[Polycystic kidney disease and kidney transplantation].
OBJECTIVE
To perform a state of the art about autosomal dominant polykystic kidney disease (ADPKD), management of its urological complications and end stage renal disease treatment modalities.


METHODS
An exhaustive systematic review of the scientific literature was performed in the Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of the following keywords (MESH): "autosomal dominant polykystic kidney disease", "complications", "native nephrectomy", "kidney transplantation". Publications obtained were selected based on methodology, language, date of publication (last 10 years) and relevance. Prospective and retrospective studies, in English or French, review articles; meta-analysis and guidelines were selected and analyzed. This search found 3779 articles. After reading titles and abstracts, 52 were included in the text, based on their relevance.


RESULTS
ADPKD is the most inherited renal disease, leading to end stage renal disease requiring dialysis or renal transplantation in about 50% of the patients. Many urological complications (gross hematuria, cysts infection, renal pain, lithiasis) of ADPKD required urological management. The pretransplant evaluation will ask the challenging question of native nephrectomy only in case of recurrent kidney complications or large kidney not allowing graft implantation. The optimum timing for native nephrectomy will depend on many factors (dialysis or preemptive transplantation, complication severity, anuria, easy access to transplantation, potential living donor).


CONCLUSIONS
Pretransplant management of ADPKD is challenging. A conservative strategy should be promoted to avoid anuria (and its metabolic complications) and to preserve a functioning low urinary tract and quality of life. When native nephrectomy should be performed, surgery remains the gold standard but renal arterial embolization may be a safe option due to its low morbidity.
Service d'urologie et transplantation, CHU Côte de Nacre, 14000 Caen, France.
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Tillou
Service d'urologie, hôpital européen Georges-Pompidou, 75015 Paris, France; Université Paris Descartes, 75006 Paris, France.
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Timsit
Département d'urologie et transplantation, CHU de Toulouse, 31400 Toulouse, France.
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Sallusto
Service d'urologie, CHU d'Angers, 49100 Angers, France.
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Culty
Service d'urologie, CHU de Rennes, 35000 Rennes, France.
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Verhoest
Service d'urologie et transplantation, CHU Côte de Nacre, 14000 Caen, France.
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Doerfler
Service d'urologie, CHU Lapeyronie, 34000 Montpellier, France; Université de Montpellier, 34000 Montpellier, France.
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Thuret
Service d'urologie et transplantation, CHRU de Besançon, 3, boulevard A.-Fleming, 25000 Besançon, France; Université de Franche-Comté, 25000 Besançon, France; Inserm UMR 1098, 25000 Besançon, France. Electronic address: fkleinclauss@chu-besancon.fr.
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Kleinclauss
D006801:Humans; D016030:Kidney Transplantation; D009392:Nephrectomy; D007690:Polycystic Kidney Diseases; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*
Autosomal dominant polycystic kidney disease; Kidney transplantation; Laparoscopie; Laparoscopy; Native nephrectomy; Néphrectomie des reins natifs; Polykystose rénale autosomique dominante; Transplantation rénale