Renal Cyst Sclerotherapy in Autosomal Dominant Polycystic Kidney Disease

BACKGROUND: Enlarged cystic kidneys, as measured by total kidney volume (TKV), highly correlate with "mass effect" symptoms and predict early loss of kidney function in autosomal dominant polycystic kidney disease (ADPKD). Sclerotherapy of large kidney cysts can reduce TKV and the associated mass effect. This study assessed if sodium tetradecyl sulfate sclerotherapy provides effective volume reduction in ADPKD and investigated its mechanism of action using porcine bladder models. METHODS: Retrospective review of 567 cysts treated with sodium tetradecyl sulfate in 306 patients between November 2014 and August 2022 was performed. Cysts were treated with single-stage (cyst<7cm) or two-stage (cyst>7cm) sclerotherapy. TKV and treated renal cyst volumes were calculated on MRI to assess response. Renal function and tolvaptan data was collected. To investigate the action of sodium tetradecyl sulfate, porcine bladder models were evaluated using confocal laser endomicroscopy and formalin-fixed hematoxylin and eosin staining, comparing treated and control tissues. RESULTS: 495 cysts had adequate MRI follow-up to determine volume response; 99% of cysts showed volume reduction on first follow-up (mean 162 days), with mean reduction of 197cm3 (88 ±16%). Larger cysts showed greater volume reduction. Long-term, 80% cysts showed further volume reduction while 18% were stable compared to the first follow-up MRI (mean 1359 days), indicating a sustained response. Mean TKV and mean height-adjusted TKV decreased by 371cm3 and 224cm3 respectively at the final follow-up. Serum creatinine increased by 30.5 ±82.6 mg/dL and eGFR decreased by 8.6 ±14.92 mL/min/1.73m2 at mean follow-up 1460 days. In the porcine bladder models, sodium tetradecyl sulfate showed near complete denudation of the epithelium, superficial inflammatory changes and vascular congestion in the lamina propria without deeper mural injury. CONCLUSIONS: Sodium tetradecyl sulfate sclerotherapy provides effective, sustained long-term volume reduction in treated renal cysts and TKV in ADPKD, and is associated with reduced renal function decline.