Intracranial aneurysm as extra-renal manifestation of polycystic kidney disease – A case report

Violeta Rabrenović; Slobodan Ćulafić; Milorad Rabrenović; Tamara Dragović; Saša Trešnjić; Siniša Mašić; Radomir Matunović; Ljiljana Ignjatović; Svetlana Antić; Milica Petrović; Dejan Pilčević; Aleksandar Rakonjac; Dragan Jovanović

doi:10.2298/VSP160728020R

Violeta Rabrenović Military Medical Academy, Clinic of Nephrology, Belgrade, Serbia ; University of Defence Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Slobodan Ćulafić Special Hospital St. Sava, Belgrade, Serbia
Milorad Rabrenović Military Medical Academy, Center for Hyperbaric Medicine, Belgrade, Serbia
Tamara Dragović University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia; Military Medical Academy, Clinic of Endocrinology, Belgrade, Serbia
Saša Trešnjić Special Hospital St. Sava, Belgrade, Serbia
Siniša Mašić Military Medical Academy, Institute of Hygiene, Belgrade, Serbia
Radomir Matunović University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Ljiljana Ignjatović Klinika za nefrologiju,Vojnomedicinska akademija , Beograd
Svetlana Antić Military Medical Academy, Clinic of Nephrology, Belgrade, Serbia
Milica Petrović Military Medical Academy, Clinic of Nephrology, Belgrade, Serbia
Dejan Pilčević Military Medical Academy, Clinic of Nephrology, Belgrade, Serbia
Aleksandar Rakonjac Military Medical Academy, Institute of Radiology, Belgrade, Serbia
Dragan Jovanović Klinika za nefrologiju VMA, Medicinski fakultet Vojnomedicinska Akademija , Beograd

DOI: https://doi.org/10.2298/VSP160728020R

Keywords: polycystic kidney disease;, kidney failure, chronic;, intracranial aneurysm;, diagnosis; angiography, digital subtraction;, stents;, treatment outcome.

Abstract

Introduction: Polycystic kidney disease is a hereditary kidney disease characterized by the occurrence of cysts (fluid-filled enlargement) in the cortex or medula of the kidney, and is inherited in an autosomal dominant or autosomal recessive. In addition to multiple cysts in the kidneys, there may be as many extra-renal manifestations (cysts of the liver, pancreas, lungs, heart, etc.), among which the most serious occurrence of intracranial aneurysms.

Case report: A 57 year old female patient with polycystic kidney disease and stage III renal failure was hospitalized in our clinic due to decreased renal function, the development of urinary tract infections, headaches, and unregulated blood pressure, despite the usual treatment. This patient also had a number of associated diseases: obesity, diabetes mellitus (the insulin-dependent type), hypothyroidism, and depression syndrome. After better regulation of blood pressure, resolved urinary tract infections, and improved renal function, there were still persistent headaches (resulting in the excessive use of analgesics), but with adequate preparation, MSCT angiography of blood vessels of the head was performed. As a result, we diagnosed the saccular intracranial aneurysm (IA) with anterior localization. Given the symptoms, age and comorbidity, digital subtraction angiography was performed, and showed IA (5,2 mm x 4 mm), saccular with wide neck, affecting both branches MCA. During the procedure the stent was placed, which filled the aneurysm with spirals, cutting it off from circulation. After the successful procedure, and without further complications, the patient no longer had headaches, and blood pressure was maintained within the required limits, with stable parameters of chronic renal failure.

Conclusion: The case of the patient with polycystic kidney disease, stage III chronic renal failure, with a number of comorbidities (headache, obesity, hypertension, diabetes mellitus, hypothyroidism) and diagnosed with symptomatic intracranial aneurysm was successfully solved with a multidisciplinary approach, emphasizing the importance of teamwork in daily practice.

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