Renal masses in end-stage renal disease patients on dialysis / 대한내과학회지

BACKGROUND/AIMS: End-stage renal disease (ESRD) patients are at a higher risk for cancer, especially renal cell carcinoma (RCC). Acquired cystic kidney disease (ACKD) and long duration of dialysis predict RCC in these patients. We explored the cilnical and pathologic characteristics of renal masses and the factors predicting malignant tumors. METHODS: The study examined the medical records of 38 ESRD patients who underwent partial/total nephrectomy due to renal masses diagnosed by abdominal ultrasound and computed tomography at YUHS from January 1995 to December 2009. RESULTS: Renal masses were recorded in 38 patients (21 males) with a mean age of 48.3+/-13.2 years. Twenty patients (52.6%) were on hemodialysis and 18 patients (47.4%) were on peritoneal dialysis, for a mean period of 106.4+/-62.5 months. ACKD was reported in 23 patients (67.6%). Of the 38 renal masses, 23 (60.5%) were diagnosed as malignant tumors and 15 (39.5%) were benign tumors. Clear cell RCC (n=16) and hematoma (n=6) was the predominant respective types. The patients with malignant tumors had a significantly longer duration of dialysis (122.3+/-61.8 vs. 81.1+/-56.7 months, p<0.05) and a higher prevalence of ACKD (87.0 vs. 46.7%, p<0.01) compared to the patients with benign tumors. CONCLUSIONS: The most common renal mass in ESRD patients was RCC. Malignant tumors were significantly associated with a longer duration of dialysis and ACKD. Therefore, early evaluation and treatment of RCC are mandatory in long-term dialysis patients with ACKD.

Renal Cell Carcinoma Occurred in Native Kidneys before and after Renal Transplantation / 대한신장학회지

One of the major risk factors of renal cell carcinoma is acquired cystic kidney disease (ACKD) developed in course of end-stage renal failure (ESRF) and the incidence of ACKD increases with the duration of dialysis. Moreover, the overall incidence of renal cell carcinoma after renal transplantation has been reported to be being more than 8 times higher compared with that of general population. But renal cell carcinomas occurred in native kidneys before and after renal transplantation in ESRF patient with ACKD are very rare. We experienced a case of renal cell carcinoma occurred in native kidneys 14 months before and 5 months after renal transplantation in an ESRF patient with ACKD.

Comparison of acquired cystic kidney disease between hemodialysis and continuous ambulatory peritoneal dialysis

OBJECTIVES: ACKD has been described mainly in patients treated with hemodialysis(HD), and there are only a few reports about the prevalence of ACKD in continuous ambulatory peritoneal dialysis (CAPD) patients. Therefore, we compared the prevalence of ACKD in patients receiving HD and CAPD, and evaluated the possible factors which may affect the development of ACKD. METHODS: Forty nine HD and 49 CAPD patients who had received dialysis therapy for at least 12 months were enrolled in this cross-sectional study. Patients who had a past history of polycystic kidney disease and had acquired cystic kidney disease on predialysis sonographic exam were excluded. Detection of ACKD was made by ultrasonography and ACKD was defined as 3 or more cysts in each kidney. RESULTS: The prevalence of ACKD was about 31+ACU- (30/98) and there was no significant difference between HD and CAPD patients(27+ACU- vs. 34+ACU-, p +AD4- 0.05). The prevalence of ACKD was not associated with age, sex, primary renal disease, the levels of hemoglobin, BUN, and serum creatinine. However, the duration of dialysis was significantly related to the development of ACKD (presence of ACKD, 74.4 42.4 months vs. absence of ACKD, 37.8 24.1 months, p +ADw- 0.05). CONCLUSION: The prevalence of ACKD is not different according to the mode of dialysis, and the major determinant of acquired cyst formation is duration of dialysis.

Acquired Cystic Kidney Disease in Patients Undergoing Long-term Hemodialysis Treatment / 대한비뇨기과학회지

PURPOSE: The present study was designed to evaluate the incidence and characteristics of acquired cystic kidney disease (ACKD) in patients with end-stage renal disease who were treated by chronic hemodialysis, using renal ultrasonography. MATERIALS AND METHODS: We performed renal ultrasonography as a screening modality in 112 patients treated with long-term hemodialysis due to end-stage renal disease. We classified the patients years from one to six years. RESULTS: In our study, cystic lesions were noted in 41 patients (36.6%) and there was no sexual predilection of ACKD. Also, a prolonged period of hemodialysis increased the incidence of ACKD, especially for those treated more than 49 months. We encountered a case of renal cell cancer, evaluated it with CT, and then treated it by radical nephrectomy. CONCLUSIONS: With these results, renal ultrasonography can be used as a screening modality in patients treated with long-term hemodialysis more than 49 months due to end-stage renal disease. As complications occur, further evaluation will be needed.