Nephrectomy in Autosomal Dominant Polycystic Kidney Disease: A consensus statement of the ERA Genes & Kidney Working Group
Authors: Geertsema Paul , Gansevoort Ron T , Arici Mustafa , Capasso Giovambattista , Cornec-Le-Gall Emilie , Furlano Monica , Fuster Daniel G , Galletti Flavia , Gómez-Dos-Santos Victoria , Perez-Gomez Maria Vanessa , Goumenos Dimitrios , Halbritter Jan , Jambon Eva , Korst Uwe , Leliveld Anna M , Felip Mireia Musquera , Figueiredo Arnaldo , Nijenhuis Tom , Olsburgh Jonathon , Pol Robert A , Sayer John A , Stippel Dirk , Torra Roser , Müller Roman-Ulrich , Casteleijn Niek F ,   members of the study group, Alam Ahsan , Bammens Bert , Bartram Malte P , Birn Henrik , Budde Klemens , Cakiroglu Figen , Castro-Alonso Cristina , Chebib Fouad T , Dahl Neera K , de Almeida Edgar , Demoulin Nathalie , Devuyst Olivier , Eleftheriadis Theodoros , Prlic Margareta Fistrek , Horie Shigeo , Idrizi Alma , Iyasere Osasuyi , Janssens Peter , Jouret Francois , Luque Yosu , Mallett Andrew , Mousseaux Cyril , Mrug Michal , Perrone Ronald D , Reiterova Jana , Robles Nicolas Roberto , Rroji Merita , Rudnicki Michael A , Schmitt Roland , Scolari Francesco , Tesar Vladimir , Topaloglu Rezan , Trillini Matias , Weekers Laurent , Zakrocka Izabela , Spahia Nereida , Kawano Haruna , Muto Satoru 
Published: January 2025

A substantial number of patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD) undergo a nephrectomy, especially in work-up for a kidney transplantation. Currently, there is no evidence-based algorithm to guide clinicians which patients should undergo nephrectomy, the optimal timing of this procedure, or the preferred surgical technique. This systematic review-based consensus statement aimed to answer important questions regarding nephrectomy in ADPKD.

A literature review was performed and extended to a meta-analysis when possible. For this purpose, PubMed and EMBASE were searched up to May 2024. Fifty-four publications, describing a total of 2391 procedures, were included. In addition, an exploratory questionnaire was sent to urologists, nephrologists, and transplant-surgeons. These sources were used to develop practice points about indications, complications, mortality, timing, and technique of nephrectomy. In addition, data on renal embolization as a potential alternative to nephrectomy was explored and summarized. To reach consensus, practice points were defined and improved in three Delphi survey rounds by experts of the European Renal Association Working Group Genes & Kidney and the European Association of Urology Section of Transplantation Urology. A total of 23 practice points/statements were developed, all of which reached consensus. Among others, it was deemed that nephrectomy can be performed successfully for various indications and is an intermediate risk procedure with acceptable mortality and minimal impact on kidney graft function when performed before, in the same session or after transplantation. The complication rate seems to increase when the procedure is performed as an emergency. During the work-up for transplantation, patient complaints should be assessed routinely by questionnaires to indicate symptom burden. Deciding on the need for nephrectomy and exploring potential alternatives such as kidney embolization should be a process of shared decision making, preferably after multidisciplinary consultation.