HDCN Article Review/Hyperlink

Ishikawa I, Chikamoto E, Nakamura M, Asaka M, Tomosugi N, Yuri T

High incidence of common bile duct dilatation in autosomal dominant polycystic kidney disease patients

Am J Kidney Dis (Mar) 27:321-326 1996

Autosomal dominant polycystic kidney disease is well known to be a multisystem disorder with protean manifestations. The authors did a retrospective analysis of CT scans of 55 ADPKD patients in Japan, using age, gender, and renal functional (including duration of dialysis if ESRD) matched controls, to study the incidence of cholelithiasis and extrahepatic biliary tree abnormalities. They found no difference in cholelithiasis, but did observe a striking increase in the prevalence of common bile duct dilatation (greater than 7 mm diameter) in the ADPKD patients vs controls (40 vs. 9 %, respectively).

The presence of bile duct dilatation was not predicted by gender or age, nor was it associated with a higher incidence of cholelithiasis. The ADPKD group with bile duct dilatation, however, had worse renal function as compared with the ADPKD patients without dilatation, but did not have worse hepatic cystic disease.

Comment: The finding of dilatation of the biliary tree in ADPKD is not surprising if one considers the view that hepatic cysts originate from biliary epithelium. Remarkably, this has not been reported previously, including recent autopsy series. Also noteworthy is that unlike in the case of hepatic cyst prevalence, there was no apparent preponderance of bile duct dilatation in females, nor was dilatation itself associated with hepatic cyst prevalence. Duration of dialysis did not affect prevalence, but I suspect that some of the associations may have failed to appear due to the sample size. Perhaps the authors' findings, particularly if confirmed prospectively (to better control for clinical parameters of the subjects), will prevent unnecessary pursuit of common duct dilation when it is found incidentally on abdominal imaging in ADPKD patients. (James A. Sondheimer MD, Wayne State University, Detroit, MI)