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2016 ; 11
(4
): e0153176
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Screening for Unruptured Intracranial Aneurysms in Autosomal Dominant Polycystic
Kidney Disease: A Survey of 420 Nephrologists
#MMPMID27054719
Flahault A
; Trystram D
; Fouchard M
; Knebelmann B
; Nataf F
; Joly D
PLoS One
2016[]; 11
(4
): e0153176
PMID27054719
show ga
BACKGROUND: Despite a high prevalence of intracranial aneurysm (ICA) in autosomal
dominant polycystic kidney disease (ADPKD), rupture events are rare. The current
recommendations for ICA screening are based on expert opinions and studies with
low levels of evidence. OBJECTIVES: The aim of our study was to describe the
attitudes of practicing nephrologists in Europe towards screening for ICA using
magnetic resonance angiography (MRA). METHODS: We conducted a web-based survey
among 1315 European French-speaking nephrologists and nephrology residents. An
anonymous, electronic questionnaire including 24 independent questions related to
ICA screening modalities, indications and participant profiles was sent by email
between September and December 2014. Four hundred and twenty nephrologists
(mostly from France) participated, including 31 nephrology residents; the
response rate was 32%. RESULTS: Systematic screening for ICA was advocated by 28%
of the nephrologists. A family history of ICA rupture, sudden death, stroke and
migraine were consensual indications for screening (> 90% of the panel). In other
clinical situations largely not covered by the recommendations (pregnancy,
nephrectomy, kidney transplantation, cardiac or hepatic surgery, uncontrolled
hypertension, lack of familial ADPKD history, at-risk activity, tobacco use), the
attitudes towards screening were highly divergent. ICA screening was influenced
by nephrologists experience with ADPKD and by their practice setting. The
majority of participants (57%) would not repeat a normal ICA screening. Only a
few participants (22%) knew that non-contrast MRA was the reference diagnostic
tool for ICA screening, whereas most participants thought that contrast
enhancement was necessary to screen for ICA. The results from the nephrology
residents were analyzed separately and yielded similar results. CONCLUSION: This
practice survey revealed that most nephrologists follow the current
recommendations for the initial screening of ICAs. However, more than a quarter
of the panel was in favor of systematic ICA screening, most nephrologists did not
know that contrast medium was not necessary to screen for ICA using MRA, and many
areas of uncertainty remain.