The effect of renal transplantation on acquired cystic disease of the kidney in patients who have been on hemodialysis for more than 5 years was examined in 7 cases by computer-assisted tomography (CT scan). Almost all acquired cysts disappeared, and the size of the original kidneys decreased remarkably in 2 cases 8–10 months after transplantation. 3 other patients, in whom CT scans were performed only after transplantation, showed contracted scarred kidneys with few or no cysts. The involution of acquired cysts was incomplete in 1 case, in whom the cysts persisted for 3 years and 2 months, despite normal renal function. The last case, who was off hemodialysis only for 4 months, exhibited enlargement of the original kidneys and an increase in the number of cysts. These results suggest that a significant number of acquired renal cysts in dialyzed patients with end-stage kidney disease regress rapidly after successful renal transplantation, but this is not always so.

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Hemolytic uremic syndrome (HUS) is a rare but serious complication following renal transplantation. It usually develops early after transplantation, and ciclosporin treatment is the most common triggering factor. We report the case of a 35-year-old male with posttransplant HUS which developed 1 year after renal transplantation. He became febrile 4 days before the onset of HUS, and the significant rise in viral titer confirmed the diagnosis of influenza A virus infection. The association of ciclosporin treatment with HUS was unlikely, because of the late onset of HUS and the low ciclosporin trough levels. The patient was treated successfully without a dose reduction of ciclosporin. An etiologic relationship between influenza A virus and HUS was highly probable in our patient. We also review a total of 156 adult cases with HUS after renal transplantation described in the literature. The prognosis of posttransplant HUS differs according to the cause. The advent of ciclosporin has improved the graft survival rate and mortality of patients with rejection-induced HUS.

In 1979, 96 patients who had undergone hemodialysis for a mean of 3 years and 4 months were entered into this study. This follow-up study revealed that the bilateral kidney volume significantly increased over 10 years in 33 male patients. Kidneys were found to have enlarged 2.7 times over the 10-year follow-up period. However, in 24 females kidney volume did not change over 10 years. This paper reports further results in 39 dialysis patients (21 males and 18 females) who were followed from the 10th to 15th year. In male patients, mean volume was 196 ± 218 ml (mean ± SD) at the 10th year and had significantly increased to 225 ± 213 ml at the 15th year (p < 0.02). In female patients, mean kidney volume was 78 ± 51 ml at the 10th year and had increased to 117 ± 91 ml at the 15th year (p < 0.01). The enlargement in kidney volume during the recent 5 years was 1.26 ± 0.39-fold in males and 1.43 ± 0.45-fold in females. These rates did not significantly differ between males and females. During this recent 5-year period, there were no surgical cases due to renal cell carcinoma. Therefore, over the entire patient-time dialysis period, there were 6 renal cell carcinomas in 1,470 patient years. In conclusion, 10- to 15-year follow-up studies of kidney size revealed that the enlargement in the kidney due to acquired cysts persisted in male patients, but the rate of increase slowed after 13.0 years of hemodialysis, while the enlargement in the kidney in female patients became significant at 17.7 years of hemodialysis, revealing the slowly progressive nature of acquired cysts in women.