of Toronto, Toronto, Ontario, Canada.
² Department of Medical Imaging, University Health Network and University of Toronto, Toronto, Ontario, Canada.
³ Division of General Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada.

Abstract

Rationale & objective: Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disorder. Progressive increase in cyst number and size leads to kidney failure in a majority of patients. Large kidney cysts, although few, can be especially deleterious by impeding kidney blood flow and obstructing urine flow over a large region. Foam sclerotherapy is a minimally invasive procedure that may be used to ablate large cysts. We examined the effectiveness and safety of foam sclerotherapy for kidney volume reduction in patients with ADPKD.

Study design: Prospective cohort study.

Setting & participants: Adults with ADPKD at a tertiary referral center in Toronto.

Predictor: Foam sclerotherapy.

Outcomes: Volume of treated kidneys and adverse events.

Analytical approach: Treated and nontreated kidney volume, kidney function, tolerability, and symptoms were analyzed within each patient.

Results: We performed 77 foam sclerotherapy treatment sessions in 66 patients. Foam sclerotherapy was associated with a 21.8% volume reduction of the treated kidneys (n = 95; median, 1,138 [IQR, 801-1,582] mL before vs 891 [IQR, 548-1,450] mL after; P < 0.001), while the volume of the nontreated kidneys increased by 3.4% during the same time frame (n = 37; median, 655 [IQR, 352-998] mL before vs 677 [IQR, 371-1,164] mL after; P < 0.001). 4 (6%) patients had a higher measured creatinine clearance by at least 10 mL/min at least 12 months after foam sclerotherapy. 9 (14%) patients experienced self-limiting pain at the procedure site and 2 (3%) had cyst or urinary tract infection. Most patients with flank/back pain, abdominal pain, and abdominal distension had improvement in their symptoms.

Limitations: Small sample, observational data.

Conclusions: Foam sclerotherapy is a safe and effective procedure for kidney volume reduction and amelioration of compressive symptoms in select patients with ADPKD. Further studies are needed to assess its effects on kidney blood flow and kidney function and determine the subgroups of patients most likely to benefit.

Keywords: Foam sclerotherapy; autosomal dominant polycystic kidney disease; cyst ablation; kidney volume reduction.