End stage renal disease associated with acquired cystic disease and neoplasia

Acquired renal cystic disease is a recently recognized disease entity that primarily afflicts patients on chronic hemodialysis. The incidence of acquired renal cystic disease in patients with end stage renal disease ranges from 30 to 95 per cent. The major complications of acquired renal cystic disease appear to be neoplasia and hemorrhage. Neoplasia has been demonstrated in up to 45 per cent of all end stage kidneys with acquired cystic disease. Our surgical experience with 7 cases of end stage renal disease is reported. Acquired renal cystic disease was noted in 4 of the 7 cases (57 per cent) and renal neoplasia was evident in all 7. Worldwide experience to date in combined pathology and radiology series of patients undergoing hemodialysis demonstrates that acquired cystic disease, "tumor" (usually adenoma or oncocytoma) and renal carcinoma occur at respective rates of 47.1, 4.8 and 1.5 per cent. Since the pathologist will detect more tumors and cysts than the radiologist, these figures probably are an underestimate of the true incidence. Long-term surveillance of patients harboring end stage kidneys is recommended beginning with a baseline ultrasound.