Dépistage des anévrismes cérébraux dans la polykystose rénale autosomique dominante ; évaluation des pratiques des néphrologues en France et de l’impact d’un dépistage ciblé

Abstract : Intracranial cerebral aneurisms (ICA) are a frequent extra-renal manifestation of autosomal dominant polycystic kidney disease (ADPKD). Its main complication is subarachnoid haemorrhage, which is associated with a high morbidity and mortality. Aneurysms can be screened using time-of-flight magnetic resonance imagery (MRI) without gadolinium enhancement. A web-based survey was conducted among 420 French-speaking nephrologists to determine the determinants of screening for ICA in ADPKD patients. Patients consulting for ADPKD at Necker hospital had a targeted ICA screening using MRI. They were followed-up prospectively for subarachnoid haemorrhage, and the results of the screening MRI, if performed, were recorded. ICA screening practices were very heterogeneous among the nephrologists who participated to our study, apart from a few consensual indications such as in case of family history of subarachnoid haemorrhage. After targeted screening, the rate of aneurisms detected was high. However, subarachnoid haemorrhage occurred mostly in the population not targeted by this screening. Benefits of ICA screening in ADPKD have never been evaluated with a prospective, controlled study, and systematic screening is not recommended according to expert opinions. This study shows the necessity to evaluate the benefits of systematic versus targeted screening of ICA in this population using a randomised controlled trial. It will help to predict the rate of events and therefore to determine the number of subjects to include in such study.
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Master thesis
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Adrien Flahaut. Dépistage des anévrismes cérébraux dans la polykystose rénale autosomique dominante ; évaluation des pratiques des néphrologues en France et de l’impact d’un dépistage ciblé. Médecine humaine et pathologie. 2015. ⟨dumas-01305409⟩

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