Diagnostic Algorithm in the Management of Acute Febrile Abdomen in Patients with Autosomal Dominant Polycystic Kidney DiseaseReportar como inadecuado




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Background

Acute febrile abdomen represents a diagnostic challenge in patients with autosomal dominant polycystic kidney disease ADPKD. Although criteria have been proposed for cyst infection CyI and hemorrhage CyH, there is a lack of comparative assessments. Furthermore, distinguishing cystic from non-cystic complications remains problematic.

Design

ADPKD patients presenting with abdominal pain and-or fever between 01-2005 and 06-2015 were retrospectively identified in a systematic computerized billing database. CyH was defined as spontaneous intracystic density above 50 Hounsfield units on computed tomography CT. CyI was definite if confirmed by cyst puncture, and probable if 4 criteria were met: 3-day fever, loin-liver tenderness, C-reactive protein CRP plasma levels >50mg-L and no CT evidence for CyH. Other episodes were grouped as inflammation of unknown origin IUO.

Results

Among a cohort of 173 ADPKD patients, 101 presented with 205 episodes of abdominal pain n = 172 and-or fever n = 33. 20 patients experienced 30 CyH, whereas 16 presented 23 episodes of definite n = 11 or probable n = 12 CyI. 35 IUO were observed in 31 patients. Clinically, fever was observed in 7% vs. 100% vs. 66% of CyH, CyI and IUO, respectively. Biologically, CRP cut-off at 70 mg-dl showed 92% sensitivity and 81% specificity in CyI diagnosis. Urine or blood cultures remained sterile in >90% of CyH, but were contributive in 53.4% of CyI and IUO, with a 74.2% prevalence for E. coli. Radiologically, ultrasounds, CT and magnetic resonance diagnosed CyI in 2.6%, 20% and 16.7% of cases, respectively. 18F-FDG positron-emission tomography PET-CT was done within a median period of 7 days post antibiotics, and significantly changed patient management in 71.4%.

Conclusions

This retrospective single-center series underscores the usefulness of clinical–fever–and biological–CRP–parameters, but emphasizes the limitations of bacteriological and radiological investigations in cases of acute febrile abdomen in ADPKD patients. 18F-FDG-PET-CT imaging may be helpful in such condition.



Autor: Marie Neuville, Roland Hustinx, Jessica Jacques, Jean-Marie Krzesinski, François Jouret

Fuente: http://plos.srce.hr/



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