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[Course of acquired renal cystic disease. An ultrasonic follow-up study]
S Veneziano1, P Pavlica, G Viglietta
1Servizio di Radiologia, Ospedale M. Malpighi, Bologna.
Insights
Acquired renal cystic disease progresses in most hemodialysis patients but stabilizes after kidney transplantation. This study tracked disease evolution over 40 months, finding no new tumors in any patients.
Area of Science:
- Nephrology
- Urology
- Radiology
Background:
- Acquired renal cystic disease (ARCD) is a common complication in patients with chronic kidney disease.
- The natural history and progression of ARCD, particularly in relation to renal replacement therapy, require further elucidation.
Purpose of the Study:
- To evaluate the 40-month evolution of acquired renal cystic disease using ultrasonography (US).
- To compare the progression of ARCD in hemodialysis patients versus kidney transplant recipients.
Main Methods:
- Prospective ultrasonographic follow-up of 81 patients over 40 months.
- Categorization of patients into two groups: 66 on hemodialysis and 15 kidney transplant recipients.
Main Results:
- Acquired renal cystic disease progressed in 52 of 66 hemodialysis patients (79%).
- In contrast, ARCD remained unchanged in 14 of 15 kidney transplant recipients (93%).
- No new renal tumors were detected in any patient during the follow-up period.
Conclusions:
- Hemodialysis may facilitate the onset and/or progression of ARCD, potentially due to uremic toxins and constitutional factors.
- Kidney transplantation appears to halt the evolution of ARCD, possibly by removing uremic-associated biologically active substances.
- The findings suggest distinct disease trajectories based on renal replacement therapy modality.
Abstract:
The authors evaluated the evolution of acquired renal cystic disease with a 40-month US follow-up. Eighty-one patients were examined by US: 66 of them were hemodialysis patients, and 15 transplant recipients. Cystic kidney disease had progressed in 52/66 hemodialysis patients, whereas the picture was unmodified in 14/15 transplant recipients. As an explanation to the different evolution possibilities, the authors hypothesize that disease etiopathogenesis is to be sought in uremic toxic elements together with constitutional factors. Hemodialysis, prolonging the life of these patients, appears to facilitate the onset and/or evolution of the disease. On the contrary, kidney transplantation stops disease evolution, because it removes biologically active substances associated to uremia. In no cases new kidney tumors were found.