Acquired Cystic Disease of the Kidney and Renal Cell Carcinoma on Long Term Hemodialysis

Abstract

Four surgical cases of acquired cystic disease of the kidney in the third decade are reported, which include renal cell carcinoma in three patients and multiple adenomas and cystadenomas in all patients. The intervening parenchyma of these kidneys was disorganized as end stage kidney and numerous cysts were found in both kidneys. Some of the cysts were lined by hyperplastic epithelium consisting of clear and granular cells arranged in piled up and papillary fashion. These cysts were diagnosed as cystadenoma. Multiple solid adenomas of a 28‐year‐old male on hemodialysis for 6 years were of various size as if arranged in developing stage of the growth. Summing up all cases included in the literature, the mean duration of hemodialysis of the cases with renal tumor was 5.2 years, while 2.9 years without tumor. With increase of duration of hemodialysis, acquired cystic disease of the kidney is exposed to a high risk of developing malignancy.

Acquired Renal Cystic Disease in End-Stage Renal Disease: An Autopsy Study of 155 Cases

“…However, we failed to demonstrate significant correla tion between ARCD and the chronological date of death. In addition, this discrepancy may be related to the larger and more heterogeneous (with and without replacement therapy) patient population included in the present study, compared to most previous reports which in cluded only patients receiving hemodialysis [3,9,14,15,17,18]. In the present report, ARCD was also noted in ESRD patients who were not receiving dialysis or re ceived it for less than 6 months prior to death.…”

“…ARCD was previously reported in patients with mild and advanced renal fail ure prior to institution of dialysis [3,7,9,12]. In recent years, most investigators found a statistically significant association between ARCD and duration of dialysis [3,14,15,18]. While we noted an incidence of 58% ARCD in our ESRD population, we did not document a strong association between the incidence of cystic transforma tion and duration of dialysis (p = 0.06), even if patients with duration of dialysis less than 6 months were ex cluded (p = 0.07).…”

“…Renal Ishikawa and Shinoda [17] reported the incidence of ARCD among patients undergoing hemodialysis for less than 3 years to be 43.5%, and 78.3% in patients on replacement therapy for a period exceeding 3 years. The overall incidence of renal tumorous degeneration (ade noma and carcinoma) in patients with end-stage renal disease (ESRD) is estimated at 9% [6,[18][19][20][21][22], The occurrence of renal tumors is enhanced when ARCD is present; the reported prevalence is 19-25% [9], Malig nant transformation of these tumors is reported to be 4% [1]. Bretan et al [9] suggested the 'pathologic continuum' from simple cyst to epithelial hyperplasia to tumorous degeneration.…”

Acquired Renal Cystic Disease in Renal Transplant Recipients

“…A high incidence of neoplastic transformation has been noted in the kidneys with ACD in dialysis patients [2,6,8,9,12,13]. In addition, various neoplasms are known to occur with increased frequency in transplant recipients [14], I of our transplant recipients was found to have multifocal clear cell carcinoma of his cystic kidneys.…”

Die klinische Bedeutung des Nierenzellkarzinoms beim dialysepflichtigen Patienten im Vergleich zu Nieren- transplantatempfängern

“…Die ARCD ist ein hä ufig vertretenes Krankheitsbild bei Patienten mit terminaler Niereninsuffizienz mit einer Inzidenzrate, die zwischen 50 und 95 % angegeben wird [9,10]. Hierbei handelt es sich um bilaterale zystische Deformationen von sekundä ren Schrumpfnieren infolge einer chronischen Dialysebehandlung.…”