Should patients with ADPKD be screened for IAs

Should patients with ADPKD be screened for IAs?

Despite the relatively higher prevalence of IA in patients with ADPKD, widespread screening for IA in asymptomatic patients without personal or family history of IA or subarachnoid hemorrhage (SAH) is not recommended. Presymptomatic screening for IA is specially indicated in patients with family history of IA or SAH or high-risk occupations (e.g., pilots), as well as in those undergoing major surgical procedures (i.e., kidney transplant, liver resection) with risk of hemodynamic instability.

Magnetic resonance angiography is the gold standard for the screening of IA in patients with ADPKD. However, a thin-cut noncontrast CT is more sensitive than MRI for detecting SAH. Therefore CT should be performed in patients with known ADPKD who present with new-onset or severe headache or other troubling central nervous system symptoms. Other treatable causes of headache (e.g., cervicocephalic artery dissection, subdural hematoma, leaking spinal meningeal diverticulum, or uncontrolled hypertension) should be considered.

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