Acute renal intracystic hemorrhage in patients with autosomal dominant polycystic kidney disease

Renal cyst bleeding is a frequent problem in patients with autosomal dominant polycystic kidney disease (ADPKD). However, there remains minimal information concerning its frequency, causative factors, and effects on ADPKD progression. We investigated the total volume of acute renal intracystic hemorrhage (ARIH) and its relationship to total kidney volume (TKV) in patients with ADPKD on dialysis; we evaluated factors potentially associated with ARIH. We enrolled 199 patients who received renal transcatheter arterial embolization (TAE) from 2014 to 2018 (107 men, 92 women; mean age: 59.1 ± 8.6 years). The median volume of ARIH was 97.3 ml (interquartile range: 36.6–261.7 ml). Multivariate analysis revealed that body weight and ARIH volume were significantly associated with TKV; age, body mass index, smoking, cerebral vascular disease, serum alkaline phosphatase, and TKV were significantly associated with ARIH; and sex, age, dialysis vintage, TKV, and ARIH volume were significantly associated with the number of microcoils required to achieve renal TAE. ARIH was common among ADPKD patients on dialysis; it was significantly associated with TKV. ARIH was greater in younger patients with greater renal artery luminal volume. In conclusion, renal cyst bleeding and renal artery blood flow volume may synergistically accelerate the enlargement of polycystic kidneys.