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Clinical Journal of American Society of Nephrology

Clinical Journal of American Society of Nephrology

Screening for Pre-Symptomatic Brain Aneurysms Recommended for People with ADPKD

Screening for Pre-Symptomatic Brain Aneurysms Recommended for People with ADPKD

Which kidney disease patients should get screened brain aneurysm? A new Mayo Clinic study sheds light on brain aneurysm risk factors for people living with autosomal dominant polycystic kidney disease (ADPKD)


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What Does ADPKD Have to Do with Aneurysms?

Autosomal dominant polycystic kidney disease (ADPKD) involves the progressive growth of fluid-filled cysts in both kidneys, enlarging the kidneys and weakening their function. The condition is often also characterized by non-kidney-related abnormalities, including intracranial (brain) aneurysms.

The rupture of brain aneurysms is one of the most challenging complications of ADPKD.

Which ADPKD Patients Are Most Likely to Develop Aneurysms? 

A recent study by the Mayo Clinic shed light on risk factors for aneurysm development in people with ADPKD, resulting in recommendations for screening and lifestyle changes.*

  • Between 1989 and 2017, 812 Mayo Clinic patients with ADPKD received magnetic resonance angiography (MRA) screening for pre-symptomatic brain aneurysms.
  • Of those screened, 75 patients (9%) were diagnosed with 94 unruptured aneurysms (14 patients had multiple aneurysms), and the other 737 patients had no aneurysms. 

The screening detected brain aneurysms more frequently in those with:

  • family history of subarachnoid hemorrhage in a first-degree relative (parent, sibling, or child)
  • persistent high blood pressure (hypertension), defined as greater than or equal to 130/80 mm Hg
  • smoking history

Overall, the study results found that:

  • prevalence of brain aneurysms was four times higher in patients with ADPKD (8-12%) than in the general population (2–3%)
  • the ADPKD group’s rupture rate was about five times higher than in the general population
  • those with aneurysms were found to have more advanced CKD

Are Any Risk Factors Controllable?

Based on the genetic and demographic makeup of the study participants…

Non-modifiable risk factors included:

  • female sex
  • older age
  • prior aneurysm or subarachnoid hemorrhage
  • family history of brain aneurysm or subarachnoid hemorrhage
  • Finnish or Japanese ethnicity

However, some modifiable risk factors were:

  • smoking
  • hypertension
  • excessive alcohol consumption

Minimizing Aneurysm Risk

In response to their findings, the study authors recommended screening for ADPKD patients at highest risk for brain aneurysm growth and rupture, including those:

  • with a family history of brain aneurysm or arachnoid hemorrhage
  • with a high-risk job where an aneurysm rupture could place them or others in danger
  • considering major elective surgery 

In a press release, Mayo Clinic nephrologist and study co-author Vincente Torres, MD, PhD said lifestyle changes and treatment for modifiable risk factors can also significantly reduce aneurysm risk. 

“We educate our patients on the importance of correcting conditions that have been associated with aneurysmal development and/or rupture, particularly smoking and inadequately controlled hypertension,” stated Torres. “The results of our study do not provide a reason for changing our current approach.”

For more information about these findings, visit the Clinical Journal of the American Society of Nephrology

*Sanchis, I.M.; Shukoor, S.; Irazabal, M.V.; et al. (2019, August). Presymptomatic Screening for Intracranial Aneurysms in Patients with Autosomal Dominant Polycystic Kidney Disease. Clinical Journal of American Society of Nephrology, 14(8), 1151-60.

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