Successful peritoneal dialysis after renal transcatheter arterial embolization in autosomal dominant polycystic kidney disease.

摘要

When continuous ambulatory peritoneal dialysis (CAPD) is performed in patients with autosomal dominant polycystic kidney disease (ADPKD), various complications specific to ADPKD, such as abdominal hernias, leakage of dialysate from the peritoneal cavity, and enlargement of the kidneys or liver, need to be considered. We encountered a patient with ADPKD who had severe nephromegaly and abdominal swelling that progressed even after starting CAPD. To treat enlarged kidneys in patients with ADPKD, renal transcatheter arterial embolization (TAE) is a therapeutic option. We report the outcome of TAE in our CAPD patient, a 63-year-old Japanese woman who was admitted to our hospital to treat enlarged kidneys 4 years after starting CAPD for end-stage renal disease secondary to ADPKD. Residual kidney function was minimal. TAE was performed for both kidneys using platinum microcoils under epidural anesthesia. Six months after TAE, volumes of the left and right kidneys had decreased from 3,037 to 1,440 cm~3 and 5,251 to 1,884 cm~3, respectively, and the patient's abdominal distension (with umbilical and inguinal hernias) subsided (Fig 1). Peritoneal dialysis (PD) fluid volume could be increased from 1,200 to 1,600 mL. Weekly Kt/V increased from 1.38 to 1.76, and total creatinine clearance increased from 27.8 to 44.4 L/wk when using 1,600 mL of PD fluid (Fig 1). Prolongation of the duration of PD was achieved. We conclude that renal TAE is a therapeutic option for patients with ADPKD for whom PD fluid volume is limited by nephromegaly.