[en] A substantial number of patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD) undergo a nephrectomy, especially in work-up for a kidney transplantation. Currently, there is no evidence-based algorithm to guide clinicians which patients should undergo nephrectomy, the optimal timing of this procedure, or the preferred surgical technique. This systematic review-based consensus statement aimed to answer important questions regarding nephrectomy in ADPKD. A literature review was performed and extended to a meta-analysis when possible. For this purpose, PubMed and EMBASE were searched up to May 2024. Fifty-four publications, describing a total of 2391 procedures, were included. In addition, an exploratory questionnaire was sent to urologists, nephrologists, and transplant-surgeons. These sources were used to develop practice points about indications, complications, mortality, timing, and technique of nephrectomy. In addition, data on renal embolization as a potential alternative to nephrectomy was explored and summarized. To reach consensus, practice points were defined and improved in three Delphi survey rounds by experts of the European Renal Association Working Group Genes & Kidney and the European Association of Urology Section of Transplantation Urology. A total of 23 practice points/statements were developed, all of which reached consensus. Among others, it was deemed that nephrectomy can be performed successfully for various indications and is an intermediate risk procedure with acceptable mortality and minimal impact on kidney graft function when performed before, in the same session or after transplantation. The complication rate seems to increase when the procedure is performed as an emergency. During the work-up for transplantation, patient complaints should be assessed routinely by questionnaires to indicate symptom burden. 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.
Disciplines :
Urology & nephrology
Author, co-author :
Geertsema, Paul ; Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Gansevoort, Ron T; Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Arici, Mustafa; Department of Nephrology, Faculty of Medicine, Hacettepe University, Altındağ, Ankara, Turkey
Capasso, Giovambattista ; Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy ; Biogem Research Institute, Ariano Irpino, Italy
Cornec-Le-Gall, Emilie ; University of Brest, Inserm, Unité Mixte de Recherche 1078, Génétique, Génomique fonctionnelle et Biotechnologies, Centre Hospitalier Universitaire Brest, Centre de Références Maladies Rénales Héréditaires de l'Adulte et de l'Enfant MARHEA, Brest, France
Furlano, Monica; Nephrology Department, Fundació Puigvert, Institut d'Investigacions Biomèdiques Sant Pau (IIB-Sant Pau), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
Fuster, Daniel G ; Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Gómez-Dos-Santos, Victoria; Fundación Jiménez Díaz University Hospital Health Research Institute, Madrid, Spain
Perez-Gomez, Maria Vanessa ; Transplantation and Research Unit, Hospital Ramón y Cajal, Alcalá University, Carretera de Colmenar Km 9.100, Madrid, Spain
Goumenos, Dimitrios; Department of Nephrology and Renal Transplantation, University Hospital of Patras, Patras, Greece
Halbritter, Jan; Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
Jambon, Eva; Department of Diagnostic and Interventional Radiology, Pellegrin University Hospital, Place Amélie-Raba-Léon, F-33076 Bordeaux, France
Leliveld, Anna M; Department of Urology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Felip, Mireia Musquera; Department of Urology, Hospital Clinic of Barcelona, Barcelona, Spain
Figueiredo, Arnaldo; Department of Urology and Renal Transplantation, Hospital and University Centre of Coimbra, Praceta Professor Mota Pinto, 3004-561, Coimbra, Portugal
Nijenhuis, Tom ; Department of Nephrology, Research Institute of Medical Innovations, Radboud University Medical Centre, Nijmegen, The Netherlands
Olsburgh, Jonathon; Department of Urology & Transplant Surgery, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
Pol, Robert A ; Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Sayer, John A; Bioscience Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK, Renal Services, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Road, Newcastle upon Tyne, UK
Stippel, Dirk; Department of General, Visceral, Cancer and Transplant Surgery, University Hospital Cologne, Köln, Germany
Torra, Roser ; Nephrology Department, Fundació Puigvert, Institut d'Investigacions Biomèdiques Sant Pau (IIB-Sant Pau), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
Müller, Roman-Ulrich ; Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany ; Center for Rare Diseases Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany ; Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
Casteleijn, Niek F; Department of Urology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands ; Department of Urology, Ommelander Ziekenhuis Groningen, Scheemda, The Netherlands
members of the study group
Jouret, François ; Université de Liège - ULiège > Département des sciences cliniques > Néphrologie
Weekers, Laurent ; Université de Liège - ULiège > Département des sciences cliniques > Néphrologie
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