title: Screening for Unruptured Intracranial Aneurysms in Autosomal Dominant Polycystic Kidney Disease: A Survey of 420 Nephrologists.
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Université Paris-Descartes; Faculté de Médecine; AP-HP; Service de Néphrologie, Hôpital Necker-Enfants Malades, Paris, France.
authors.forename: Adrien
authors.initials: A
authors.lastname: Flahault
authors.affiliation: Université Paris-Descartes, INSERM UMR 894, Service de Neuroradiologie, Centre Hospitalier Sainte-Anne, Paris, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Trystram
authors.affiliation: Université Paris-Descartes; Faculté de Médecine; AP-HP; Service de Néphrologie, Hôpital Necker-Enfants Malades, Paris, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Fouchard
authors.affiliation: Université Paris-Descartes; Faculté de Médecine; AP-HP; Service de Néphrologie, Hôpital Necker-Enfants Malades, Paris, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Knebelmann
authors.affiliation: Université Paris-Descartes, INSERM UMR 894, Service de Neurochirurgie, Centre Hospitalier Sainte-Anne, Paris, France.
authors.forename: François
authors.initials: F
authors.lastname: Nataf
authors.affiliation: Université Paris-Descartes; Faculté de Médecine; AP-HP; Service de Néphrologie, Hôpital Necker-Enfants Malades, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Joly
mesh_terms: D005060:Europe / Q000453:epidemiology; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D018810:Magnetic Resonance Angiography; D008403:Mass Screening; D009398:Nephrology; D010820:Physicians; D016891:Polycystic Kidney, Autosomal Dominant / Q000150:complications*; D017410:Practice Guidelines as Topic / Q000592:standards*; D015995:Prevalence; D011795:Surveys and Questionnaires