scholarly journals P0083HLA-DRB1*1301-DQB*0603-DRB3*0202 HAPLOTYPE IS INDEPENDENTLY ASSOCIATES WIHT POOR PROGNOSIS IN PLA2R-RELATED MEMBRANOUS NEPHROPAHTY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Weibo Le ◽  
JingSong Shi ◽  
Qin Hou
Keyword(s):  
Linkage Disequilibrium ◽  
Poor Prognosis ◽  
High Linkage Disequilibrium ◽  
Renal Outcome ◽  
Hla Alleles ◽  
Risk Alleles ◽  
Lower Egfr ◽  
Almost All ◽  
Egfr Decline

Abstract Background and Aims The susceptibility of Idiopathic membranous nephropathy (MN) is associated with HLA alleles. We previously found almost all (98.7%) patients with PLA2R-related MN carry either or both of the HLA-DRB1*1501 and DRB3*0202 risk alleles. However, the associations of HLA alleles and renal outcome is not known. Method we investigated the associations between HLA alleles and renal outcome in 392 PLA2R-related MN patients. Results We found that HLA-DRB1*1301 and DQB1*0603, which are in high linkage disequilibrium (R2 = 1.0, D’=1.0), are associated with at least 30% eGFR decline during follow-up (HR 2.2, p<0.001). HLA-DRB1*1301 and DQB1*0603 are not a susceptible HLA allele for PLA2R-related MN. Neither HLA-DRB1*1501 nor DRB3*0202 is associated with renal outcome. After adjusting age, gender and the two susceptible HLA alleles, DRB1*1301 haplotype remains significant associated with renal outcome. Compared those patients with negative DRB1*1301, patients with positive DRB1*1301 showed a similar eGFR level at baseline, but a significant lower eGFR at the last follow up. There were 12 PLA2R-related MN patients with positive DRB1*1301, eight of them (66.7%) showed more than 30% eGFR decline during follow-up. Among the 12 patients carrying DRB1*1301, all (100%) had DRB3*0202, four (33.3%) had DRB1*1501, and none (0%) had DRB1*0301. Linkage disequilibrium analysis showed the susceptible allele DRB3*0202 was highly linked with DRB1*0301 and DRB1*1301, while HLA-DRB1*0301 was not associated with renal outcome. Conclusion HLA-DRB1*1301-DQB*0603-DRB3*0202 haplotype is independently associated with Poor Prognosis in PLA2R-related Membranous.

HLA Alleles and Prognosis of PLA2R-Related Membranous Nephropathy

2021 ◽  
pp. CJN.18021120
Author(s):  
Wei-Bo Le ◽  
Jingsong Shi ◽  
Fan Yang ◽  
Si-Wen Gong
Keyword(s):  
Membranous Nephropathy ◽  
Prospective Cohort ◽  
Poor Prognosis ◽  
Significant Risk ◽  
Chinese Patients ◽  
Hla Alleles ◽  
Cox Analysis ◽  
Antibody Levels ◽  
Egfr Decline

Background and objectives Associations between HLA alleles and susceptibility to PLA2R-related membranous nephropathy have been well defined previously in Chinese patients. However, the relationships between HLA alleles and kidney outcome remain unclear. Design, setting, participants, & measurements Five HLA genes (DRB1, DQA1, DQB1, DRB3, and DRB5) were genotyped in a prospective cohort of 392 patients with PLA2R-related membranous nephropathy. The associations between HLA alleles and kidney outcomes were studied. Results A total of 79 HLA alleles were identified in this study. Four HLA alleles, DRB1*13:01 (n=12, HR 3.7, 95% CI 1.8 - 7.8, P < 0.001) , DQB1*06:03 (n=12, HR 3.7, 95% CI 1.8 - 7.8, P < 0.001), DRB1*04:05 (n=12, HR 3.8，95% CI 1.5 - 9.5, P = 0.004) and DQB1*03:02 (n=21, HR 3.1，95% CI 1.4 - 6.7, P = 0.005), were associated with a ≥ 40% eGFR decline during follow-up. DRB1*13:01 and DQB1*06:03 were tightly linked with each other. Forty-four of the 392 patients (11%) carried at least one of the four identified risk HLA alleles in this study. Compared with patients who were negative for all risk HLA alleles, those carrying at least one risk HLA allele had a significant risk of a ≥ 40% eGFR decline during follow-up (HR 3.9, 95% CI 2.3 - 6.7, P < 0.001). After adjusting for age, sex, proteinuria, albumin, eGFR, and anti-PLA2R antibody levels, multivariable Cox analysis showed that patients carrying any of the four risk HLA alleles remained associated with a higher risk of a ≥40% decline in eGFR (HR 4.1, 95% CI 2.3 - 7.1, P < 0.001). Conclusions Carrying any of the HLA alleles, DRB1*13:01/DQB1*06:03, DRB1*04:05 and DQB1*03:02, was independently associated with poor prognosis in Chinese patients with PLA2R-related membranous nephropathy.

scholarly journals APOL1 Genotype and Renal Function of Black Living Donors

2018 ◽  
Vol 29 (4) ◽  
pp. 1309-1316 ◽  
Author(s):  
Mona D. Doshi ◽  
Mariella Ortigosa-Goggins ◽  
Amit X. Garg ◽  
Lihua Li ◽  
Emilio D. Poggio ◽  
...  
Keyword(s):  
Renal Function ◽  
High Risk ◽  
Confidence Interval ◽  
Kidney Donors ◽  
Living Kidney Donors ◽  
Risk Genotype ◽  
Risk Alleles ◽  
Lower Egfr ◽  
Developing Kidney ◽  
Egfr Decline

Black living kidney donors are at higher risk of developing kidney disease than white donors. We examined the effect of the APOL1 high-risk genotype on postdonation renal function in black living kidney donors and evaluated whether this genotype alters the association between donation and donor outcome. We grouped 136 black living kidney donors as APOL1 high-risk (two risk alleles; n=19; 14%) or low-risk (one or zero risk alleles; n=117; 86%) genotype. Predonation characteristics were similar between groups, except for lower mean±SD baseline eGFR (CKD-EPI equation) in donors with the APOL1 high-risk genotype (98±17 versus 108±20 ml/min per 1.73 m2; P=0.04). At a median of 12 years after donation, donors with the APOL1 high-risk genotype had lower eGFR (57±18 versus 67±15 ml/min per 1.73 m2; P=0.02) and faster decline in eGFR after adjusting for predonation eGFR (1.19; 95% confidence interval, 0 to 2.3 versus 0.4; 95% confidence interval, 0.1 to 0.7 ml/min per 1.73 m2 per year, P=0.02). Two donors developed ESRD; both carried the APOL1 high-risk genotype. In a subgroup of 115 donors matched to 115 nondonors by APOL1 genotype, we did not find a difference between groups in the rate of eGFR decline (P=0.39) or any statistical interaction by APOL1 status (P=0.92). In conclusion, APOL1 high-risk genotype in black living kidney donors associated with greater decline in postdonation kidney function. Trajectory of renal function was similar between donors and nondonors. The association between APOL1 high-risk genotype and poor renal outcomes in kidney donors requires validation in a larger study.

scholarly journals Renal Outcome of IgM Nephropathy: A Comparative Prospective Cohort Study

2021 ◽  
Vol 10 (18) ◽  
pp. 4191
Author(s):  
Yura Chae ◽  
Hye Eun Yoon ◽  
Yoon Kyung Chang ◽  
Young Soo Kim ◽  
Hyung Wook Kim ◽  
...  
Keyword(s):  
Kidney Biopsy ◽  
Interstitial Fibrosis ◽  
Immunoglobulin M ◽  
Renal Outcome ◽  
Tubular Atrophy ◽  
Significant Difference ◽  
Lower Egfr ◽  
Matrix Expansion ◽  
Renal Prognosis

Immunoglobulin M nephropathy (IgMN) is an idiopathic glomerulonephritis characterized by diffuse deposits of IgM in the glomerular mesangium. However, its renal prognosis remains unknown. We compared renal outcomes of IgMN patients with those of patients with minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), or mesangial proliferative glomerulonephritis (MsPGN) from a prospective observational cohort, with 1791 patients undergoing native kidney biopsy in eight hospitals affiliated with The Catholic University of Korea between December 2014 and October 2020. IgMN had more mesangial proliferation and matrix expansion than MsPGN and more tubular atrophy and interstitial fibrosis than MCD. IgMN patients had decreased eGFR than MCD patients in the earlier follow-up. However, there was no significant difference in urine protein or eGFR among all patients at the last follow-up. When IgMN was divided into three subtypes, patients with FSGS-like IgMN tended to have lower eGFR than those with MCD-like or MsPGN-like IgMN but higher proteinuria than MsPGN-like IgMN without showing a significant difference. The presence of hypertension at the time of kidney biopsy predicted ≥20% decline of eGFR over two years in IgMN patients. Our data indicate that IgMN would have a clinical course and renal prognosis similar to MCD, FSGS, and MsPGN

P0829THE ASSOCIATION BETWEEN URINARY NGAL AND EGFR SLOPE IN PATIENTS WITH CKD

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Shungo Fukuda ◽  
Naohiko Fujii ◽  
Taisuke Matsushita ◽  
Sayoko Yonemoto ◽  
Daisuke Hayashi ◽  
...  
Keyword(s):  
Tubular Damage ◽  
Clinical Value ◽  
Loss To Follow Up ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Lower Egfr ◽  
Exposure Variable ◽  
Renal Tubular ◽  
Neutrophil Gelatinase ◽  
Egfr Decline

Abstract Background and Aims Urinary neutrophil gelatinase-associated lipocalin (uNGAL) is a new biomarker for renal tubular damage. The association between uNGAL and renal prognosis have been reported in many papers; however, it may often be affected by urinary tract infection (UTI), and its clinical value with consideration of UTI has not been well investigated in patients with chronic kidney disease (CKD). The aims of our study were to investigate the association between uNGAL and eGFR decline in CKD incorporating the effect of UTI. Method This was a retrospective observational cohort study at a single hospital in Japan. We included adult patients with the estimated glomerular filtration rate (eGFR) of 10 to 70 mL/min/1.73m2 from Jan 2017, who had at least one measurement of uNGAL. We used baseline uNGAL adjusted for urinary creatinine (Cr) as an exposure variable and divided the patients into quartiles. UTI was determined by a single evaluation of urinalysis at baseline. The repeated measured eGFRs were obtained from the electrical health record until dialysis initiation, loss to follow-up, or the end of the observation period whichever occurred first. We performed longitudinal analyses for eGFR decline using the mixed effects model and evaluated the longitudinal effect of uNGAL taking into account of UTI. All statistical analyses were done using STATA 13.1. Results In total, 281 patients with CKD were included. Mean age and eGFR at baseline were 70.2 years and 33.9 mL/min/1.73m2, respectively. The median [interquartile range (IQR)] of baseline uNGAL and urinary protein to Cr ratio (uPCR) were 49.6 [19.4 - 171.4] ug/gCr and 0.82 [0.18 - 3.26] g/gCr, respectively. Patients with UTI (15%) showed significantly higher uNGAL at baseline than those without (219 [89 - 425] vs. 39 [16 - 131]). During the mean follow up of 229 days, nine patients developed eGFR &lt; 5 mL/min/1.73m2. Although a higher uNGAL level was significantly associated with lower eGFR levels at baseline (-3.3 [95% confidence interval (CI): -7.6, 0.93], -9.6 [-14.2, -4.9], and -16.3 [-21.4, -11.1] mL/min/1.73m2 in quartiles Q2-4 as compared to Q1); the eGFR trajectory did not differ with or without baseline UTI in the analytic model, while baseline proteinuria was significantly associated with a steeper slope of eGFR. Conclusion A higher uNGAL was significantly associated with lower eGFR levels at baseline; however, it was not associated with a steeper slope of eGFR in the longitudinal analysis, even with the consideration of the effect of UTI.

scholarly journals P0279DIABETIC KIDNEY DISEASE VERSUS CHRONIC KIDNEY DISEASE IN ADULTS WITHOUT DIABETES MELLITUS: A RENAL SURVIVAL ANALYSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Gabriel Stefan ◽  
Ligia Petrescu ◽  
Simona Stancu ◽  
Gabriel Mircescu
Keyword(s):  
Kidney Disease ◽  
Cox Regression ◽  
Kidney Diseases ◽  
Renal Outcome ◽  
Total Serum ◽  
Rapid Progression ◽  
Renal Survival ◽  
Arterial Blood ◽  
Egfr Decline

Abstract Background and Aims Diabetic kidney disease (DKD) is the most common cause of end-stage renal disease, but the decline in kidney function varies considerably between chronic kidney diseases (CKD), and determinants of renal function loss, early in the course of the disease, are still a matter of debate. Method We retrospectively examined the renal outcome at 31 July 2017 of 309 CKD patients (age 59.1 (50.1-68.6) years; 60% male; eGFR 32.7 (21.7-44.8) mL/min) admitted in our hospital during January 2007-December 2012 with a median follow up time of 7.2 (95%CI, 6.8-7.6) years. Only patients who had at least 3 admissions and who were alive during the study period were included. CKD was defined as the presence of an eGFR &lt;60ml/min/1.73m2 or the presence of albuminuria &gt;30mg/g creatinine for more than 3 months. The primary endpoint was renal survival defined as renal replacement therapy (RRT) initiation. Factors affecting renal survival were evaluated in a Cox proportional hazard model. Results DKD (24%), glomerular (GN, 24%), tubulo-interstitial (TIN, 27%) and vascular nephropathies (VN, 25%) were the causes of CKD. Patients with DKD (66.8 (56.5-72.2) years) and VN (68.5 (59.7-76.2) years) were older than those with GN (50.3 (37.4-59.0) years) and TIN (55.6 (45.8-61.8) years). Moreover, the highest cardiovascular comorbidity score was found in patients with VN and DKD (p&lt;0.001). Median eGFR decline was -1.23 ( -3.39 – 0.35) mL/min/year; 29% of the patients had CKD progression of &gt;3mL/min/year and 14% had rapid progression (&gt;5mL/min/year). Patients with GN had the lowest eGFR (26.8 (19.1-38.9) versus DKD 36.2 (23.4-47.7), VN 34.9 (22.4-51.0), TIN 32.4 (21.8-44.8) mL/min, p&lt;0.001), the fastest eGFR decline (-3.1 versus DKD -1.9, VN -1, TIN -1,2 mL/min/year, p 0.5) and the highest proteinuria (2.7 versus DKD 1.4, VN 0.4, TIN 0.6 g/24h, p&lt;0.001). During follow up, 29% of the studied patients started RRT; mean renal survival time for the entire cohort was 7.4 (95%CI, 7.0-7.8) years. CKD cause (versus DKD p=0.04, Figure 1), lower eGFR (HR 0.89 (95%CI, 0.85-0.93)), elevated albuminuria (HR 1.4 (95%CI, 1.2-1.7)), higher total serum cholesterol (HR 1.00 (95%CI, 1.00-1.01)) and elevated mean arterial blood pressure (HR 1.03 (95%CI, 1.00-1.06)) were associated with RRT initiation in the Cox regression model. Conclusion Patients with DKD and VN had similar poorer renal survival as compared with GN and TIN. Earlier referral to the diabetic renal clinic and intensive management of the modifiable risk factors (albuminuria, hypercholesterolemia, hypertention) are necessary to retard progression of CKD and, subsequently, prolong renal survival.

scholarly journals Crescents and Global Glomerulosclerosis in Chinese IgA Nephropathy Patients: A Five-Year Follow-Up

2019 ◽  
Vol 44 (1) ◽  
pp. 103-112 ◽  
Author(s):  
Wei Peng ◽  
Yi Tang ◽  
Li Tan ◽  
Wei Qin
Keyword(s):  
Serum Creatinine ◽  
Iga Nephropathy ◽  
Treatment Modalities ◽  
Renal Outcome ◽  
Urine Protein ◽  
Lower Egfr ◽  
Global Glomerulosclerosis ◽  
Stage Renal Disease ◽  
End Stage

Background/Aims: This study aims to evaluate the clinical significance of crescent and global glomerulosclerosis formation on renal outcome in patients with IgA nephropathy (IgAN). Methods: Biopsy-proven primary IgAN patients from West China Hospital of Sichuan University were studied retrospectively between 2008 and 2015. Clinicopathological features and treatment modalities were recorded. The patients were divided into several groups on the basis of cellular and/or fibrocellular crescents scores and global glomerulosclerosis scores. Crescent (C) was scored according to the updated Oxford classification (C0/C1/C2). Global glomerulosclerosis (G) was scored according to the frequency of global glomerulosclerosis: G0 (≤25% of glomeruli), G1 (26–50% of glomeruli), and G2 (> 50% of glomeruli). The primary endpoint was defined as a 50% reduction in renal function or end stage renal disease. Patients were followed up for at least 12 months, or shorter if they reached study endpoints. 1328 patients with IgAN were recruited. Mean follow-up time was 46.1±23.6 months. The percentage of patients with C1 and C2 was 19.3% and 5.9% respectively. Higher crescent scores was associated with lower estimated glomerular filtration rates (eGFR), decreased serum albumin levels, increased amounts of urine protein, higher serum creatinine, as well as greater proportions of M1 and E1. The percentage of patients with G0, G1 and G2 was 70.5%, 20.7% and 8.8%, respectively. Elevated glomerulosclerosis scores were associated with lower eGFR levels, increased amounts of urine protein, higher levels of serum creatinine, higher incidences of arterial hypertension, as well as greater proportions of M1. There was a significantly higher proportion of T1/2 in patients with G2. In a multivariate model, crescent and global glomerulosclerosis were identified as independent predictors of decreased renal survival. Conclusion: Global glomerulosclerosis and crescents, as detected in renal biopsies, are strong predictors of long-term renal outcome of IgAN.

Nierenbeteiligung bei Spondylarthritiden: Spezifisch oder unabhängig?

2021 ◽  
pp. 1-3
Author(s):  
Sibylle von Vietinghoff
Keyword(s):  
Renin Angiotensin System ◽  
Renal Outcome ◽  
Frequent Use ◽  
Tnf Α ◽  
Ckd Stage ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage ◽  
Egfr Decline

<b>Introduction:</b> IgA nephropathy (IgAN) can be associated with spondyloarthritis (SpA). The course of SpA-associated IgAN remains largely unknown due to the absence of large cohorts. <b>Methods:</b> This retrospective study included patients with biopsy-proven IgAN and definite SpA. Kidney biopsies were centrally examined and scored according to the IgAN Oxford Classification. Thirty-two patients fulfilled the inclusion criteria, with a male:female ratio of 9:1 and median age of 27 and 37 years at SpA and IgAN diagnosis, respectively. HLA-B27 was positive in 90% of cases, and most patients (60%) presented with ankylosing spondylitis. The mean baseline estimated glomerular filtration rate (eGFR) was 84 ± 26 ml/min per 1.73 m<sup>2</sup>, and the urine protein-to-creatinine ratio was 0.19 g/mmol. <b>Results:</b> Renal biopsy revealed frequent presence of crescents (33%) and interstitial inflammation (18%). Despite almost constant use of renin-angiotensin system inhibitors, combined with steroids in 13 of 32 patients, renal outcome was particularly poor. After a median follow-up of 5.9 years, 4 patients (12.5%) reached end-stage renal disease and 41% of patients experienced a &#x3e;50% decrease of eGFR. The mean annual eGFR decline rate was –4.3 ± 6.7 ml/min per 1.73 m<sup>2</sup>. The risk of reaching class IV or V chronic kidney disease (CKD) stage during follow-up was associated with the presence of hypertension, level of proteinuria, and baseline S- and T-scores of the Oxford. <b>Conclusion:</b> SpA-associated IgAN is associated with a poor renal outcome, despite frequent use of steroids. Tumor necrosis factor (TNF)-α blockade did not appear to influence the rate of eGFR decline in this setting.

scholarly journals Absence of renal remission portends poor long-term kidney outcome in lupus nephritis

2021 ◽  
Vol 8 (1) ◽  
pp. e000533
Author(s):  
Valérie Pirson ◽  
Antoine Enfrein ◽  
Frédéric A Houssiau ◽  
Farah Tamirou
Keyword(s):  
Lupus Nephritis ◽  
Negative Impact ◽  
Renal Outcome ◽  
Class Iii ◽  
Treatment Change ◽  
Lower Egfr ◽  
Stage Renal Disease ◽  
End Stage

BackgroundThe very long-term consequences of absence of remission in lupus nephritis (LN) remain understudied.MethodsIn this retrospective analysis, we studied a selected cohort of 128 patients with biopsy-proven class III, IV or V incident LN followed for a median period of 134 months (minimum 25). Remission was defined as a urine protein to creatinine (uP:C) ratio <0.5 g/g and a serum creatinine value <120% of baseline. Renal relapse was defined as the reappearance of a uP:C >1 g/g, leading to a repeat kidney biopsy and treatment change. Poor long-term renal outcome was defined as the presence of chronic kidney disease (CKD).ResultsTwenty per cent of patients never achieved renal remission. Their baseline characteristics did not differ from those who did. Absence of renal remission was associated with a threefold higher risk of CKD (48% vs 16%) and a 10-fold higher risk of end-stage renal disease (20% vs 2%). Patients achieving early remission had significantly higher estimated glomerular filtration rate (eGFR) at last follow-up compared with late remitters. Accordingly, patients with CKD at last follow-up had statistically longer time to remission. Among patients who achieved remission, 32% relapsed, with a negative impact on renal outcome, that is, lower eGFR values and higher proportion of CKD (33% vs 8%).ConclusionEarly remission should be achieved to better preserve long-term renal function.

Volume of Crescents Affects Prognosis of IgA Nephropathy in Patients without Obvious Chronic Renal Pathology

2021 ◽  
pp. 1-12
Author(s):  
Zaoqiang Lin ◽  
Lichang Liu ◽  
Rongling Zhang ◽  
Xuefei Lin ◽  
Fuhua Lu ◽  
...  
Keyword(s):  
Iga Nephropathy ◽  
Kidney Tissue ◽  
Treatment Modalities ◽  
Renal Outcome ◽  
Renal Lesions ◽  
Increased Risk ◽  
Lower Egfr ◽  
The Oxford Classification ◽  
Renal Prognosis

<b><i>Introduction:</i></b> A working group on the Oxford classification of IgA nephropathy (IgAN) recently reported that crescents detected in the kidney tissue predicted a worse renal outcome. However, the effect of C1 lesion (crescents in &#x3c;1/4th of all glomeruli) and their volume on the prognosis of IgAN is still unclear. We explored the association of C1 lesion with the renal prognosis in IgAN patients without obvious chronic renal lesions (glomerulosclerosis &#x3c;25%, T score &#x3c;2). <b><i>Methods:</i></b> We investigated 305 biopsy-proven IgAN patients without obvious chronic renal lesions. Clinicopathologic features and treatment modalities were recorded. The patients were divided into several groups according to the presence or absence of a global crescent: no crescent (NC) group, only segmental crescent (SC) group, and global crescent (GC) group. The outcome was the survival from a combined event defined by a ≥15% decline in the estimated glomerular filtration rate (eGFR) after 1 year or ≥30% decline in the eGFR after 2 years. <b><i>Results:</i></b> Among all patients, 75.7% were in the NC group, 14.8% were in the SC group, and 9.5% were in the GC group. Compared with the NC group, patients in the SC group and the GC group had more urine protein, lower eGFR, and presented with more severe pathological change. During a median follow-up of 34.8 (26.16–57.95) months, the combined event occurred in 34 individuals (11.1%). In a multivariate model, the GC group (HR = 2.756, 95% CI = 1.068–7.109) was associated with an increased risk of the combined event. <b><i>Conclusions:</i></b> In IgAN patients without obvious chronic renal lesions, the GC group had more severe clinical and pathological manifestations than in the NC group. GC is an independent risk factor for the progression of IgAN renal function.

Is 3 years adequate for tracking completely occluded coiled aneurysms?

2020 ◽  
Vol 133 (3) ◽  
pp. 758-764
Author(s):  
Eung Koo Yeon ◽  
Young Dae Cho ◽  
Dong Hyun Yoo ◽  
Su Hwan Lee ◽  
Hyun-Seung Kang ◽  
...  
Keyword(s):  
De Novo ◽  
Careful Monitoring ◽  
Surveillance Period ◽  
Radiological Data ◽  
De Novo Aneurysm ◽  
Low Probability ◽  
Almost All ◽  
Annual Risk

OBJECTIVEThe authors conducted a study to ascertain the long-term durability of coiled aneurysms completely occluded at 36 months’ follow-up given the potential for delayed recanalization.METHODSIn this retrospective review, the authors examined 299 patients with 339 aneurysms, all shown to be completely occluded at 36 months on follow-up images obtained between 2011 and 2013. Medical records and radiological data acquired during the extended monitoring period (mean 74.3 ± 22.5 months) were retrieved, and the authors analyzed the incidence of (including mean annual risk) and risk factors for delayed recanalization.RESULTSA total of 5 coiled aneurysms (1.5%) occluded completely at 36 months showed recanalization (0.46% per aneurysm-year) during the long-term surveillance period (1081.9 aneurysm-years), 2 surfacing within 60 months and 3 developing thereafter. Four showed minor recanalization, with only one instance of major recanalization. The latter involved the posterior communicating artery as an apparent de novo lesion, arising at the neck of a firmly coiled sac, and was unrelated to coil compaction or growth. Additional embolization was undertaken. In a multivariate analysis, a second embolization for a recurrent aneurysm (HR = 22.088, p = 0.003) independently correlated with delayed recanalization.CONCLUSIONSAlmost all coiled aneurysms (98.5%) showing complete occlusion at 36 months postembolization proved to be stable during extended observation. However, recurrent aneurysms were predisposed to delayed recanalization. Given the low probability yet seriousness of delayed recanalization and the possibility of de novo aneurysm formation, careful monitoring may be still considered in this setting but at less frequent intervals beyond 36 months.

Sign in / Sign up

Export Citation Format

Share Document