TY - JOUR
T1 - Nephrectomy in Autosomal Dominant Polycystic Kidney Disease
T2 - A consensus statement of the ERA Genes & Kidney Working Group
AU - members of the study group
AU - Geertsema, Paul
AU - Gansevoort, Ron T
AU - Arici, Mustafa
AU - Capasso, Giovambattista
AU - Cornec-Le-Gall, Emilie
AU - Furlano, Monica
AU - Fuster, Daniel G
AU - Galletti, Flavia
AU - Gómez-Dos-Santos, Victoria
AU - Perez-Gomez, Maria Vanessa
AU - Goumenos, Dimitrios
AU - Halbritter, Jan
AU - Jambon, Eva
AU - Korst, Uwe
AU - Leliveld, Anna M
AU - Felip, Mireia Musquera
AU - Figueiredo, Arnaldo
AU - Nijenhuis, Tom
AU - Olsburgh, Jonathon
AU - Pol, Robert A
AU - Sayer, John A
AU - Stippel, Dirk
AU - Torra, Roser
AU - Müller, Roman-Ulrich
AU - Casteleijn, Niek F
N1 - © The Author(s) 2025. Published by Oxford University Press on behalf of the ERA.
PY - 2025/1/23
Y1 - 2025/1/23
N2 - 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.
AB - 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.
U2 - 10.1093/ndt/gfaf019
DO - 10.1093/ndt/gfaf019
M3 - Article
C2 - 39848914
SN - 0931-0509
JO - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
M1 - gfaf019
ER -