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[Acquired renal cystic disease]
K Kawamura1, R Ikeda, K Suzuki
1Department of Urology, Kanazawa Medical University.
Insights
Acquired cystic disease of the kidney (ACDK) is common in hemodialysis patients, increasing renal cell carcinoma (RCC) risk. Early detection through regular screening like CT scans is crucial for managing this condition.
Area of Science:
- Nephrology
- Oncology
- Radiology
Context:
- Acquired cystic disease of the kidney (ACDK) is frequently observed in patients undergoing long-term hemodialysis.
- The incidence of ACDK rises significantly with dialysis duration, particularly in male patients.
- ACDK can occur even before patients begin hemodialysis.
Purpose:
- To highlight the increased incidence of renal cell carcinoma (RCC) in patients with ACDK.
- To emphasize the necessity of early detection and screening for RCC in ACDK patients.
- To discuss the management and potential risks associated with RCC in the context of ACDK.
Summary:
- ACDK affects 40-50% of hemodialysis patients, with incidence exceeding 90% after 5-10 years.
- Patients with ACDK have a 5-19% increased risk of developing renal cell carcinoma (RCC), which may be asymptomatic.
- Regular screening via ultrasound or CT scans is recommended for early RCC detection in ACDK patients, with nephrectomy indicated for suspected or confirmed kidney cancer.
Impact:
- Early detection of renal cell carcinoma (RCC) in acquired cystic disease of the kidney (ACDK) patients can improve outcomes.
- Understanding the link between ACDK and RCC aids in developing targeted monitoring strategies.
- This research underscores the importance of vigilant radiologic monitoring for end-stage renal disease patients with ACDK.
Abstract:
In 1977, Dunnill et al. described a new disorder, bilateral multiple renal cystic disease. It occurred among hemodialysis patients whose original illness had not been cyst-related. Acquired cystic disease of the kidney (ACDK) is commonly observed in patients undergoing hemodialysis. The incidence of ACDK is 40-50% in reports of autopsy and surgical specimens, rising to more than 90% after 5-10 years of dialysis. The volume of the kidneys decreases in the first 3 years of dialysis and then increases as the rate of cyst formation increases. In male patients undergoing long-term hemodialysis the incidence of ACDK is markedly high. ACDK is also found in patients before hemodialysis. The primary concern in patients with ACDK is the increased incidence (5-19%) of renal cell carcinoma (RCC). The incidence is about twelve to eighteen times higher than that in the general population and the cancers may be asymptomatic. Therefore, screening is essential if carcinomas are to be detected early. Regular screening by ultrasonic examination or CT scan is needed. A patient requires nephrectomy when the kidney cancer exists or is suspected by dynamic CT scan. Nephrectomy is performed only on the side with renal mass. It has been argued that RCC associated with ACDK are innocuous and do not predispose the patient to an increased risk of death from RCC. RCC arising from ACDK is considered to be a tumor of low malignant potential, compared with classic RCC. However, RCC has been reported to metastasize in 16% of the patients on dialysis and to be the cause of death in 2% of the kidney transplant recipients. The etiology of ACDK is unclear and its incidence increases with the duration of dialysis. ACDK patients have a propensity to develop adenocarcinoma. The increased incidence of RCC in ACDK patients warrants careful radiologic monitoring of end-stage kidneys in selected patients.