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We report 3 cases of acquired cystic disease of the kidneys with associated renal carcinoma in 2 of the cases. In all 3 cases, the patients had chronic renal insufficiency due to hypertension but had never required dialysis. Review of 176 reported cases of acquired cystic disease of the kidneys and renal tumors disclosed that 18 patients (including 1 previously reported by us) had never received dialysis treatment. These cases support the hypothesis that acquired cystic disease of the kidney is not restricted to patients treated with maintenance dialysis. Among the 18 patients, hypertension was the most common underlying cause of renal failure. Patients with chronic renal failure due to or associated with severe hypertension should be monitored carefully for the development of both renal cysts and tumors even though they have not started on chronic dialysis.

Moxalactam pharmacokinetics were determined in 18 patients with renal insufficiency (creatinine clearance, 0 to 99 ml/min). Each patient was given 0.5 g of moxalactam intramuscularly. Drug half-life ranged from 4.1 to 49.1 h and correlated inversely with creatinine clearance (r = -0.97). Total body drug clearance ranged from 0 to 88 ml/min, and renal clearance ranged from 0 to 57 ml/min. In four patients studied during hemodialysis, drug half-life was 21.7 +/- 7.5 h (mean +/- standard error) between dialyses and 4.4 +/- 0.5 h during dialysis. Moxalactam dialysance averaged 44 +/- 2 ml/min per m2 of dialyzer surface area, and approximately 50% of the drug was removed during a single hemodialysis. We confirmed that moxalactam is eliminated from the body primarily by renal excretion. Recommendations are given for dosage adjustment in patients with renal insufficiency.

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