Ishikawa I, Chikamoto E, Nakamura M, Asaka M, Tomosugi N,
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.
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)